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Upper airway emergency

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https://www.readbyqxmd.com/read/29755518/double-barrel-nasal-trumpets-to-prevent-upper-airway-obstruction-after-nasal-and-non-nasal-surgery
#1
Macario Camacho, Justin M Wei, Lauren K Reckley, Sungjin A Song
Objectives: During anesthesia emergence, patients are extubated and the upper airway can become vulnerable to obstruction. Nasal trumpets can help prevent obstruction. However, we have found no manuscript describing how to place nasal trumpets after nasal surgery (septoplasties or septorhinoplasties), likely because (1) the lack of space with nasal splints in place and (2) surgeons may fear that removing the trumpets could displace the splints. The objective of this manuscript is to describe how to place nasal trumpets even with nasal splints in place...
2018: Anesthesiology Research and Practice
https://www.readbyqxmd.com/read/29755094/-giant-intrathoracic-goiter-requiring-emergency-airway-management-report-of-a-case
#2
Marina Shiikawa, Kazuki Hayasaka, Kei Yarimizu, Katsuyuki Suzuki, Makoto Endo, Naoki Yanagawa, Satoshi Shiono
An 81-year-old woman with acute respiratory distress was referred to our hospital. Computed tomography showed a large mass in the upper mediastinum with severe tracheal stenosis. Endotracheal intubation was performed under the preparation of extracorporeal membrane oxygenation and high-frequency jet ventilation, and the tumor was completely removed. The pathologic diagnosis was a goiter. Post-operatively, respiratory distress disappeared. No tumor recurrences have been noted for more than 2 years after surgery...
May 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/29746617/a-wake-up-call-for-human-immunodeficiency-virus-hiv-providers-obstructive-sleep-apnea-in-people-living-with-hiv
#3
Robert L Owens, Charles B Hicks
Obstructive sleep apnea (OSA) is defined by repetitive collapse of the upper airway during sleep leading to transient hypoxemia and arousals from sleep. Surges in sympathetic activity, repeated oxygen desaturation, and sleep fragmentation can lead to cardiovascular (eg, myocardial infarction) and neurocognitive (eg, excessive daytime sleepiness) consequences. Emerging data suggest that OSA is common in people living with human immunodeficiency virus (PLWH) and that traditional risk factors for OSA, such as obesity, are not highly predictive of OSA in PLWH...
May 9, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/29740589/cervical-hyperostosis-leading-to-dyspnea-aspiration-and-dysphagia-strategies-to-improve-patient-management
#4
Georgios Psychogios, Monika Jering, Johannes Zenk
Diffuse idiopathic skeletal hyperostosis (DISH) is a rare but well known cause of dysphagia. In very few cases aspiration and dyspnea are described as a clinical manifestation. An 82-year-old man presented himself in our clinic with severe dyspnea, aspiration, and pneumonia. After performing a microlaryngoscopy an emergency tracheotomy became necessary. In laryngoscopy a severe bulging of the posterior oropharyngeal and hypopharyngeal wall was detected. The glottis area was not observable and immobilisation of the right vocal cord could be detected...
2018: Frontiers in Surgery
https://www.readbyqxmd.com/read/29732233/pathogenesis-of-recalcitrant-chronic-rhinosinusitis-the-emerging-role-of-innate-immune-cells
#5
REVIEW
Il Gyu Kong, Dae Woo Kim
Chronic rhinosinusitis (CRS) is a major part of the recalcitrant inflammatory diseases of the upper airway that needs enormous socioeconomic burden. T helper (Th) 2 type immune responses recruiting eosinophils were the most well-known immune players in CRS pathogenesis especially in western countries. By the piling up of a vast amount of researches to elucidate the pathogenic mechanism of CRS recently, heterogeneous inflammatory processes were found to be related to the phenotypes of CRS. Recently more cells other than T cells were in the focus of CRS pathogenesis, such as the epithelial cell, macrophage, innate lymphoid cells, and neutrophils...
April 2018: Immune Network
https://www.readbyqxmd.com/read/29703020/flumazenil-reduces-respiratory-complications-during-anesthesia-emergence-in-children-with-preoperative-upper-respiratory-tract-infections
#6
Ruiqiang Sun, Guolin Wang, Xuesong Gao, Shuzhen Wang
Despite its benignity, upper respiratory infections (URIs) 1 increase the risk of postoperative respiratory complications during the perioperative and postoperative periods. Flumazenil could improve the symptoms of respiratory obstruction.To evaluate the effect of flumazenil on the occurrence of respiratory complications during anesthesia emergence of children with preoperative URI.This was a prospective study of 164 consecutive pediatric patients who underwent strabismus surgery under general anesthesia at the Tianjin Eye Hospital between August 2016 and April 2017...
April 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29696352/-allergic-emergencies
#7
REVIEW
A-C Herr, T Biedermann, K Brockow
Both anaphylactic reactions and angioedema in the head and neck area can be life-threatening and require emergency treatment. Therapy needed is primarily directed by the patient's symptoms. The first measures taken should consist of immediate disruption of the allergen contact, adequate positioning of the patient, the insertion of an intravenous catheter and an emergency call. In case of cardiovascular or respiratory involvement, intramuscular ± inhalative adrenalin is the treatment of choice. In case of cardiovascular involvement, volume substitution by intravenous catheter and oxygen administration are crucial and in lower airway obstruction, additionally short-acting beta mimetics should be inhaled...
April 25, 2018: Der Hautarzt; Zeitschrift Für Dermatologie, Venerologie, und Verwandte Gebiete
https://www.readbyqxmd.com/read/29669351/bronchial-thermoplasty-in-severe-asthma-best-practice-recommendations-from-an-expert-panel
#8
Peter I Bonta, Pascal Chanez, Jouke T Annema, Pallav L Shah, Robert Niven
Bronchial thermoplasty (BT) is a bronchoscopic treatment for patients with severe asthma who remain symptomatic despite optimal medical therapy. In this "expert best practice" paper, the background and practical aspects of BT are highlighted. Randomized, controlled clinical trials have shown BT to be safe and effective in reducing severe exacerbations, improving quality of life, and decreasing emergency department visits. Five-year follow-up studies have provided evidence of the functional stability of BT-treated patients with persistence of a clinical benefit...
2018: Respiration; International Review of Thoracic Diseases
https://www.readbyqxmd.com/read/29629678/hereditary-angio-oedema-in-the-western-cape-province-south-africa
#9
K M Coovadia, M-Y Chothia, S G Baker, J G Peter, P C Potter
BACKGROUND: Hereditary angio-oedema (HAE) is an autosomal dominant condition caused by a deficiency in the C1-esterase inhibitor protein, resulting in increased bradykinin release. It presents clinically with recurrent attacks of angio-oedema, commonly affecting the limbs, face, upper airway and gastrointestinal tract. Little is known about this condition in sub-Saharan Africa. OBJECTIVES: To analyse and report on the clinical presentation and treatment of patients with HAE in the Western Cape Province, South Africa...
March 28, 2018: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
https://www.readbyqxmd.com/read/29628567/comparison-of-upper-lip-bite-test-and-ratio-of-height-to-thyromental-distance-with-other-airway-assessment-tests-for-predicting-difficult-endotracheal-intubation
#10
D Shobha, Maitri Adiga, D Devika Rani, Sudheesh Kannan, S S Nethra
Background and Aims: Unanticipated difficult intubation or the failed intubation in operating room and in emergency department is an imperative source of anesthesia-related patient's mortality. The aim of this study is to compare the predictive value of upper lip bite test (ULBT) and ratio of height to thyromental distance (RHTMD) with other commonly used preoperative airway assessment tests for predicting difficult intubation in Indian population. Materials and Methods: In this prospective, single-blinded observational study, 260 adult patients of either sex, belonging to American Society of Anesthesiologists physical Status I and II undergoing elective surgical procedure under general anesthesia were included in the study...
January 2018: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29601152/combat-zone-exposure-and-respiratory-tract-disease
#11
REVIEW
Sean M Parsel, Charles A Riley, Edward D McCoul
BACKGROUND: The impact of deployment to combat zones on the respiratory and sinonasal health of U.S. soldiers is an emerging public health concern. Retrospective studies have shown a correlation between deployment and development of post-deployment pathology, particularly of the aerodigestive system. Respiratory disease, including sinusitis, allergic rhinitis, and asthma, are commonly reported in soldiers deployed to the Middle East and Southwest Asia. METHODS: Current literature pertaining to combat zone exposure and development of respiratory disease was retrieved using PubMed, Embase, Web of Science, and Google Scholar...
March 30, 2018: International Forum of Allergy & Rhinology
https://www.readbyqxmd.com/read/29575773/non-invasive-ventilation-practices-in-children-across-europe
#12
Juan Mayordomo-Colunga, Martí Pons-Òdena, Alberto Medina, Corsino Rey, Christophe Milesi, Merja Kallio, Andrea Wolfler, Mireia García-Cuscó, Demet Demirkol, Milagros García-López, Peter Rimensberger
OBJECTIVES: To describe the diversity in practice in non-invasive ventilation (NIV) in European pediatric intensive care units (PICUs). WORKING HYPOTHESIS: No information about the use of NIV in Pediatrics across Europe is currently available, and there might be a wide variability regarding the approach. STUDY DESIGN: Cross-sectional electronic survey. METHODOLOGY: The survey was distributed to the ESPNIC mailing list and to researchers in different European centers...
March 24, 2018: Pediatric Pulmonology
https://www.readbyqxmd.com/read/29564227/taste-receptor-polymorphisms-and-immune-response-a-review-of-receptor-genotypic-phenotypic-variations-and-their-relevance-to-chronic-rhinosinusitis
#13
REVIEW
Vasiliki Triantafillou, Alan D Workman, Michael A Kohanski, Noam A Cohen
Bitter (T2R) and sweet taste (T1R) receptors have emerged as regulators of upper airway immune responses. Genetic variation of these taste receptors additionally confers susceptibility to infection and has been implicated in severity of disease in chronic rhinosinusitis (CRS). Ongoing taste receptor research has identified a variety of biologically active compounds that activate T1R and T2R receptors, increasing our understanding of not only additional receptor isoforms and their function but also how receptor function may contribute to the pathophysiology of CRS...
2018: Frontiers in Cellular and Infection Microbiology
https://www.readbyqxmd.com/read/29548630/sleep-apnea-morbidity-a-consequence-of-microbial-immune-cross-talk
#14
REVIEW
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
https://www.readbyqxmd.com/read/29543311/unusual-case-of-central-alveolar-hypoventilation
#15
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
https://www.readbyqxmd.com/read/29532807/acute-management-of-croup-in-the-emergency-department
#16
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
https://www.readbyqxmd.com/read/29508714/infant-rhinitis-and-watery-eyes-predict-school-age-exercise-induced-wheeze-emergency-department-visits-and-respiratory-related-hospitalizations
#17
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
https://www.readbyqxmd.com/read/29489307/emergency-department-management-of-smoke-inhalation-injury-in-adults-digest
#18
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
https://www.readbyqxmd.com/read/29489306/emergency-department-management-of-smoke-inhalation-injury-in-adults
#19
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
https://www.readbyqxmd.com/read/29440393/granule-stored-muc5b-mucins-are-packed-by-the-non-covalent-formation-of-n-terminal-head-to-head-tetramers
#20
Sergio Trillo-Muyo, Harriet E Nilsson, Christian V Recktenwald, Anna Ermund, Caroline Ridley, Lauren N Meiss, Andrea Bähr, Nikolai Klymiuk, Jeffrey J Wine, Philip J B 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 that 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...
April 13, 2018: Journal of Biological Chemistry
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