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Treatment of SJS and TEN
Published in Kirsti Kauppinen, Kristiina Alanko, Matti Hannuksela, Howard Maibach, Skin Reactions to Drugs, 2020
Widespread detachment of epithelium, resembling skin lesions both on visual and microscopic examination, has been observed in trachea, bronchi, and the gastro-intestinal tract9 The prevalence of such lesions is unknown. We have observed erosions of trachea and bronchi in 20% of a series of 40 patients (unpublished data). Because they are frequently associated with the occurrence of acute respiratory distress, these lesions are predictive of a very poor prognosis. Visceral involvement may occur in patients with a limited extent of epidermal detachment. We also reported urinary changes indicating a dysfunction of the epithelial cells from the proximal tubules of the kidney. Similar mechanisms probably induce these “specific” lesions as well as damages to the epidermis.
Critical Care and Anaesthesia
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Rajkumar Rajendram, Alex Joseph, John Davidson, Avinash Gobindram, Prit Anand Singh, Animesh JK Patel
What are the signs of respiratory distress?Tachypnoea, inability to speak, mouth opening during inspiration (breathlessness)Pursed lips, expiratory grunting, groaning (Auto-PEEP)Use of accessory muscles of respirationCyanosisTachycardia, dilated pupils, sweating (sympathetic overactivity)Initially restlessness and fidgeting, then anxiety, apathy and eventually coma
Pyrexia Two Weeks after an Attack of Alcohol-Induced Acute Pancreatitis
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
The respiratory dysfunction could be made worse with excess fluid resuscitation and the early signs of acute respiratory distress syndrome indicate the need for careful management. Although no specific therapy exists for acute respiratory distress syndrome, treatment is initially non-invasive ventilation (i.e. high flow oxygen, humidification, and positive pressure) and later mechanical ventilation using low tidal volumes (to minimize lung injury), if required. And conservative “maintenance” fluid management is indicated rather than resuscitation. Cardiovascular support with vasopressors should be considered early to avoid excess fluid administration. The judicious use of diuretics might help improve lung function, but should not be given until normal renal function is confirmed.
Use of Point-of-Care Ultrasound by Intensive Care Paramedics to Assess Respiratory Distress in the Out-of-Hospital Environment: A Pilot Study
Published in Prehospital Emergency Care, 2023
Jake K. Donovan, Samuel O. Burton, Samuel L. Jones, Luke M. Phillips, David Anderson, Benjamin N. Meadley
Respiratory distress is a common presentation attended by paramedics (1, 2). This presentation is characterized by a high degree of diagnostic uncertainty in the out-of-hospital environment. A diverse range of pathologies can cause respiratory distress, and gaining an accurate patient history from a breathless patient is one of the more significant challenges faced by paramedics (1). Without the availability of medical imaging (CT & x-ray), paramedics rely on chest auscultation, physical examination, and patient history to differentiate causes of respiratory distress. The diagnostic accuracy of chest auscultation for respiratory complaints is low (3, 4). A recent meta-analysis found a pooled sensitivity for detection of four common lung diseases to be 37% (3). Incorrect diagnosis and management may result in worse patient outcomes (1).
Clinical factors associated with the use of dexamethasone for asthma in the pediatric emergency department
Published in Journal of Asthma, 2021
Amy M. DeLaroche, Fabrice Mowbray, Sarah J. Parker, Yagnaram Ravichandran, Aaron Jones
All factors examined in the multivariable model were selected based on extant literature in addition to clinical judgment, and included: triage acuity, history of asthma severity, the use of bronchodilators prior to PED presentation, the presence of respiratory distress, pulse oximetry (SpO2) reading in triage and the triage respiratory rate. Triage acuity was measured using the emergency severity index (ESI) and was trichotomized: an ESI score of one or two was labeled as “most urgent,” an ESI score of three was labeled “urgent,” and an ESI score of four or five was labeled “non-urgent” (18). A history of severe asthma was defined as a previous pediatric intensive care unit admission or endotracheal intubation. Respiratory distress was defined as the presence of any nasal flaring, grunting, or retracting documented by the treating health care provider. Both SpO2 and respiratory rate were measured during the triage process, with SpO2 measured as a percentage and respiratory rate measured as breaths per minute.
Association between HLA genotype and ferritin levels in COVID-19 infection: a study of a Saudi cohort
Published in Infectious Diseases, 2021
Fatmah M. A. Naemi, Shurooq Al-adwani, Ashwaq Al-nazawi, Heba Al-khatabi
The new coronavirus, which first emerged in Wuhan, China, in December 2019, has infected more than 58 million people and caused more than a million deaths worldwide (https://covid19.who.int). The new virus belongs to the beta-coronavirus family and was named by the International Committee on Taxonomy of Viruses (ICTV) as a severe acute respiratory syndrome coronavirus 2 (SARS-COV2). The virus caused a novel coronavirus disease in 2019 (COVID-19), a disease with a heterogeneous phenotype affecting mostly the respiratory system [1]. Infection severity can range from mild/moderate symptoms, or it can even be asymptomatic, up to a severe pattern of the disease [2]. In mild cases, patients suffer from fever, cough, fatigue, and diarrhoea with moderate respiratory symptoms that may require oxygen therapy [3]. Severe cases display acute respiratory distress that requires mechanical ventilation support in an intensive care unit (ICU). This condition can lead to multi-organ failure, including but not limited to kidney dysfunction and liver damage [3]. Although mortality related to severe infection is a serious consequence, the mortality rate of COVID-19 is <5% worldwide [4]. The severity of the infection has been linked with many risk factors including old age, presence of comorbidities, and gender—with males being more susceptible to infection than females [4,5]. The clinical treatment involves only symptom management including oxygen therapy and mechanical ventilation for patients with respiratory distress and respiratory failure, respectively [6].