1/48. Apneustic breathing in children with brainstem damage due to hypoxic-ischemic encephalopathy.To confirm the presence of apneusis in patients with hypoxic-ischemic encephalopathy and to clarify which factors influence their respiratory patterns, polygraphic studies were performed on two patients. Apneusis was clinically suspected in both patients who had severe brainstem damage. In one subject, inputs of vagal afferents from the gastrointestinal tract and the urinary bladder often resulted in extreme tachypnea instead of apneusis. lung inflation facilitated expiration during inspiratory arrest. Expiration preceded a periodic inhibition of rigospastic discharge in the right biceps muscle. In the other subject, prolonged inspiratory pauses with cyanosis occurred with or without preceding epileptic seizure. Both phenytoin dose reduction and treatment with tandospirone, a serotonin-1A agonist, were effective in improving the respiratory distress in this subject.- - - - - - - - - - ranking = 1keywords = breathing (Clic here for more details about this article) |
2/48. Drowning and near-drowning--some lessons learnt.Over a period of sixteen months, 17 cases of submersion injury (encompassing victims of drowning and near-drowning) were attended to at our Accident and Emergency Department at Changi General Hospital. Most of the victims were inexperienced recreational swimmers, and in 6 of them, early bystander cardiopulmonary resuscitation enabled them to recover without severe morbidity. Non-cardiogenic pulmonary oedema with resulting chest infection was the commonest complication in survivors. Most of the episodes occurred in an urban setting in swimming pools without supervision by lifeguards. About two-thirds of the cases were adults over the age of fifteen years. In addition, there were patients in whom submersion injury was associated with more sinister conditions (fits, traumatic cervical spine injury, dysbarism, intoxication from alcohol or drugs), some of which were unsuspected by the doctors initially. Apart from the immediate threats of hypoxia and pulmonary injury, active search for any possible precipitating causes and associated occult injury should be made. In this study, the determinants of survival from near-drowning were early institution of cardiopulmonary resuscitation, presence of pupil reactivity, and presence of a palpable pulse and cardiac sinus rhythm.- - - - - - - - - - ranking = 0.001801151396756keywords = chest (Clic here for more details about this article) |
3/48. pressure limited ventilation with permissive hypoxia and nitric oxide in the treatment of adult respiratory distress syndrome.In the management of adult respiratory distress syndrome pressure limited mechanical ventilation may protect the lungs from overdistention injury. Unacceptable hypoxia may be avoided by adding nitric oxide to the inspiratory gas, and thus make pressure limited ventilation easier to perform. There exists no consensus about an acceptable lower limit of SaO2, and in the present case we gave preference to pressure limitation at the cost of oxygenation. A young woman with severe adult respiratory distress syndrome was set on pressure limited mechanical ventilation with peak pressures of 35-38 cm H2O, PEEP of 10-12 cm H2O, and FiO2 of 0.95 with 20 ppm nitric oxide. SaO2 varied between 75 and 85%, and cardiac output ranged between 5.2 and 7.5 L min-1. oxygen consumption was in the upper normal range, and she did not became acidotic. After 3 days, she started to improve. In conclusion, it seems that hypoxia might be well tolerated as long as the circulation is not compromised. It might prove beneficial to accept some hypoxia to avoid ventilator induced lung damage.- - - - - - - - - - ranking = 0.00014784887159581keywords = upper (Clic here for more details about this article) |
4/48. Carotid brainstem reflex myoclonus after hypoxic brain damage.A patient comatose after acute anoxia developed bilaterally synchronous, periodic myoclonic jerks most prominently in the bilateral upper limbs. Although the myoclonus seemed to occur spontaneously, electrophysiological studies showed that the myoclonic jerks correlated in timing and size with arterial pulses, and was suppressed by massage over the carotid sinus. It is proposed that the present myoclonus is a variant of brainstem reflex myoclonus in which arterial pulses served as intrinsic trigger stimuli via the carotid sinus and the medullary reticular formation.- - - - - - - - - - ranking = 0.00014784887159581keywords = upper (Clic here for more details about this article) |
5/48. Hypoxia following interscalene block.BACKGROUND AND OBJECTIVES: Interscalene brachial plexus block is often used for surgeries involving the shoulder and upper arm. Known complications include phrenic nerve paralysis, intravascular injection, and cervical epidural block. We report a patient who developed acute hypoxia immediately following this block, presumably secondary to an acute pulmonary thromboembolus (PTE) coupled with phrenic nerve paralysis. CASE REPORT: A 43-year-old man with end-stage renal disease secondary to hypertension was scheduled for primary placement of a left upper extremity arteriovenous fistula. A technically unremarkable interscalene brachial plexus block was performed using a 22-gauge regional block needle and 35 mL of 1.5% mepivacaine. Immediately following injection, the patient's oxygen saturation decreased from 99% to 85%, and he complained of chest pain and shortness of breath and developed hemoptysis. Workup revealed an elevated hemidiaphragm, but no pneumothorax or evidence of local trauma. A spiral computed tomogram (CT) suggested acute pulmonary thromboemboli as the etiology of the hypoxia and hemoptysis, although the diagnosis was uncertain. CONCLUSIONS: This case report suggests that manipulations and vasodilation related to an interscalene block may have facilitated the dislodgement of a pre-existing upper extremity thrombus.- - - - - - - - - - ranking = 0.0023475078731628keywords = chest, upper, pain (Clic here for more details about this article) |
6/48. Drowning: another plunge.Hypoxia, pulmonary edema, acidosis, and aspiration compose the syndrome of near drowning. A review of 20 cases of near drowning indicated that the initial chest roentgenogram bears little weight in assessing the present or future clinical status. In some cases a 24 to 48 hour delay occurred before roentgenographic evidence for pulmonary edema was noted. The composition of fluid aspirated does not affect the outcome. The results of this report suggest that patients with a history of near drowning should be followed closely for at least 48 hours despite an initial normal chest roentgenogram.- - - - - - - - - - ranking = 0.0036023027935121keywords = chest (Clic here for more details about this article) |
7/48. Bilateral vocal cord dysfunction complicating short-term intubation and the utility of heliox.Bilateral vocal cord paralysis is an extremely rare complication of short-term endotracheal intubation. Its etiology following intubation is likely due to recurrent laryngeal nerve injury on intubation. The anterior ramus of the recurrent laryngeal nerve is especially susceptible to pressure injury in intubated patients. Heliox is reported as a successful means of decreasing the work of breathing in upper airway obstruction via decreases in airway resistance. Two cases of bilateral vocal cord dysfunction following short-term intubation are reported. The first case of bilateral vocal cord paresis treated with Heliox is described.- - - - - - - - - - ranking = 0.2501478488716keywords = breathing, upper (Clic here for more details about this article) |
8/48. Cardiovascular complications on upper vagal rootlet section for glossopharyngeal neuralgia; case report.Acute hypotension and right bundle-branch block occurred when the authors sectioned the uppermost rootlet of the vagus nerve in a case of glossopharyngeal neuralgia. hypotension lasted for 20 minutes and arrhythmia for 4 days. A possible mechanism is discussed and cardiovascular disorders are reviewed in similar cases.- - - - - - - - - - ranking = 0.00073924435797903keywords = upper (Clic here for more details about this article) |
9/48. Unusual facial markings and lethal mechanisms in a series of gasoline inhalation deaths.A review of deaths associated with hydrocarbon toxicity from gasoline sniffing in south australia throughout a 10 year period from July 1987 to June 2002 revealed 4 cases. The victims were all Aboriginal people from remote inland communities. Each death had occurred while the victim was lying in bed sniffing gasoline from a can held to the face. Once unconsciousness had occurred, the mouth and nose had been pressed firmly against the can by the weight of the head. In each case, the effects of gasoline toxicity had been exacerbated by hypoxia and hypercapnia from rebreathing into the container once a tight seal had been established between the face and the can. The circular impressions left by the can edges on the faces of each of the victims provided an autopsy marker that assisted in clarifying the details of the fatal episodes. Discouraging solitary gasoline sniffing in bed may reduce the death rate in communities where this behavior is practiced.- - - - - - - - - - ranking = 0.25keywords = breathing (Clic here for more details about this article) |
10/48. Decerebrate rigidity with preserved cognition and gait: a possible role of anoxic-ischemic brain damage.A case of stable decerebrate posture in the upper limbs following sudden loss of consciousness and prolonged coma is described. The patient recovered most of her cognitive functions and gait, without clinical, neurophysiological or neuroradiological evidence of brainstem lesion. MRI shows borderzone infarcts. It is suggested that anoxic-ischemic cortical damage, affecting specially corticoreticular neurons, could explain the development of decerebrate rigidity in patients without apparent brainstem lesion.- - - - - - - - - - ranking = 0.00014784887159581keywords = upper (Clic here for more details about this article) |
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