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Upper airway emergency

Nuria Farré, Ramon Farré, David Gozal
Obstructive Sleep Apnea (OSA) has emerged as a highly prevalent public health problem that imposes important mid-term and long-term consequences, namely cardiovascular, metabolic, cognitive and cancer-related alterations. OSA is characterized by increased upper airway resistance, alveolar hypoventilation, and recurrent upper airway obstruction during sleep. Recurrent collapse of the upper airway develops with sleep onset, and is associated with both intermittent hypoxemia and sleep fragmentation. The microbiome is a vast and complex polymicrobial ecosystem that coexists with the human organism, and has been identified as playing significant roles in the development of host immunological phenotypes...
March 13, 2018: Chest
Hadil Ak AlOtair, Abdulaziz H Alzeer, Mohammed A Abdou, Shaden O Qasrawi
Central alveolar hypoventilation is rarely encountered. This case report describes a young woman who was recently diagnosed with hypertension and ischemic heart disease. She presented to the emergency room with hypercapnic respiratory failure, for which she was mechanically ventilated. This was preceded by an acute upper respiratory tract infection. She was initially suspected to have Guillain-Barré syndrome, but further investigations ruled out neuromuscular or autoimmune disorders. Sleep-related hypoventilation was suspected after she experienced recurrent apneas at night that resulted in re-intubation...
March 2018: Saudi Medical Journal
Oliva Ortiz-Alvarez
Croup is one of the most common causes of upper airway obstruction in young children. It is characterized by sudden onset of barky cough, hoarse voice, inspiratory stridor and respiratory distress caused by upper airway inflammation secondary to a viral infection. Published guidelines for the diagnosis and treatment of croup advise using steroids as the mainstay treatment for all children who present to emergency department (ED) with croup symptoms. Dexamethasone, given orally as a single dose at 0.6 mg/kg, is highly efficacious in treating croup symptoms...
June 2017: Paediatrics & Child Health
Khalil W Savary, Rachel L Miller, Emilio Arteaga-Solis, Lori Hoepner, Luis M Acosta, Frederica P Perera, Andrew G Rundle, Inge F Goldstein, Matthew S Perzanowski
BACKGROUND: Rhinitis and conjunctivitis are often linked to asthma development through an allergic pathway. However, runny nose and watery eyes can result from nonallergic mechanisms. These mechanisms can also underlie exercise-induced wheeze (EIW), which has been associated with urgent medical visits for asthma, independent of other indicators of asthma severity or control. OBJECTIVE: To test the hypothesis that rhinitis or watery eyes without cold symptoms (RWWC) in infancy predict development of EIW and urgent respiratory-related medical visits at school age, independent of seroatopy...
March 2018: Annals of Allergy, Asthma & Immunology
Karalynn Otterness, Christine Ahn, Jeffrey Nusbaum, Nachi Gupta
Smoke inhalation injury portends increased morbidity and mortality in fire-exposed patients. Upper airway thermal burns, inflammation from lower airway irritants, and systemic effects of carbon monoxide and cyanide can contribute to injury. A standardized diagnostic protocol for inhalation injury is lacking, and management remains mostly supportive. Clinicians should maintain a high index of suspicion for concomitant traumatic injuries. Diagnosis is mostly clinical, aided by bronchoscopy and other supplementary tests...
March 1, 2018: Emergency Medicine Practice
Karalynn Otterness, Christine Ahn
Smoke inhalation injury portends increased morbidity and mortality in fire-exposed patients. Upper airway thermal burns, inflammation from lower airway irritants, and systemic effects of carbon monoxide and cyanide can contribute to injury. A standardized diagnostic protocol for inhalation injury is lacking, and management remains mostly supportive. Clinicians should maintain a high index of suspicion for concomitant traumatic injuries. Diagnosis is mostly clinical, aided by bronchoscopy and other supplementary tests...
March 2018: Emergency Medicine Practice
Sergio Trillo-Muyo, Harriet E Nilsson, Christian V Recktenwald, Anna Ermund, Caroline Ridley, Lauren N Meiss, Andrea Bahr, Nikolai Klymiuk, Jeffrey J Wine, Philip J Koeck, David J Thornton, Hans Hebert, Gunnar C Hansson
Most MUC5B mucin polymers in the upper airways of humans and pigs are produced by submucosal glands. MUC5B forms N-terminal covalent dimers, which are further packed into larger assemblies because of low pH and high Ca2+ in the secretory granule of the mucin-producing cell. We purified the recombinant MUC5B N-terminal covalent dimer and used single-particle electron microscopy to study its structure under intracellular conditions. We found that at intragranular pH, the dimeric MUC5B organized into head-to-head noncovalent tetramers where the von Willebrand D1-D2 domains hooked into each other...
February 13, 2018: Journal of Biological Chemistry
Amal M Osman, Sophie G Carter, Jayne C Carberry, Danny J Eckert
The prevalence of obstructive sleep apnea (OSA) continues to rise. So too do the health, safety, and economic consequences. On an individual level, the causes and consequences of OSA can vary substantially between patients. In recent years, four key contributors to OSA pathogenesis or "phenotypes" have been characterized. These include a narrow, crowded, or collapsible upper airway "anatomical compromise" and "non-anatomical" contributors such as ineffective pharyngeal dilator muscle function during sleep, a low threshold for arousal to airway narrowing during sleep, and unstable control of breathing (high loop gain)...
2018: Nature and Science of Sleep
J J Braun, C Delmas, A Charloux, P Schultz, F de Blay
INTRODUCTION: Vocal cord dyskinesia or vocal cord dysfunction (VCD) is characterized by intermittent abnormal adduction of the vocal cords leading to airflow limitation at the level of the larynx, in the absence of local organic disease. It may occur in isolation or in association with asthma. The pathophysiology is complex and poorly understood. Wheeze, stridor or apparent upper airway obstruction are the most common symptoms. It occurs in a wide age range, more commonly in women, and diagnosis is often delayed and leads to unnecessary treatments (intubation, tracheostomy and high dose steroids)...
January 31, 2018: Revue des Maladies Respiratoires
Antonio Piralla, Nicola Principi, Luca Ruggiero, Alessia Girello, Federica Giardina, Elisabetta De Sando, Silvia Caimmi, Sonia Bianchini, Gian Luigi Marseglia, Giovanna Lunghi, Fausto Baldanti, Susanna Esposito
BACKGROUND: In recent years, several outbreaks due to Enterovirus D-68 (EV-D68) have been reported, and it was confirmed that the virus can cause upper and lower respiratory tract diseases and be associated with the development of neurological problems. OBJECTIVES: The main aim of this research was to study the genetic characteristics of EV-D68 strains that were circulating in Italy identified during an outbreak of an EV-D68 infection that occurred in Italy during the period March-October 2016...
January 12, 2018: Journal of Clinical Virology: the Official Publication of the Pan American Society for Clinical Virology
J A Murphy, S R McWilliams, M Lee, G Warburton
There are limited published data about the surgical management of self-inflicted facial gunshot wounds. The aim of this retrospective study was to review our management of subjects who initially survive such a wound and were admitted to a tertiary care trauma centre between 2002 and 2012. Only subjects with definitive evidence of a self-inflicted facial gunshot wound and who were admitted alive were included. Data collected included personal and clinical details, characteristics of the gunshot wound, and medical and surgical management...
January 27, 2018: British Journal of Oral & Maxillofacial Surgery
Selis Gülseven Güven
Tracheotomy is one of the oldest surgical procedures, and it is a life-saving procedure to overcome upper airway obstructions. While congenital causes play an important role in pediatric tracheotomy indications, upper airway edema and obstruction due to anaphylaxis rarely require tracheotomy. Allergy can cause life-threatening acute edema by anaphylactic reactions in the respiratory tract. Henna stone is the material for dyeing hair with henna and making a temporary tattoo. It contains high proportions of paraphenylendiamine...
March 2017: Turkish archives of otorhinolaryngology
Phi-Vu Dong, Leontien Ter Horst, Ralf Krage
(Un)anticipated difficult airway remains a challenge in anaesthesia. Percutaneous transtracheal jet ventilation has been shown to be an adequate technique for temporary oxygenation and ventilation and has been described as an acknowledged method in emergency settings of an unanticipated difficult airway. These emergency settings can be considered as low incidence high-risk situations. Both technical and non-technical skills should be trained regularly as education and simulation continues to play an important factor in patient safety...
January 26, 2018: BMJ Case Reports
B S Alabi, O A Afolabi, A D Dunmade, H K Omokanye, I O Ajayi, S O Ayodele, N O Busari
BACKGROUND: The study aims to highlight common indications as well as outcome of treatment among patients with tracheostomy in Ilorin, North-Central Nigeria. METHODS: A review of clinical records of all patients with tracheostomy over a period of ten years (2002-2011), using the Theatre, Ward, ICU and the emergency register after approval from the ethical review committee. Data retrieved included; demographic profile, primary diagnosis, indication for tracheostomy, surgical technique, hospital admission and care outcome of management...
January 2018: Annals of African Medicine
Kimberly Truong, Christian Guilleminault
Numerous physiologic and anatomic changes during pregnancy exacerbate or unmask obstructive sleep apnea in women. Left untreated, upper airway flow limitation during pregnancy may lead to dire maternal and fetal health consequences. Areas covered: This review outlines the relationship between sleep disordered breathing (SDB) and gestational hypertension, preeclampsia, and gestational diabetes. It also discusses the implications of SDB on fetal and maternal health and concludes with a review of the emerging literature of treatment options for SDB in pregnancy and its benefit...
March 2018: Expert Review of Respiratory Medicine
Kong Eric You-Ten, Naveed Siddiqui, Wendy H Teoh, Michael S Kristensen
Airway management is a critical skill in the practice of several medical specialities including anesthesia, emergency medicine, and critical care. Over the years mounting evidence has showed an increasing role of ultrasound (US) in airway management. The objective of this narrative review is to provide an overview of the indications for point-of-care ultrasound (POCUS) of the upper airway. The use of US to guide and assist clinical airway management has potential benefits for both provider and patient. Ultrasound can be utilized to determine airway size and predict the appropriate diameter of single-lumen endotracheal tubes (ETTs), double-lumen ETTs, and tracheostomy tubes...
January 18, 2018: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Elizabeth A Hall, Ibrahim Showaihi, Frances S Shofer, Nova L Panebianco, Anthony J Dean
BACKGROUND: Recognition of the difficult airway is a critical element of emergency practice. Mallampati score and body mass index (BMI) are not always predictive and they may be unavailable in critically ill patients. Ultrasonography provides high-resolution images that are rapidly obtainable, mobile, and non-invasive. Studies have shown correlation of ultrasound measurements with difficult laryngoscopy; however, none have been performed in the Emergency Department (ED) using a consistent scanning protocol...
January 18, 2018: Critical Ultrasound Journal
Carlos Almeida, Maria João Freitas, Diogo Brandão, José Pedro Assunção
Female, 85 y.o., weighting 60kg, multiple trauma patient. After an initial laparotomy, an emergent thoracotomy was performed using a bronchial blocker for lung isolation (initial active suction was applied). During surgery, bronchial cuff was deflated, causing a self-limited tracheal blood flooding. A second lung isolation was attempted but it was not as effective as initially. Probably, a lung collapse with the same bronchial blocker was impaired in the second attempt because of the obstruction of bronchial blocker lumen by intraoperative endobronchial hemorrhage...
January 13, 2018: Revista Brasileira de Anestesiologia
Andrie C Westerkamp, A Fred de Geus, Bouwe Molenbuur, Peter Meyer, J K Götz Wietasch, Michel M R F Struys, Herman G D Hendriks
BACKGROUND: Comparisons of peri-operative complications associated with paediatric (≤16 years) and adult anaesthesia are poorly available, especially in which cardiac surgery, organ transplantation and neurosurgery are involved. OBJECTIVE: The aim of this study was to evaluate the nature and incidence of peri-operative complications that might be due to anaesthesia and to identify independent risk factors for complications in children and adults, including those undergoing cardiac surgery, organ transplantation and neurosurgery...
January 13, 2018: European Journal of Anaesthesiology
Akifumi Funatsu, Konomi Kobayashi, Motoyasu Iikura, Satoru Ishii, Shinyu Izumi, Haruhito Sugiyama
Bronchial thermoplasty (BT) is a bronchoscopic treatment for severe asthma using thermal energy to reduce smooth muscle in the bronchial wall. A 47-year-old man underwent BT for uncontrolled severe asthma despite maximal pharmacological treatment. After a third procedure, he experienced hypoxaemia because of complete bilateral upper lobe atelectasis. A pulmonary cyst suddenly emerged in to the right middle lobe, associated with the pneumothorax on postoperative day 6, and a chest drainage tube was inserted...
February 2018: Respirology Case Reports
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