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The patient with acute cardiovascular problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Pulmonary auscultation is a valuable skill in assessing pulmonary status and is now included in the standards of proficiency for registered nurses (NMC 2018a). Pulmonary auscultation of an individual with heart failure may reveal pulmonary crackles. Crackles are non-musical popping sounds heard during inspiration, caused by the re-opening of collapsed alveoli, or by air moving through fluid. Inspiratory crackles will remain even after a cough to clear secretions. Crackles are associated with a number of lung problems (see Chapter 5), including pulmonary oedema secondary to acute left ventricular failure. The expectoration of pink frothy sputum is also a feature of acute pulmonary oedema. This sign of significant deterioration is accompanied by tachypnoea, distress and hypoxaemia, requiring urgent medical review. Respiratory rate is counted over 1 full minute to ensure accuracy, ensuring even small changes, which can be clinically significant, are detected.
Respiratory
Published in Kristen Davies, Shadaba Ahmed, Core Conditions for Medical and Surgical Finals, 2020
Crackles occur both in pneumonia and in ILD. To distinguish between the two, ask the patient to cough. If the crackles change or disappear following a cough, then the cause is more likely to be due to pneumonia rather than ILD, where the crackles do not change following a cough. This is due to the underlying mechanism causing the crackles. In an infectious cause, the crackles are caused by pus from the causative organism that can move around the airway, whereas fibrotic lungs cannot move around as freely.
Pulmonary Tuberculosis In Children
Published in Lourdes R. Laraya-Cuasay, Walter T. Hughes, Interstitial Lung Diseases in Children, 2019
Early symptoms are systemic: anorexia, fatigue, and afternoon fever. Later, productive cough and weight loss are noted. Moist crackles may be heard over the involved lung area. The chest roentgenogram shows an infiltrate in an upper lobe, often containing a cavity. The Mantoux skin test should be positive. An early diagnosis can be made by seeing the acid-fast bacilli in the sputum smear and confirmed when M. tuberculosis is grown on culture.
Successful Treatment of Covid-19 Associated Cytokine Release Syndrome with Colchicine. A Case Report and Review of Literature
Published in Immunological Investigations, 2021
Nahal Mansouri, Majid Marjani, Payam Tabarsi, Christophe von Garnier, Davood Mansouri
A 42-year-old non-smoker man with no prior medical history presented to our clinic with fever, dry cough, myalgia, weakness, and sore throat beginning 3 days earlier. His vital signs were normal except for a fever of 38.5°C. He had an oxygen saturation level of 94% while breathing ambient air. The physical exam revealed scattered bilateral crackles on auscultation and was otherwise normal. Laboratory results and reference ranges can be found in Table 1. In brief, white blood cell (WBC), hemoglobin and platelet count were normal. He had a slightly elevated C-reactive protein (CRP, 15 mg per deciliter), erythrocyte sedimentation rate (ESR, 12 mm per hour), and Ferritin level was normal (254 ng per milliliter). Two sets of blood cultures and a urine culture were sterile. A nasopharyngeal swab PCR was negative for all respiratory viruses except Covid-19 (positive on two occasions 24 hours apart). Chest computed tomography (CT) revealed bilateral basilar ground glass opacities (Figure 1). The patient was started on oseltamivir 75 mg twice a day and hydroxychloroquine 200 mg twice a day for 5 days. Respiratory symptoms improved 5 days following his presentation. However, fever, fatigue, and loss of appetite persisted.
Clinical pearls in hospital nephrology
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Abdurrahman Hamadah, Tibor Fulop, Kamel Gharaibeh
A 71-year-old woman presented to the ED with persistent cough for past 10 days. A chest x-ray showed a large irregular mass in right upper lung concerning for malignancy. She is being admitted to the hospital for workup of this finding. Her PMH is significant for hypothyroidism and takes levothyroxine. She has a 45-pack-year smoking history. Vital signs were normal. Pertinent physical examination findings were crackles noted in right upper lung fields, moist mucus membranes, and no lower extremity edema. Her neurologic examination was normal. Her clinical investigation revealed a sodium of 120 mEq/L, glucose 121 mg/dL, Creatinine 0.8 mg/dL, serum osmolality 255, serum uric acid 2.1 mg/dL, TSH 2.1, and normal free T4. Her urine sodium was 40 mEq/L, urine potassium 18 mEq/L, and urine osmolality 280 mOsm/kg. Her urine output was 1.1 L in 24 h. Recognizing that syndrome of inappropriate diuresis (SIAD) is the likely cause for her hyponatremia, and given she is asymptomatic, you decide to restrict her oral fluid intake as the initial treatment.
Telomerase-related monogenic lung fibrosis presenting with subacute onset: a case report and review of literature
Published in Acta Clinica Belgica, 2019
Thomas Planté-Bordeneuve, Hanae Haouas, Kim Vanderheyde, Antoine Froidure
On physical examination, the patient was polypneic (20 respiration per minute at rest) and desaturating (SaO2 70%, pO2 39 mmHg without oxygen supplementation). Diffuse crackles could be heard at lung auscultation, without squeezes or wheezing. He displayed high levels of inflammation with a C-reactive protein level of 126 mg/L (normal levels <5mg/L). The initial workup revealed an underlying lung fibrosis with a high-resolution thoracic CT displaying an extensive fibrosis with ground-glass attenuation, traction bronchiectasis and enlarged lymph nodes (Figure 2). This pattern was incompatible with usual interstitial pneumonia (UIP) according to the the 2011 ATS-ERS guidelines [10] (or undetermined following the recent 2018 criteria [11]). Lung function test demonstrated a marked restrictive disease with a Forced Vital Capacity (FVC) of 20%. Other spirometric tests, especially lung diffusion capacity, were not performed due to the severe respiratory insufficiency.