1/8. vocal cord dysfunction mimics asthma and may respond to heliox.vocal cord dysfunction (VCD), an under appreciated cause of wheezing, may be mistaken for or coexist with asthma. The vocal cords involuntarily adduct during inspiration, leading to inspiratory or biphasic wheezing. asthma therapy offers no benefit and may result in injury. Proof of diagnosis requires endoscopy during an episode. Definitive therapy involves voice training by a speech pathologist, but heliox (20% to 40% oxygen in helium) has been used to reduce symptoms, resulting in dramatic improvement in wheezing and less anxiety. A retrospective review of recent experience with heliox treatment for patients with VCD was conducted, using a search of computerized inpatient and outpatient physician dictation reporting at Scott & White Memorial Hospital and Clinic. Five patients age 10 to 15 years were treated with a favorable response in four. There were no complications of therapy. A high index of suspicion can lead to the diagnosis of VCD, avoiding expensive, inappropriate, and harmful therapy. A trial of heliox inhalation for patients with symptomatic VCD may prove beneficial, analogous to the "reliever" role of beta agonists for asthma. Home or school use of heliox may reduce acute care visits, while voice training ("controller" therapy) is instituted.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/8. The pulmonary physician in critical care * illustrative case 3: pulmonary vasculitis.The case history of a patient admitted to the ICU with severe hypoxic respiratory failure later diagnosed as Wegener's granulomatosis is presented. The diagnosis and management of patients with suspected pulmonary vasculitis is discussed.- - - - - - - - - - ranking = 4keywords = physician (Clic here for more details about this article) |
3/8. Profiles in patient safety: when an error occurs.Medical error is now clearly established as one of the most significant problems facing the American health care system. Anecdotal evidence, studies of human cognition, and analysis of high-reliability organizations all predict that despite excellent training, human error is unavoidable. When an error occurs and is recognized, providers have a duty to disclose the error. Yet disclosure of error to patients, families, and hospital colleagues is a difficult and/or threatening process for most physicians. A more thorough understanding of the ethical and social contract between physicians and their patients as well as the professional milieu surrounding an error may improve the likelihood of its disclosure. Key among these is the identification of institutional factors that support disclosure and recognize error as an unavoidable part of the practice of medicine. Using a case-based format, this article focuses on the communication of error with patients, families, and colleagues and grounds error disclosure in the cultural milieu of medial ethics.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
4/8. 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 = 1keywords = physician (Clic here for more details about this article) |
5/8. Acute lower respiratory tract illness in illicit drug users--south carolina, 1995.On July 31, 1995, the south carolina Department of health and Environmental Control was notified of a cluster of five patients with acute, severe lower respiratory illnesses among previously healthy residents of a small rural community in Berkeley County (1990 population: 128,776). All five patients were users of illicit drugs. This report summarizes the preliminary findings of an investigation initiated to describe the clinical features and epidemiology of this syndrome and to determine an etiology. Based on information about the five cases obtained from interviews with the patients and reviews of records, a case was defined as an unexplained acute, severe respiratory illness in a previously healthy person aged < 65 years characterized by shortness of breath and/or pleuritic pain with onset of symptoms during July 15-31. One additional case was identified by contacting local physicians, intensive-care units, and pulmonary and infectious disease specialists. No cases of similar acute respiratory illness were noted in household contacts of patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/8. Fatal methemoglobinemia due to inhalation of isobutyl nitrite.Isobutyl nitrite is a popular recreational drug among both homosexuals and heterosexuals as it is alleged to enhance sexual pleasure and prolong orgasm. In contrast to the ingestion of this volatile nitrite, inhalation is associated only rarely with serious sequelae, though symptomatic methemoglobinemia may occur. The case reported is the first documented fatality from inhalation of isobutyl nitrite. The widespread use of isobutyl nitrite is a cause for concern and physicians should be aware of the potentially fatal consequence of abuse, particularly in those with ischemic heart disease, and its management.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/8. Profound atelectasis following alkaline corrosive airway injury.We report a case of life-threatening acute atelectasis following intubation for alkaline corrosive injury to the upper airway. The risk factors for and diagnosis of acute atelectasis as well as current methods of treatment are reviewed. It is important for emergency physicians to be familiar with this potentially fatal respiratory emergency during care for acutely ill and injured patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/8. A whiff of death: fatal volatile solvent inhalation abuse.inhalation abuse of volatile solvents, previously known generically as "glue sniffing," is typically pursued by adolescents. A wide range of legal, easily obtained products containing volatile substances are available for abuse. We report two illustrative cases of fatal volatile substance abuse: gasoline sniffing in a 20-year-old man and aerosol propellant gas inhalation (aerosol air freshener) in a 16-year-old girl with underlying reactive airway disease. Although the ratio of deaths to nonfatal inhalation escapades is extremely low, volatile solvent abuse carries the risk of sudden death due to cardiac arrest after a dysrhythmia or vasovagal event, central nervous system respiratory depression, hypoxia and hypercapnia due to the techniques of inhalation, and other mechanisms. Investigation of the patient's substance abuse history, examination of the scene of death, and special toxicologic analyses are critical to identifying volatile substance inhalation abuse as the cause of death because anatomic autopsy findings will typically be nonspecific. Above all, physicians must suspect the diagnosis of volatile substance inhalation abuse, especially in any case of sudden death involving an otherwise healthy young person.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |