1/35. 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) |
2/35. 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 = 0.0042196418673409keywords = chest (Clic here for more details about this article) |
3/35. 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 = 0.0042196418673409keywords = chest (Clic here for more details about this article) |
4/35. 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 = 0.0084392837346819keywords = chest (Clic here for more details about this article) |
5/35. 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 = 0.25keywords = breathing (Clic here for more details about this article) |
6/35. 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) |
7/35. Therapeutic benefits of helium-oxygen delivery to infants via nasal cannula.OBJECTIVE: The benefits of helium-oxygen (heliox) administration for pediatric upper and lower respiratory disorders have been well described. However, while most studies advocate delivery via a sealed or semisealed facemask system, such systems may not be tolerated in the young child. This report describes the successful and efficacious delivery of heliox via nasal cannula to 5 infants. methods: A mixture of 80% helium/20% oxygen was blended with 100% oxygen from a wall source and delivered via nasal cannula to 5 spontaneously breathing infants with respiratory distress at flow rates of 2 to 3 liters per minute. Treatment efficacy was retrospectively extracted from nursing, respiratory therapist, and physician entries in the medical record, specifically focusing on changes in respiratory rate, work of breathing, and oxygenation and/or ventilation parameters. RESULTS: All 5 infants tolerated the nasal cannula well. In 2, nasal cannulae were used after attempts to use a facemask system were not tolerated. All patients demonstrated rapid improvements in respiratory parameters including a decreased work of breathing (n = 5), respiratory rate (n = 4), transcutaneous CO2 (n = 2), and stridor (n = 2), or improved oxygenation (n = 1). In 1 patient, the recurrence of distress shortly after discontinuing heliox was rapidly reversed with heliox reinstitution. CONCLUSIONS: In infants with respiratory distress who do not tolerate a facemask, the use of nasal cannula represents a viable and efficacious alternative for heliox delivery.- - - - - - - - - - ranking = 0.75keywords = breathing (Clic here for more details about this article) |
8/35. Sudden hypoxia during anesthesia in a patient with Kartagener's syndrome.We report a case of anesthesia in an adolescent with recurrent left pneumothorax, Kartagener's syndrome, and severe learning disability with behavioral difficulties. After induction of anesthesia, he rapidly developed severe desaturation as measured on pulse oximetry. Placement of an intercostal chest drain did not remedy the situation and he was found to have blocked the left main bronchus with viscous secretions. Subsequent suctioning relieved the obstruction. Despite successful postoperative thoracic epidural analgesia and minitracheostomy for bronchial toilet, he developed bronchopneumonia that resolved with antibiotics. We discuss anesthesia for patients with Kartagener's syndrome and for patients with pneumothorax.- - - - - - - - - - ranking = 0.0042196418673409keywords = chest (Clic here for more details about this article) |
9/35. Hypoxia and cyanosis in alpha-1-antitrypsin deficiency. Cirrhosis as an unusual etiologic factor.A patient with type PiZZ alpha-1-antitrypsin deficiency was found to have severe hypoxia despite normal pulmonary function testing and a normal chest radiograph. A nuclear medicine ventilation-perfusion study revealed a right-to-left shunt. Computed tomography showed minimal bleb formation, no diffuse changes, and hepatic changes of cirrhosis with portal hypertension. No nodular pulmonary masses or enlarged peripheral pulmonary vessels were found. The diagnosis of diffuse intrapulmonic arteriovenous shunts ("pulmonary spiders of cirrhosis") was suggested and then confirmed with a dynamic radionuclide flow study.- - - - - - - - - - ranking = 0.0042196418673409keywords = chest (Clic here for more details about this article) |
10/35. Rigid spine syndrome with respiratory failure.The pathogenesis and therapy of respiratory failure in the rigid spine syndrome are discussed in two cases who improved with respiratory assistance. In both cases, the partial pressures of oxygen and carbon dioxide were reversed in arterial blood gas analysis and %VC was less than 30%. Remission from respiratory failure has been obtained by the use of a ventilator during the night. The cause of the respiratory failure in both cases was severe restrictive respiratory dysfunction due to extreme flattening of the chest and fixation of the thorax during respiration as a result of contracture of costovertebral joints. All the previously reported cases of the rigid spine syndrome with respiratory failure died. Appropriate use of the ventilator can improve the prognosis.- - - - - - - - - - ranking = 0.0042196418673409keywords = chest (Clic here for more details about this article) |
| | Next -> |