scholarly journals Loss of compensation by accessory muscles of breathing in advanced dystrophic disease

2021 ◽  
Vol 35 (S1) ◽  
Author(s):  
Ken O'Halloran ◽  
David Burns
Keyword(s):  
Dystrophic Disease ◽  
Accessory Muscles

Clinical manifestations and diagnosis of keratoconus. Treatment of iatrogenic keratoconus

2020 ◽  
pp. 37-42
Author(s):  
Fedor Ermolyuk
Keyword(s):  
Research Methods ◽  
Contact Lenses ◽  
Correct Diagnosis ◽  
Clinical Manifestations ◽  
Refractive Errors ◽  
Dry Eyes ◽  
Advanced Stages ◽  
Dystrophic Disease ◽  
Iatrogenic Origin ◽  
Binocular Diplopia

Keratoconus is a dystrophic disease of the cornea, when it is thinned with the formation of a conus-like protrusion (protrusion of the cornea). This disease belongs to the group of keratectasia, it has a multifactorial nature and occurs in approximately 25 % of all corneal pathologies. The disease can be either primary, which is based on dystrophic changes in the cornea, or secondary, which develops against the background of prenatal keratitis. Keratoconus of iatrogenic origin, which develops as a result of refractive eye microsurgery, has become widespread during the last 20 years. Most often primary keratoconus manifests during puberty, progresses to 30–40 years, after which its development slows down. An early clinical manifestation of this corneal pathology is a progressive decrease in visual acuity, development of double vision (binocular diplopia) with the development of a strong headache against this background. Monocular polyopia — images and symbols with multiple contours — develops subsequently. Severe dry eyes, itching, photophobia appear in advanced stages. Diagnosis of keratoconus in some cases can be a significant difficulty, since the use of conventional research methods only allow to suspect refractive errors in the form of myopia or astigmatism. It is necessary to take into account the impossibility of correcting visual impairment using conventional methods — glasses or contact lenses — to make correct diagnosis. As a rule, diagnosis of keratoconus requires use of expanded spectrum of instrumental research methods.

Accessory muscles of the lower calf.

Radiology ◽  
1984 ◽  
Vol 151 (1) ◽  
pp. 47-48 ◽  
Author(s):  
A C Nidecker ◽  
A von Hochstetter ◽  
H Fredenhagen
Keyword(s):  
Accessory Muscles

Accessory Muscles of the Lower Calf

Radiology ◽  
1984 ◽  
Vol 152 (2) ◽  
pp. 539-539
Author(s):  
G. David Dixon
Keyword(s):  
Accessory Muscles

scholarly journals ORTHOPAEDIC ASPECTS OF SURGICAL TREATMENT OF PATIENTS WITH DEGENERATIVE-DYSTROPHIC DAMAGE OF THE LUMBOSACRAL SPINE

2005 ◽  
pp. 061-070
Author(s):  
Vladimir Mikhailovich Shapovalov ◽  
Aleksandr Kaisinovich Dulaev ◽  
Yury Alekseyevich Shulev ◽  
Vladimir Petrovich Orlov ◽  
Konstantin Alekseyevich Nadulich ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Clinical Practice ◽  
Surgical Treatment ◽  
Spinal Stenosis ◽  
Functional Results ◽  
Surgical Approaches ◽  
Lumbosacral Spine ◽  
Suggested Approach ◽  
Modern Level ◽  
Dystrophic Disease

Objective. On the basis of clinical and anatomico-functional results of surgical treatment of patients with degenerativedystrophic disease of the lumbosacral spine to develop and introduce into clinical practice orthopaedic surgical approaches aimed mainly to the correction and stabilization of the spine. Materials and Methods. The results of surgical treatment of 340 patients operated on for degeneconventionally and by the technique proposed by authors with the account for orthopaedic factors rative-dystrophic disease of the lumbosacral spine were analyzed. Results. The treatment outcome was mainly influenced by the following factors: spinal stenosis, instability and lumbosacral shape (balance) disturbance. The pattern of preopreative planning was developed on the basis of the introduced comprehensive methods of diagnosis. The suggested approach to surgical treatment has gone through clinical approbation resulted in recommendations for its application in practice. The paper presents the advantages of use of modern neuroorthopaedic technologies for various forms of spinal stenosis, and orthopaedic correction techniques in patients with discogenic radiculopathy associated with instability and deformity of the lumbosacral spine. Conclusion. The modern level of neuroorthopaedic care suggests new approaches to diagnosis and surgical management of patients with degenerative-dystrophic disease of the lumbosacral spine.

Abstract 108: Work of Breathing Scale to Assess Need of Intubation in Covid-19 Pneumonia

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Raul J Gazmuri ◽  
Mylene Apigo ◽  
Philip Fanapour ◽  
Amin Nadeem
Keyword(s):  
Respiratory Rate ◽  
Work Of Breathing ◽  
Invasive Mechanical Ventilation ◽  
Lung Compliance ◽  
Respiratory Physiology ◽  
High Flow Nasal Cannula ◽  
Radiographic Evidence ◽  
Multiple Risk Factors ◽  
Rate Score ◽  
Accessory Muscles

COVID-19 pneumonia presents in most patients with significant hypoxemia but without substantial impairment of lung compliance that would increase the work of breathing (WOB) to levels requiring invasive mechanical ventilation. Thus, the ability to assess the WOB independent of the oxygen needs could help guide management and possibly avoid intubation. We previously developed and implemented in our ICU a WOB scale based on respiratory physiology ranging from 1 to 7 by assigning points to the respiratory rate level and the use of respiratory accessory muscles. We analyzed the use of our WOB scale in 10 patients admitted to our ICU with severe COVID-19 pneumonia. All patients had radiographic evidence of extensive lung disease with significant hypoxemia and multiple risk factors associated with poor outcome. Hypoxemia was successfully managed using high-flow nasal cannula. The WOB level was measured every 4 hours. The maximum WOB was 4.3 ± 0.9, contributed primarily by the respiratory rate with a score of 3.6 ± 0.5 but with infrequent use of respiratory accessory muscles. All 10 patients survived without need of intubation. For comparison, three other patients who needed intubation had a maximal work of breathing within the preceding 24 hours of 5.3 ± 1.2 with a respiratory rate score of 3.7 ± 0.6, as in non-intubated patients, but with more often use of respiratory accessory muscles. Our data suggest that patients with COVID-19 pneumonia can be supported for extended periods using HFNC despite tachypnea provided there is only infrequent use of respiratory accessory muscles, corresponding to a WOB scale ≤ 4, prompting closer assessment for possible intubation when WOB > 4. This approach would be especially advantageous under conditions of high disease intensity when avoidance of intubation is likely to result in a better outcome.

Haematemesis

2015 ◽  
Author(s):  
Hugo Farne ◽  
Edward Norris-Cervetto ◽  
James Warbrick-Smith
Keyword(s):  
Head Injury ◽  
Central Venous Access ◽  
Venous Blood ◽  
Venous Access ◽  
High Flow ◽  
High Flow Oxygen ◽  
Do It Yourself ◽  
Venous Blood Gas ◽  
Accessory Muscles ◽  
Intraosseus Access

First of all, call for help. You cannot manage an emergency alone—it involves teamwork. Call for help and involve your seniors. Second, this patient has potentially lost a lot of blood. Start with ABCDE—Airway, Breathing, Circulation, Disability, Exposure. Airway: Ensure it is patent. Can he talk? Is there any gurgling or stridor? Beware of blood in the oropharynx in a patient with haematemesis. If necessary, use suction to remove the blood. Breathing: Are there any signs of respiratory distress (tachypnoea, use of accessory muscles, low saturations)? Circulation: Does he have a pulse? Is he in shock (tachycardia, narrow pulse pressure, hypotension, cold peripheries)? Disability: what is the patient’s Glasgow Coma Score (GCS)? Always calculate this in an emergency as a GCS ≤8 (or rapidly dropping towards that point) suggests that the patient may soon require intubation to protect their airway. If you can’t remember the components of a GCS in an emergency, use the AVPU score (patient is Alert, responds to Voice, responds to Pain or is Unresponsive), where an avPu score (i.e. a patient who is responding to painful stimuli but not voice) is roughly equivalent to a GCS = 8. Exposure: The patient may have suffered multiple trauma and/or have various sites of blood loss. Although it is unlikely, what the hostel staff perceived as drunken behaviour may in fact represent behaviour from an unwitnessed assault resulting in significant head injury, and the haematemesis may reflect a stab wound to the chest or abdomen. Always expose the patient or you will be caught out by unsuspected findings. Mr Tucker is in shock, often defined as a BP <90/60 mmHg. He needs fluid resuscitation: • Apply high flow oxygen (15 L/min). • Get intravenous (IV) access: insert a large-bore (14G–16G) cannula and if you can’t do it yourself, ask a senior to help. They may need to resort to ultrasound-guided peripheral vascular access, to intraosseus access or to central venous access. • Send bloods for: ■ Venous blood gas: this will give you a rapid estimate of the patient’s haemoglobin.

A perspective of respiratory mechanics

1983 ◽  
Vol 54 (5) ◽  
pp. 1183-1187 ◽  
Author(s):  
A. B. Otis
Keyword(s):  
Smooth Muscle ◽  
Experimental Approach ◽  
Respiratory Mechanics ◽  
Bronchial Smooth Muscle ◽  
Pharmacological Agents ◽  
Early 19Th Century ◽  
Willem Einthoven ◽  
Normal Physiological Function ◽  
Accessory Muscles ◽  
Muscular Action

Breathing was recognized very early to be a muscular action. The participation of the diaphragm, intercostals, and accessory muscles was appreciated by Galen. Consideration of a possible role for smooth muscle in breathing did not occur until much later. Even today smooth muscle is seldom included as a topic in discussions of “respiratory mechanics.” Bronchial smooth muscle was first described in the classic study of Reisseisen in the early 19th century, although the presence of contractile elements in lungs had been demonstrated a few decades previously. An important comprehensive investigation of the action of bronchial smooth muscle was published in 1892 by Willem Einthoven. His experimental approach became a paradigm. On the other hand, his analysis of dynamic collapse of the airways received little attention and was independently arrived at half a century later. Although we now have a considerable understanding of the mechanics of bronchial smooth muscle and of the effects of numerous physiological and pharmacological agents on its behavior, the exact role it plays in normal physiological function is unclear. Numerous plausible suggestions have been made, but none has been convincingly demonstrated.

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