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Thoracic trauma
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Management of isolated rib fractures in children is usually supportive and includes appropriate analgesia, physiotherapy, and, where necessary, supplemental oxygen. Pain may be managed with non-steroidal anti-inflammatory drugs (NSAIDs), opioids, local anesthesia in the form of nerve blocks, and regional anesthesia in the form of thoracic epidurals. In cases of severe respiratory compromise, mechanical ventilation may be considered.
The patient with acute respiratory problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
The skilled nurse has a sound theoretical knowledge of respiratory physiology and the many factors possibly contributing to respiratory problems. A comprehensive, holistic assessment will facilitate early detection and, through ongoing vigilance in monitoring the patient, potential problems can be anticipated and appropriate measures taken to prevent further deterioration. Before changes are seen in oxygen saturation values, there are often earlier signs of respiratory compromise, and ongoing inspection of the patient and recording of observations is paramount.
TEE to guide interventional cardiac procedures in the catheterization laboratory
Published in Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead, Cardiovascular Catheterization and Intervention, 2017
Matthias Greutmann, Christiane Gruner, Mellita Mezody, Eric Horlick
Whether or not TEE or echocardiography is at all helpful for a particular intervention is determined by several fac tors. First, not surprisingly, if TEE were unable to visualize the structure of interest in high quality, we would not expect any yield in adding this modality. This is true for any structures remote from the esophagus, as for example patent ductus arteriosus, aortopulmonary collaterals, or peripheral pulmonary artery stenoses. Some clinical sce narios preclude the use of TEE. This includes patients with esophageal disease (strictures, varices, etc.) and those in whom it is safer to perform a procedure without general anesthesia. The latter may be the case in hemodynamically unstable patients or patients with severe respiratory compromise. In those cases, we avoid the use of TEE, as we feel discouraged about the safety of TEE with topical anesthesia and sedation only. However, TEE without gen eral anesthesia is a widely practiced technique in many European centers. ICE might be more helpful in cases of this nature.
The efficacy and safety of midazolam with fentanyl versus midazolam with ketamine for bedside invasive procedural sedation in pediatric oncology patients: A randomized, double-blinded, crossover trial
Published in Pediatric Hematology and Oncology, 2022
Chalinee Monsereenusorn, Wanwipha Malaithong, Nawachai Lertvivatpong, Apichat Photia, Piya Rujkijyanont, Chanchai Traivaree
Ketamine is an N-methyl-D-aspartate receptor antagonist,15 intravenous anesthetic drug-producing anxiolytic effect and dissociative sedation, characterized by analgesia, sedation, and amnesia despite maintenance of consciousness, allowing invasive procedures to comply smoothly with rapid onset and adequate duration of action and preserve airway reflexes.4 Nonetheless, periodically side effects may occur such as hypersalivation, hallucination, laryngospasm, and respiratory compromise.16 Ketamine combined with other drugs such as propofol and midazolam17 provided a lowering of 10% and 4% of overall and serious adverse events, respectively.18,19 Ketamine is used for bedside sedation before undergoing invasive procedures in gastroenterology20 and pediatric oncology.10,11,21
Acute chest syndrome of sickle cell disease: genetics, risk factors, prognosis, and management
Published in Expert Review of Hematology, 2022
Elizabeth S. Klings, Martin H. Steinberg
Stratification of ACS severity is based upon clinical features associated with risk for clinical deterioration and death. One important factor is the degree of respiratory compromise as assessed by the degree of hypoxia. The optimal target oxygen saturation in SCD is unclear, but expert opinion is that an oxygen saturation <95% is abnormal. In adults, an initial oxygen saturation or partial pressure of oxygen on arterial blood gas sampling may be helpful initially but perhaps the trajectory of hypoxia is most essential to the assessment. Additional factors to consider in assessing the severity of ACS are the presence of chronic end-organ failure prior to the event and the development of acute organ failures during the event. Acute and chronic organ dysfunction, particularly of the heart, lungs, brain, and kidneys, are common in SCD and their presence may increase mortality risk in ACS [82–84]. Most notably, this is observed in patients with co-existent pulmonary hypertension [85]. Pulmonary hypertension diagnosed by right heart catheterization occurs in 6–10% of adults with the HbS-only phenotype. During ACS, an acute rise in pulmonary artery systolic pressure can occur leading to acute right-sided congestive heart failure and increased mortality risk [85]. The National Acute Chest Syndrome study group found that the presence of an acute neurologic event, present in 11% of patients was associated with a 46% risk of acute respiratory failure [5]. Acute kidney or hepatic injury, coagulopathy, and/or shock all can occur and each of these could increase ACS severity.
Swallowing rehabilitation following spinal injury: A case series
Published in The Journal of Spinal Cord Medicine, 2022
Shaolyn Dick, Jess Thomas, Jessica McMillan, Kelly Davis, Anna Miles
In a population often contending with a plethora of new diagnoses and disabilities, as well as multiple medical and therapy commitments, research to support swallow rehabilitation is notably lacking. In the context of other health issues, dysphagia may have to compete for priority in terms of time and resource. However, the psychological, social and physical implications of severe dysphagia are significant. Dysphagia, and in particular, aspiration may lead to aspiration pneumonia.22 This can be serious, particularly for those with respiratory compromise, and can result in readmission to acute care and can significantly impact progress in other medical and therapeutic interventions.18 For some patients, the untenable nature of restrictive dysphagia recommendations on top of what, for some, has been a life altering injury, may drive increased non-compliance and risk-taking with oral intake. For others, the combination of untreated dysphagia and impaired respiratory system/ protective cough response may result in fear around swallowing and oral intake, making progress in dysphagia therapy difficult.