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Respiratory system
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
Improvement in FEV1 in acute asthma results in improvement of arterial oxygen tension. Hypoxia usually precedes hypercapnia. Rhonchi will not be heard in asthma if air entry is poor. Arterial oxygen tension falls following intravenous aminophylline due to disturbance of pulmonary perfusion. Cyanosis is a poor sign for arterial hypoxaemia as it does not occur until the oxygen saturation has dropped below 75%.
The Respiratory System and Its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
Cough and expectoration (discharge of sputum from the mouth) are also classic signs of pulmonary disease. Paroxysmal or episodic cough may be present in bronchial asthma. The sputum may be described as pink, frothy, watery, mucoid, mucopurulent, rusty, thick, gelatinous, or blood-streaked, depending on the disorder. When sputum is bloody, the term applied is hemoptysis, the coughing up of blood. Other terms frequently encountered to describe respiratory symptoms include rales, rhonchi, wheeze, pleural friction rub, and adventitious breath sounds.
Otorhinolaryngology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Chris Jephson, C. Martin Bailey
Inhaled foreign bodies are most common in toddlers. Objects tend to lodge at the carina or in the right main bronchus (Fig. 19.34), as it branches off the trachea at a less acute angle than the left main bronchus. The inhalation may be witnessed; if not, coughing spasms, choking or respiratory obstruction may be evident. Stridor if present may be inspiratory, expiratory or biphasic depending upon the level of the foreign body. Occasionally, the episode may be asymptomatic, and these children may present with recurrent or chronic respiratory infections or with an irritable airway mimicking asthma. Classically with bronchial obstruction, there will be reduction of air entry to the affected lung segments with expiratory rhonchi.
Multifactorial jaundice and pigmented choledocholithiasis secondary to warm autoimmune hemolytic anemia and alcoholic cirrhosis
Published in Baylor University Medical Center Proceedings, 2022
Colten Watson, Mazen Hassan, Grant Breeland
Upon admission, the patient’s skin was highly jaundiced with a measured bilirubin of 43.8 mg/dL and a blood pressure of 104/50 mm Hg. Acute diffuse abdominal pain was present on palpation. Some shortness of breath was noted with rhonchi and abdominal distention. A rectal exam was guaiac positive and showed occult blood. His hemoglobin was 6.3 g/dL, resulting in the immediate transfusion of 4 units of packed red blood cells on his first day of admission. His total bilirubin of 43.8 mg/dL was fractionated, and direct bilirubin measured 32.7 mg/dL. The blood bank laboratory tests also had several findings; an antibody screen was positive and was confirmed with a direct Coombs test. The lab then discovered a warm agglutinin IgG antibody through a direct antiglobulin test. Other notable laboratory data included a lipase level of 390 U/L, elevated lactate dehydrogenase, decreased haptoglobin, and 1+ schistocytes (Supplemental Table).
A rare case of cytomegalovirus causing respiratory failure and a large pericardial effusion
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Leah Burkovsky, Wahab M. Kahloan, Aashish Acharya, Gayatri Nair, Ricardo A. S. Conti
On physical examination, she was cachectic, ill-appearing and tachypneic with the use of accessory muscles for respiration. Her blood pressure was 88/55 mm Hg, temperature was 37.4°C, pulse rate was 146 beats per minute and regular, oxygen saturation of 70% on room air, and body mass index of 18.9. Lung auscultation revealed bilateral rhonchi. Heart auscultation revealed normal S1 and S2 without significant murmurs or rubs. She was placed on a non-rebreather mask with FiO2 of 100% without improvement of respiratory status and was switched to non-invasive mechanical ventilation. Her status continued to decline, and she underwent endotracheal intubation within an hour of arriving at the ED for hypoxic respiratory failure. SARS-CoV-2 testing done upon arrival in the ED was negative. She tested positive for HIV, and further evaluation revealed an initial viral load of 343,636 copies per milliliter and an absolute CD4 count of 5 cells/μL.
Palliative care, when should it be a physicians’ choice of treatment?
Published in Progress in Palliative Care, 2019
E. Ruivo, M. Buni, A. Buketov, A. Lares
On the day of surgery, general anesthesia was induced by giving fentanyl 2 µg/kg, propofol 1% 2 mg/kg and rocuronium 0.6 mg/kg. Furthermore, anesthesia was maintained with sevoflurane and rocuronium boluses when necessary. After induction, the patient was noted to be hypotensive, which was corrected using crystalloid saline solution 0.9% of sodium chloride, colloid hydroxyethyl starch sterile 6% and intravenous boluses of ephedrine. The operation was uneventful, with peak ventilatory pressures always below 30 cm of water, lasting for approximately 3 h and 30 min. For emergence, sevoflurane was suspended and 200 mg of sugammadex was administered for neuromuscular block reversal. After emergence, the patient presented spontaneous bilateral and symmetrical vesicular lung sounds, with sparse rhonchi, and a SpO2 of 98%.