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Published in Chris Schelvan, Annabel Copeman, Jacky Davis, Annmarie Jeanes, Jane Young, Paediatric Radiology for MRCPCH and FRCR, 2020
Chris Schelvan, Annabel Copeman, Jacky Davis, Annmarie Jeanes, Jane Young
There is nothing the matter with the child’s chest. The first film was taken in expiration (looking for air trapping). This film was taken immediately after the first one, and is in full inspiration. The lung fields are clear.
Cardiovascular system
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
8.16. Which of the following statements is/are true of atrial septal (septum secundum) defect?The systolic murmur is usually present at birth.The systolic murmur is due to increased flow across pulmonary outflow tract and valve.There is fixed splitting of the second heart sound.The lung fields are plethoric.There is no risk of pulmonary hypertension.
Unusual Inherited Pulmonary Diseases Which Provide Clues to Pulmonary Physiology and Function
Published in Stephen D. Litwin, Genetic Determinants of Pulmonary Disease, 2020
Thomas Κ. C. King, Robert A. Norum
Characteristically, symptoms develop within some hours after the rapid ascent to a high altitude of over 9000 ft (2700 m). The peak risk is between 12 and 72 hr. There may be a history of physical exertion or exposure to cold. The symptoms include fatigue, weakness, headaches, giddiness, anorexia, insomnia, nausea, and vomiting. In the cases that go on to develop pulmonary edema, these complaints are followed by dyspnea on exertion and a persistent dry cough. These frequently progress with alarming rapidity to extreme dyspnea, frothy sputum which may be blood tinged, cyanosis, and coma. Physical signs are those of pulmonary edema with tachycardia, cyanosis, and rales over the lung fields. Auscultation of the heart may reveal splitting of the second sound or accentuation of its pulmonic component. There may be fever and a leukocytosis but the sedimentation rate is usually normal. Chest x ray shows pulmonary infiltrates compatible with pulmonary edema without cardiomegaly. Hemodynamic studies will show pulmonary hypertension with an increase in the pulmonary vascular resistance but a normal wedge pressure.
Effect of COVID-19 on the incidence of postintubation laryngeal lesions
Published in Baylor University Medical Center Proceedings, 2023
Madison Buras, Nicole DeSisto, Randall Holdgraf
As previously mentioned, studies have shown that COVID-positive patients have increased risk factors for tissue damage. However, because increased risk of vocal fold injury in our study was associated directly with pronation rather than COVID infection, early laryngoscopy may be generalized to patients who undergo pronation therapy for other reasons. Pronation describes the act of placing a ventilated patient face down. It is not an uncommon maneuver, and in a multicenter randomized controlled trial by Guérin et al, it was shown to decrease the mortality of patients with acute respiratory distress syndrome from 32.8% to 16% in a 28-day period.13 Benefits from the prone position have been well described by many studies. These benefits include mobilizing secretions from the posterior lung fields, which allows for increased alveolar recruitment in those regions, thereby improving ventilation.14 However, pronation therapy has risks. Repositioning the patient can cause the endotracheal tube to shift or dislodge. Movement of the endotracheal tube and the increased pressure that pronation causes on areas such as the posterior commissure can increase the risk of laryngeal trauma. According to the American Thoracic Society, the benefits of pronation therapy outweigh the potential adverse events, so it recommends that patients with acute respiratory distress syndrome be positioned face down for 12 to 16 hours a day.14
Isolated pulmonary embolism following COVID vaccination: 2 case reports and a review of post-acute pulmonary embolism complications and follow-up
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Nwosu Ifeanyi, Nsofor Chinenye, Oreoluwa Oladiran, Edidiong David, Chiamaka Mmonu, Chinyere Ogbonna-Nwosu
A 61-year-old man with a past medical history of hypertension, type 2 diabetes mellitus, and hypercholesterolemia attended the emergency department following a syncopal episode. Five days prior, the patient endorsed worsening exertional shortness of breath, lethargy, and a day history of bilateral calf pain. Of note, these symptoms began 8 days post 2nd dose of the ChAd0x1 nCoV-19 vaccine. He is active and independent with no family history of thromboembolic disorders, is a non-smoker, and consumes less than 14 units of alcohol/week. Physical examination noted an alert and responsive patient with hypoxia and oxygen saturation of 89% on room air. His respiratory rate was 19 breaths per minute, afebrile, tachycardia with a heart rate of 114 beats per minute, and blood pressure of 165/95 mmHg. Further examination noted clear lung fields and an absence of lower extremity swelling or tenderness. Other systemic examination findings were unremarkable. Oxygen saturation maintained >94% with 6 L of supplemental oxygen using a nasal cannula.
Adrenaline is effective in reversing the inadequate heart rate response in atropine treated organophosphorus and carbamate poisoning
Published in Clinical Toxicology, 2021
Abhishek Samprathi, Binila Chacko, Shilpa Reynal D’sa, Grace Rebekah, C. Vignesh Kumar, Mohammad Sadiq, Punitha Victor, John Prasad, Jonathan Arul Jeevan Jayakaran, John Victor Peter
A modified protocol of atropinization was followed [3]. The mandatory clinical targets for atropinization that were used in the study included (a) clear lung fields on auscultation (indicated by the absence of bronchorrhea, bronchospasm and increased salivation), (b) target HR >100/minute on day 1 and (c) systolic BP >90 mm Hg. The higher targets for HR and BP were based on prior experience of management of patients with severe poisoning and late presentations. Following atropinization, atropine infusion was titrated to maintain the above targets on day one. The target HR was reduced to >90/min on day two and >80/min on subsequent days. The other secondary targets for atropinization that were monitored routinely in these patients included pupils (aiming for mid-size pupils) and bowel sounds (bowel sounds being just present rather than absent).