Consultation with the Specialist

1995 ◽  
Vol 16 (2) ◽  
pp. 69-72
Author(s):  
Margaret A. Kenna
Keyword(s):  
Physical Examination ◽  
Pediatric Intensive Care ◽  
Definitive Diagnosis ◽  
Upper Respiratory Infection ◽  
The Past ◽  
Subsequent Discussion ◽  
Life Threatening ◽  
History Of ◽  
Upper Respiratory ◽  
Vocal Nodules

Hoarseness in children is very common and usually self-limiting, but there are several very serious and potentially life-threatening causes of hoarseness that always should be considered. A careful history and physical examination usually can suggest underlying etiologies, with the definitive diagnosis usually made at the time of airway endoscopy. The following case and subsequent discussion attempt to clarify some of these issues. Case Report An 8-year-old boy presented to the emergency room with a 2-week history of increasing hoarseness, accompanied in the past 5 days by some respiratory distress. On physical examination he was alert and cooperative, with a hoarse but understandable voice and moderate inspiratory and expiratory stridor. Further history revealed that 6 weeks earlier he had been admitted to the pediatric intensive care unit with severe asthma that required 8 days of intubation and mechanical ventilation. He had done well after discharge for about 4 weeks, when his symptoms of hoarseness and then stridor developed. Differential Diagnosis The entities causing hoarseness can be divided primarily into congenital, neurogenic, neoplastic, inflammatory, physiologic, and traumatic (Table). The most common overall etiology is laryngitis associated with an upper respiratory infection (URI), which generally is benign and self-limiting. Vocal nodules are the acquired lesions encountered most frequently and usually are not associated with airway compromise.

Medical Record Documentation of Asthma

1992 ◽  
Vol 13 (6) ◽  
pp. 214-215
Keyword(s):  
Blood Pressure ◽  
Physical Examination ◽  
Lymph Nodes ◽  
Acute Asthma ◽  
Chief Complaint ◽  
Upper Respiratory Infection ◽  
The Past ◽  
Upper Respiratory ◽  
Regular Rhythm ◽  
Medical Record Documentation

Name: Jason Barnard1 Date of birth: August 3, 19842 Drug allergies: None known3 Immunizations: Complete4 Monday, November 11, 1991 8 PM CHIEF COMPLAINT: Wheezing, getting worse. HISTORY: Just moved to town last month with mother after parental separation. Was with father over the weekend (1 hour away). Has had wheezing attacks in the past, which usually respond to albuterol inhaler. Did not have inhaler at father's house. Started with sneezing and coughing on Saturday. Wheezing began on Sunday, but was mild. Has gotten progressively tighter throughout the day, despite use of inhaler. Temperature 101°F this afternoon. Vomited just before coming and brought up fruit juiced mixed with mucus. Has eaten nothing; drank 2 glasses of juice all day. Urinated 2 hours ago and twice earlier today. PHYSICAL EXAMINATION: Alert but breathing with obvious labor. Temperature: 100.5°F orally. Pulse: 100/min. Blood pressure: 120/70. Weight: 55 lbs. Tympanic membranes: Shiny and clear. Nose: Swollen, reddened membranes with white mucus. Throat: Clear. Neck: Small anterior lymph nodes. Chest: Breathing at 40/mm with moderate suprastemal and intercostal retractions and prolonged expiration. Audible wheeze, with faint inspiratory and moderate expiratory wheezing on auscultation. No rales heard. Heart: Good sounds in regular rhythm without murmurs. Abdomen: Soft and nontender. IMPRESSION: Acute asthma, probably triggered by viral upper respiratory infection. PLAN: Albuterol by nebulizer: 0.5 mL (2.5 mg; 0.1 mg/kg) in saline.

scholarly journals Successful Management of Rhabdomyolysis with Acute Infection Resulting from Chronic Sacrococcygeal Pressure Ulcers in a Paraplegic Patient: A Case Report

2020 ◽  
Author(s):  
Kai Huang ◽  
Yansheng Zhu
Keyword(s):  
Physical Examination ◽  
Laboratory Tests ◽  
Pressure Ulcers ◽  
Acute Infection ◽  
Case Presentation ◽  
The Past ◽  
Sacrococcygeal Region ◽  
Skin Sensation ◽  
Life Threatening ◽  
Paraplegic Patient

Abstract Background: Rhabdomyolysis, a potentially life-threatening syndrome, is caused by the breakdown of skeletal muscle cells and leakage of intramyocellular contents into the bloodstream. The treatment of cases with rhabdomyolysis resulting from chronic sacrococcygeal pressure ulcers have been rarely reported.Case presentation: A 62-year-old man suffered from high fever and dark-colored urine. For the past 30 years, the patient has lived with paraplegia, which led to his immobility. According to his physical examination, the wound on his sacrococcygeal region was dehisced and exuded repeatedly with loss of skin sensation. Upon corroboration of a physical examination and laboratory tests, the patient was diagnosed with rhabdomyolysis with an acute infection resulting from sacrococcygeal pressure ulcers. We first debrided the necrotic tissue, and then the chronic ulcer was repaired. The wound dressing was changed frequently, and antimicrobial therapy and nutritional support were included in the treatment. The fever and dark-colored urine were gradually relieved post-operatively. Renal function was also improved according to the typical indicators in laboratory tests. Additionally, the size of the pressure ulcers was reduced, to some extent. The patient was discharged after one month of hospitalization.Conclusions: Accurate diagnosis is critical for clinicians to administer precise treatment to paraplegic patients with progressive rhabdomyolysis.

Asthma and Pneumomediastinum

PEDIATRICS ◽  
1985 ◽  
Vol 75 (5) ◽  
pp. 990-991
Author(s):  
JACOB HEN
Keyword(s):  
Physical Examination ◽  
Subcutaneous Emphysema ◽  
Childhood Asthma ◽  
Previous History ◽  
Clinical Information ◽  
Mediastinal Emphysema ◽  
Respiratory Problems ◽  
The Past ◽  
History Of ◽  
Clinical Clue

To the Editor.— An important piece of clinical information to add to Sturtz's recent review of spontaneous mediastinal emphysema in children1 is that mediastinal emphysema may be the first clinical clue to the presence of childhood asthma. Over the past 4 years, we have seen four children with cough and subcutaneous emphysema in the neck and no previous history of respiratory problems or asthma. These children had hyperinflated lungs and mediastinal emphysema demonstrated on admission chest roentgenograms and physical examination revealed wheezing.

Possible GoLytely-Associated Cardiac Arrest: A Case Report and Literature Review

2019 ◽  
Vol 33 (3) ◽  
pp. 364-367 ◽  
Author(s):  
Yoonsun Mo ◽  
Shiv Gandhi ◽  
Jose Orsini
Keyword(s):  
Cardiac Arrest ◽  
Abdominal Pain ◽  
Sudden Cardiac Arrest ◽  
Lower Abdominal Pain ◽  
The Past ◽  
Life Threatening ◽  
History Of ◽  
Artery Disease ◽  
Possible Cause

Purpose: To report a case of sudden cardiac arrest possibly associated with the administration of GoLytely® (polyethylene glycol 3350 and electrolytes). Summary: A 60-year-old male with a history of hypertension, hyperlipidemia, type 2 diabetes, and coronary artery disease presented to the emergency department with complaints of constipation and lower abdominal pain over the past week, and the inability to urinate over the past day. The patient had received GoLytely as treatment to alleviate symptoms of constipation and abdominal pain. However, several hours after administration of the bowel prep solution, the patient suffered an episode of cardiac arrest. After ruling out other possible etiologies, GoLytely was suspected as a possible cause of cardiac arrest. The patient had suffered an anoxic brain injury and remained intubated and unconscious until he eventually expired, 20 days after the event. Conclusion: Although GoLytely appears to be a safe agent with fewer side effects, clinicians need to be mindful of potential life-threatening adverse events following GoLytely administration and monitor patients closely during and after administration.

Upper Respiratory Infection

2018 ◽  
Author(s):  
Kenneth Wayman ◽  
Nancy B. Samol ◽  
Eric Wittkugel
Keyword(s):  
Adverse Events ◽  
Anesthetic Management ◽  
Airway Disease ◽  
Upper Respiratory Tract ◽  
Upper Respiratory Infection ◽  
Reactive Airway Disease ◽  
Respiratory Events ◽  
History Of ◽  
Upper Respiratory ◽  
Adverse Respiratory Events

The child with an upper respiratory tract infection presenting for surgery is probably the most common dilemma that faces the pediatric anesthesiologist. While cancellation of such a child’s operation had been a common practice in the past, nowadays, an anesthesiologist will more than likely proceed with the anesthetic management of a child with a mild common cold. Research has shown that while perioperative respiratory adverse events are likely to occur in a child with a mild cold, these events are very easily managed. In addition, the use of a laryngeal mask airway which prevents instrumentation of a child’s airway drastically decreases the incidence of perioperative adverse events in this patient population. Planned airway surgery, history of prematurity, reactive airway disease, and passive smoking in the home are factors that increase the incidence of perioperative adverse respiratory events in a child with an active cold.

A Prospective and Retrospective View of Pediatric Hematology/Oncology

2006 ◽  
Author(s):  
Momcilo Jankovic ◽  
Giuseppe Masera
Keyword(s):  
Health Care Professionals ◽  
Pediatric Hematology ◽  
The Past ◽  
Life Threatening Illness ◽  
Retrospective View ◽  
Simple Question ◽  
Life Threatening ◽  
Working Together ◽  
History Of ◽  
The Moment

How does one help a family whose child has been diagnosed with a life-threatening illness? It is a deceptively simple question with complicated answers. This brief chapter is not meant to be a history of biopsychosocial pediatric oncology, and it does not cover every theme. The explosion of studies on children with cancer over these past decades (Pizzo & Poplack, 2001) renders a retrospective look formidable and subjective. The sole purpose of this retrospective examination into the earliest beginnings is to place into context some of the main themes that have appeared over the past years, so that they can serve as a foundation for our recommendations for future intervention and research in the field. That is our assigned task. Much of the review reflects personal respective experiences beginning in the late 1960s. The chapters that form this volume, written by many of the most experienced psychosocial researchers who have brought the field so far forward over these many years, are the state of the art, tell us where we have been most recently, and tell us in greater detail where we are at the moment. Where does our psychosocial history begin? What have we done these past many years to help the children and their families cope with the illness and its treatment? With due awareness of the subjectivity and inevitable unfairness of our venture, we undertake the task with due apologies for any omissions that may occur in this retrospective review. As we begin to look in some detail at the main themes formed over the past four decades, we place our review into the context of four preambles: a multidisciplinary and international effort; an alliance between physicians and parents; research and service; and a sharing of the research wealth with economically struggling countries. From the earliest years, the effort to care for the child with cancer has been multidisciplinary, multi-institutional, and international, involving a highly cooperative and collaborative effort of physicians, nurses, psychologists, social workers, and allied health care professionals working together across national borders.

scholarly journals Serotonin Syndrome after Sertraline Overdose in a Child: A Case Report

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Joana Grenha ◽  
Ana Garrido ◽  
Hernani Brito ◽  
Maria José Oliveira ◽  
Fátima Santos
Keyword(s):  
Case Report ◽  
Behavioral Problems ◽  
Serotonin Syndrome ◽  
Drug Effect ◽  
Pediatric Intensive Care ◽  
Free Access ◽  
Self Medication ◽  
Neurological Sequelae ◽  
Life Threatening ◽  
History Of

Serotonin syndrome is a potentially life-threatening drug effect. It may be misdiagnosed because it has mostly been reported in adults.Case Report. An 8-year-old girl with behavioral problems and medicated with risperidone and sertraline was admitted in the emergency department after she had taken voluntarily 1500 mg of sertraline (50 mg/kg). At admission, she had marked agitation, visual hallucinations, diaphoresis, flushing, and tremor. She had fever and periods of hypertension. She also showed generalized rigidity and involuntary movements. She was treated with fluids and iv diazepam, midazolam, clemastine, and biperiden. As the patient presented a severe insomnia and a progressive rhabdomyolysis, she was transferred to pediatric intensive care unit (ICU), where she was under treatment with cyproheptadine, mechanical ventilation, and muscular paralysis for 11 days. She was discharged from hospital a few days later with no neurological sequelae.Conclusions. Serotonin syndrome is still not well recognized by physicians. In our patient, the diagnosis was made early due to the history of overdose with serotonin reuptake inhibitors and the triad of mental, neurological, and autonomic signs. Parents must be educated to prevent children from having free access to drugs, avoiding self-medication or overdose.

scholarly journals Surgical Management of Glaucoma Secondary to Bilateral Acute Iris Transillumination: A Role for Gonioscopy-assisted Transluminal Trabeculotomy

2021 ◽  
Author(s):  
Stephanie Wey ◽  
Jason Flamendorf ◽  
Sapna Sinha ◽  
Daniel Lee
Keyword(s):  
Surgical Intervention ◽  
Cataract Extraction ◽  
Glaucoma Surgery ◽  
Visual Field Defects ◽  
Blurred Vision ◽  
Upper Respiratory Infection ◽  
Keratic Precipitates ◽  
Healthy Female ◽  
History Of ◽  
Upper Respiratory

Purpose: We report a case of bilateral acute iris transillumination (BAIT) in a young woman associated with ocular hypertension which eventually progressed to glaucoma that was treated with gonioscopy-assisted transluminal trabeculectomy (GATT). Case Report: A 37-year-old otherwise healthy female presented with intermittently red and inflamed eyes and blurred vision. She was treated with oral moxifloxacin months prior to presentation. Iris transillumination defects, a pigmented anterior chamber reaction, the absence of keratic precipitates, and a history of upper respiratory infection treated with an oral fluoroquinolone prompted the diagnosis of BAIT. Intraocular pressure (IOP) remained uncontrolled on multiple glaucoma medications. Following the development of new visual field defects, indicating progression to glaucoma, GATT with cataract extraction was performed. Conclusion: Although surgical intervention is rare with BAIT, our case demonstrates that GATT may be used effectively in those patients needing better IOP control before considering incisional glaucoma surgery.

Anesthesia for MRI

2018 ◽  
Author(s):  
Trung Du ◽  
Mohamed A. Mahmoud
Keyword(s):  
Anesthetic Techniques ◽  
Resonance Imaging ◽  
Safety Issues ◽  
The Past ◽  
Anesthesia Providers ◽  
Obstructive Sleep ◽  
Life Threatening ◽  
History Of ◽  
Pediatric Sedation ◽  
Magnetic Resonance Imaging Mri

Over the past two decades, recent advances in technological innovation have led to an increased demand for pediatric noninvasive procedures. This clinical demand has resulted in tremendous growth in pediatric sedation in non-operating room anesthesia (NORA) locations. Providing anesthesia in these locations challenges anesthesia providers to gain familiarity with the procedures, tailor an anesthesia plan to the procedure and location, and plan for the management of life-threatening situations in these challenging locations. Anesthesiologists are the final arbiter of whether the child is optimized for the procedure or not in NORA location with potentially limited access to backup help. This chapter explores the current and important safety issues for anesthetic administration in magnetic resonance imaging (MRI) suite, the available anesthetic techniques for MRI anesthesia/sedation and finally discuss some specialty-specific considerations for children with history of obstructive sleep apnea and difficult airway.

scholarly journals The Natural History of “Inhibitors” to Factors VIII and IX in Hemophiliacs

1977 ◽  
Author(s):  
C.E.C. Harris
Keyword(s):  
Factor Viii ◽  
Room Temperature ◽  
Factor Ix ◽  
Standard Dosage ◽  
The Past ◽  
Frequent Administration ◽  
Life Threatening ◽  
History Of ◽  
Viii And Ix

Since 1954 an increasing number of adult hemophiliacs have been followed and “inhibitors” have been found in a minority of patients. A retrospective study was made of 9 factor-VIII and of 9 factor-IX cases who have attended with sufficient regularity for adequate documentation. The presence of this complication was, until recently, suspected because of failure clinically to respond to replacement therapy and confirmed by the original Biggs’ technique in the laboratory. In the past k years, this has been replaced by her method using serial dilutions at room temperature and at 37°C, incubated for 1 hour. In addition, studies have been made of factor recovery and survival following infusions.In no case were immuno-suppressive agents used. There were no deaths. Life-threatening crises were met by conservative measures, including hypothermia, and by the use of porcine factor-VIII. Instances when in vivo survival of infused concentrate was shortened were usually managed successfully by more frequent administration of equal or lesser dosage quantities; it was exceptional in such cases to witness enhancement of “inhibitor” potency as a consequence.In no less than 6 of the 9 patients would it seem that the “inhibitor” has disappeared and full clinical response is now being obtained with standard dosage schedules. The nature of “inhibitors” would not seem to be well understood.

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