1/20. Unresponsive wheezing to asthma therapy in a 32-year-old female.Repeat failure of any patient to respond to asthma therapy, particularly corticosteroids, should alert physicians to carry out further pulmonary evaluation. This will prevent unnecessary side effects of asthma therapy and provide prompt treatment for other diseases that may require urgent attention.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/20. Late-onset respiratory distress after inhalation of laundry detergent.Accidental poisoning with household cleaning products can pose significant risks to children. Exposure to granular laundry detergents accounts for a number of calls each year to poison control centers, though few of these exposures result in hospitalization. While caustic gastrointestinal injury resulting from ingestion of these highly alkaline cleaning agents is well-recognized, few reports address the potential damage to the respiratory tract that can occur following ingestion or inhalation of granular laundry detergent. We present a previously healthy 1-year-old who presented to the emergency department with Late-onset stridor and increased work of breathing following presumed inhalation of granular laundry detergent. parents, primary care providers, and emergency department physicians need to be aware of the potential toxicity of these widely used household products.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/20. Early detection of cardiac disease masquerading as acute bronchospasm: The role of bedside limited echocardiography by the emergency physician.We report two cases in which the patients experienced dyspnea, cough, and acute bronchospasm. Pulmonary pathology was initially suspected. Failure to respond to an initial trial of inhaled bronchodilator prompted the use of bedside limited echocardiography by the emergency physician. The potential role of limited echocardiography by the emergency physician as a triage tool in facilitating early diagnosis and emergent therapy, reducing time to final discharge, and enhancing interaction between the pediatric emergency physician and cardiology consultants is highlighted.- - - - - - - - - - ranking = 7keywords = physician (Clic here for more details about this article) |
4/20. Anomalous left coronary artery masquerading as infantile bronchiolitis.Four infants less than six months of age with anomalous left coronary artery from the pulmonary artery who present with symptoms of wheezing are described. All had cardiomegaly on chest radiographs and because of wheezing received beta-agonist agents (albuterol alone or with epinephrine). One developed cardiopulmonary collapse secondary to supraventricular tachycardia after administration of these agents. The literature is reviewed for utility of chest radiographs in infants presenting with wheezing and for the efficacy of beta-adrenergic agents in infants less than six months of age. The authors suggest that physicians have a low threshold for obtaining a chest radiograph prior to treating a first-time wheezing infant less than six months of age with a beta-agonist agent.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/20. Olivopontocerebellar atrophy presenting with stridor.The spectrum of degenerative ataxia includes the symptomatic degenerative ataxias and the primary degenerative ataxias. The later may be sporadic and idiopathic or hereditary, being genetically determined. When an individual ataxic patient presents with an adult-onset degenerative ataxia and has a negative family history, the physician is faced with a diagnosis of pure idiopathic sporadic degenerative ataxia or one of the hereditary ataxias. The clinical spectrum of olivopontocerebellar atrophy (OPCA) usually consists of pancerebellar signs with pyramidal and abnormal eye movements. Although Stridor is more commonly found in multisystem atrophy, it is rarely seen in OPCA. We, here report a case of third decade onset of ataxia presenting with stridor.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/20. The wheezer that wasn't.The expression of cardiac dysfunction in pediatric patients with myocarditis may not be conspicuous. While older children with myocarditis may abruptly present with pleuritic or angina-like pain, infants and toddlers with fulminant disease are unable to verbalize such complaints. Cardiac compromise in preverbal children may only be inferred from variable examination findings that include gallop rhythm, tachycardia, malignant dysrhythmias, murmur, rub, and signs of congestive heart failure. The emergency physician is likely to overlook a cardiac origin for wheezing in a child with a past medical history of asthma. Therapeutic modalities chosen for reactive airway disease may adversely influence the outcome of a patient with myocarditis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/20. Laryngeal obstruction and obstructive sleep apnea syndrome.Obstructive sleep apnea syndrome has been studied intensively since it was introduced in the 1970's; these studies have shown that the site of upper airway obstruction appears to vary among patients. snoring is typically defined as the sound created by rhythmic oscillations of the soft palate in the inspiratory air stream during sleep. snoring occurs in 100% of patients with obstructive sleep apnea and, for selected patients, is treatable by surgery. snoring can, however, mean different things to different patients and physicians. Five atypical cases of obstructive sleep apnea syndrome are presented in which laryngeal dysfunction played a role in producing symptoms of obstructive sleep apnea syndrome. Recording nocturnal sounds during sleep and examining the entire upper respiratory tract may be important in determining appropriate medical or surgical management.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/20. All that wheezes.New onset wheezing in the young child can present an interesting differential diagnostic challenge, especially when there is an atypical presentation of a foreign body lodged in the airway. A thorough history and physical examination helps, but one must remember that a foreign body in the trachea or esophagus can masquerade as a respiratory illness. The chest x-ray is a useful part of the evaluation process. A high degree of suspicion is necessary on the part of the physician to remember that "all that wheezes is not asthma," even in the absence of a history of aspiration of a foreign body.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/20. Hysterical stridor: a benign cause of upper airway obstruction.We present the cases of three patients with stridor that resolved spontaneously. Paradoxical vocal cord motion was documented in one patient. Normal vocal cord motion was present in the other two patients, but stridor had resolved in both cases. Many different terms have been used to describe this entity in the literature. Emergency physicians must recognize the subtle signs of hysterical stridor. Once more serious etiologies are ruled out, sedation and reassurance instead of aggressive airway intervention are required for this benign condition.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/20. Tracheal obstruction presenting as new-onset wheezing.Two cases of recent-onset dyspnea and wheezing initially treated with bronchodilator therapy for presumed reactive airway disease are presented. Plain-film chest radiographs subsequently demonstrated mediastinal masses causing extrinsic tracheal compression. The first patient had inoperable poorly differentiated squamous cell carcinoma resistant to radiotherapy. The second patient underwent resection of a substernal multinodular goiter with complete resolution of symptoms. The physician should always entertain the diagnosis of upper airway obstruction in all adult patients with new-onset wheezing. New-onset adult wheezing of uncertain etiology should prompt the physician to refer the patient for pulmonary function testing with flow-volume loops.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
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