Pulmonary sarcoidosis
Muhunthan Thillai, David R Moller, Keith C Meyer in Clinical Handbook of Interstitial Lung Disease, 2017
Pulmonary manifestations are seen in >90% of patients. Respiratory symptoms are non-specific and include cough, shortness of breath, chest tightness, occasionally wheezing or haemoptysis. Many sarcoidosis patients are initially diagnosed as having asthma, bronchitis or chronic obstructive pulmonary disease (COPD). Sarcoidosis patients often see multiple physicians until new manifestations or a chest radiograph is obtained that instigate further diagnostic evaluation. Physical exam of the lungs is usually unremarkable with crackles heard in <10% of patients; this may be due to the fact that nodules and infiltrates in sarcoidosis tend to be central in location along bronchovascular bundles rather than peripheral as in IPF, where crackles are typically heard.
Pyrexia Two Weeks after an Attack of Alcohol-Induced Acute Pancreatitis
Savio George Barreto, Shailesh V. Shrikhande in 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.
Thoracic Trauma
Ian Greaves, Keith Porter, Jeff Garner in Trauma Care Manual, 2021
The lungs, while physiologically complex, are anatomically rather simple consisting primarily of alveoli and blood vessels. They have a dual blood supply, a low-pressure pulmonary arterial circulation and bronchial arteries under systemic pressure. Alveolar rupture can result in pneumothorax, which if under tension produces mediastinal shift to the contralateral side. Increased intrathoracic pressure results in decreased venous return as a consequence of compression of the superior and inferior vena cavae. This leads to decreased pre-load, low cardiac output and hypotension, and if untreated, cardiovascular collapse and death. Air dissecting the mediastinal tissues results in pneumo-mediastinum. Aetiologies include parenchymal lung injury and, less commonly, tracheobronchial injury; oesophageal injury as the cause of pneumo-mediastinum is extremely rare. Pneumopericardium is also rare but can cause tamponade. Parenchymal injury with disrupted alveolar architecture, localized oedema and pulmonary haemorrhage results in pulmonary contusion. This leads to impaired gas exchange, shunting, hypoxia and increased work of breathing and, if severe, respiratory distress necessitating mechanical ventilation.
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 severe retinopathy of prematurity and postnatal weight gain in very low-birthweight infants at Chiang Mai University Hospital, Thailand
Published in Paediatrics and International Child Health, 2020
Ananya Wongnophirun, Varangthip Khuwuthyakorn, Watcharee Tantiprabha, Atchareeya Wiwatwongwana
SGA was diagnosed when birthweight was <10th percentile on Fenton’s growth chart [22]. Surfactant replacement was considered when a preterm infant had respiratory distress and required an oxygen concentration of >40% to maintain SpO2 at 90–94%. PDA was diagnosed by the presence of all the following: (i) respiratory distress; (ii) clinical signs of PDA: systolic ejection murmur at the left upper sternal border with wide pulse pressure or active precordium or bounding pulse; (iii) typical radiographic appearances including increased cardiothoracic ratio >0.6, increased perihilar vascular marking or haziness of both lungs’ parenchyma; (iv) with or without echocardiographic results. NEC was diagnosed on the basis of modified Bell’s staging criteria [23]. BPD was defined as persistent oxygen dependency up to 28 days of life, IVH and PVL were screened and recorded on the basis of the most extensive cranial ultrasonographic results and classified by Papile’s classification [24], sepsis was defined as a positive blood culture, and hypotension was defined as any systolic blood pressure <3rd percentile for age [25].
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).
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