Respiratory Illness Ebook
'The Task Force agreed that the clinical characteristics to consider when deciding whether to order a pre-operative chest X-ray include smoking, recent upper respiratory tract infection (URTI), chronic obstructive pulmonary disease (COPD) and cardiac disease. The Task Force agreed chest X-ray abnormalities may be higher in such patients but does not believe that extremes of age, smoking, stable COPD, stable cardiac disease or recent resolved URTI should be considered unequivocal indications for chest X-ray.'
Acute abdominal pain is a common complaint in the pediatric age group. A total of 10 of school-age children have recurrent abdominal pain and in only 10 of these children can etiology be detected. The majority of these children have self-limited disease. The most common associated conditions include upper respiratory tract infection, pharyngitis, viral syndrome, gastroenteritis, and constipation (Henderson et al. 1992). Therefore, it is uncommon for the underlying condition in these children to require surgical intervention.
Allison, a five-year-old preschooler with a history of wheezy colds, and her mother interacted with several microsystems as they navigated the health care system. At various points the system failed to address Allison's needs. We apply the Haddon matrix, a useful framework for analyzing medical failures in patient safety, to this scenario, showing how this process sets the stage for developing countermeasures.
Appropriate indications for use of a nonprescription medicine are self-limiting problems, such as coughs and colds. The FDA decides whether a layperson should be able to discriminate these from serious diseases that may have similar symptoms in their early stages. So, for example, labeling of nonprescription cough preparations includes warnings to consult a doctor if the cough is accompanied by certain other symptoms or if it persists. The FDA has authority to regulate advertising of prescription medications to professionals and laymen, but only limited authority over the advertising of nonprescription drug products. Advertising of OTC drugs is actually under the authority of the Federal Trade Commission. Claims made for nonprescription drugs should have a scientific basis, and corrective advertising can be required by the FTC. For example, Warner-Lambert once claimed that Listerine mouthwash prevents colds and sore throats. The FTC found this claim to be unsubstantiated and required...
Topical therapy is widely used to treat allergic rhinitis. It is well known that histamine is an important mediator of allergic symptoms causing itching, sneezing and hypersecretion. Research is being directed towards discovering the relative roles of leucotrienes, prostaglandins and other arachidonic acid metabolites in the allergic process. Local eosinophilia is a characteristic feature of allergic rhinitis, some non-allergic rhinitis and nasal polyposis. Rhinitis is commonly treated with topical administration of corticosteroids, sodium cromoglycate or azelastine, an -antagonist which is administered via a nasal spray. The a-adrenergic agonist decongestant sprays containing phenylephrine, xylometazoline or tetrahydrozoline, often used in the management of allergic rhinitis, significantly increase nasal mucous velocity within ten minutes of administration. This is
Symptoms include rhinitis, conjunctivitis, abdominal pain, vomiting, diarrhoea and a sense of impending doom. The skin colour often changes and the patient may appear either flushed or pale. Cardiovascular collapse is caused by vasodilation and loss of plasma from the blood compartment into the tissues. It is a common clinical manifestation, especially in response to intravenous drugs or stings. Any cardiac dysfunction is due principally to hypotension or, rarely, to an underlying disease or to intravenous administration of epinephrine.
Intranasal examination (with a headlight and speculum or, ideally, an endoscope) may be performed, looking for the presence of fluorescein in the inferior meatus, polyps, allergic rhinitis, septal deviation, turbinate impaction (rare), or other intranasal diseases (Figure 10.16). Preoperative nasal endoscopy is essential in the assessment of patients for endonasal lacrimal procedures.
Antigen reduces nasal transepithelial electric potential differences and alters ion transport in allergic rhinitis in vivo. Acta Otolaryngol. 1992 112 552-558. 35. Borum P, Olsen L, Winther B, Mygind N. Ipratropium nasal spray a new treatment for rhinorrhea in the common cold. Am. Rev. Respir. Dis. 1981 123 418-420. 66. Braat JPM, Ainge G, Bowles JAK. The lack of effect of benzalkonium chloride on the cilia of the nasal mucosa in patients with perennial allergic rhinitis a combined functional, light scanning and transmission electron microscopy study. Clin. Exp. Allergy 1995 25 957-965.
Figure 8.1 illustrates a hypothetical scenario that volume authors Julie K.Johnson and Paul Barach have used to connect patient safety principles with clinical microsystems thinking. In this scenario the patient is Allison, a five-year-old preschooler with a history of wheezy colds. As we follow the scenario, it is clear that Allison and her mother interact with several microsystems as they navigate the health care system in an attempt to address Allison's illness the hypothetical community-based pediatric clinic (which we call Mercy Acute Care Clinic) and several overlapping microsystems within the university hospital. a history of wheezy colds. Child with history of wheezy colds
Case Study Planning Services for Subpopulations of Patients to Best Provide Care for Individual Patients
When a patient calls the office with a medical problem, a patient representative triages him or her using the Triage Coupler. This software program is driven by protocols that can handle a broad spectrum of problems, from the common cold to complex chest pain, and services, such as standardized protocols to help people prepare for overseas travel and providing prescription refills. If the patient needs to be seen, prompts suggest questions to ask and diagnostic tests that might be required before the patient comes to the office. Sometimes the patient can be provided with a standard treatment and does not need to make an office visit. This information system supports highly trained individuals, who do not have medical degrees, in safely and competently making direct decisions about clinical care at the point of contact with the patient. If a patient questions the advice being given, then an appointment can be booked.
Almost all of the organs of the human body can be infected by one or more of the spectrum of 14 microsporidian species described in the previous section. Many tissues and cell types are involved (Table 8.1). According to site of infection, clinical manifestations may be diarrhoea, weight loss, cholecystitis, cholangitis, bronchitis, bronchiolitis, pneumonitis, sinusitis, rhinitis, hepatitis, peritonitis, nephritis, ureteritis, cystitis, urethritis, prostatitis, keratoconjunctivitis, corneal ulcer, myositis or encephalitis. The pathology has been reviewed by Weber et al. (1994) and Schwartz et al. (1996). Cardiac disease and probable pancreatic, parathyroid and thyroid dysfunction have been reported for T. anthropophthera (Yachnis et al., 1996). Without treatment, the outcome is likely to be fatal for severely immunocompromised hosts infected with the disseminating species.
True orbital cellulitis (post-septal infection) presents with fever, systemic illness, periorbital swelling with proptosis, a red eye with chemosis and restricted eye movements (Figure 12.13). Optic neuropathy is present in more severe cases, being a sign of rising intraorbital pressure, and the onset of meningism or central neurological signs may herald the very serious complication of cavernous sinus thrombosis. In many cases there will be a history of antecedent upper respiratory tract infection or, in adults, a history of chronic sinus disease or dental infection. The most commonly identified bacteria are Staphylococcus aureus, Streptococcus species and, in children, also Haemophilus influenzae.
A 24-year-old man came for advice before trekking through India and Nepal. He had an IgA deficiency, and had been treated on and off until the age of 18 by a paediatrician with several experimental treatments. He had to be treated regularly for respiratory tract infections and had been plagued by chronic nasal congestion. As a child he had received the usual vaccinations without problems. He received diphtheria-tetanus and polio boosters, typhoid fever vaccine, hepatitis A vaccine, meningococcal A C vaccine and Haemophilus influenzae vaccine. Instructions were given on the use of standby treatment consisting of co-amoxiclav,
BPD, also known as neonatal chronic lung disease, is another important cause of respiratory illness in preterm newborns. BPD is usually defined by the requirement of oxygen at 36 weeks since the mother's last menstrual period and is characterized by small airway injury, dilated alveolar ducts, and decreased alveolarization. The incidence of BPD is directly related to birth weight, with rates of 7 percent in infants weighing 1,241 to 1,500 grams, 15 percent in infants weighing 1,001 to 1,240 grams, 34 percent in infants weighing 751 to 1,000 grams, and 52 percent in infants weighing 501 to 750 grams (Lemons et al., 2001).
A retrospective review of cases of high-altitude pulmonary edema suggested that children, but not adults, were more likely to have had an antecedent viral upper respiratory infection when they developed their altitude-related illness (Durmowicz et al., 1997). Details of the pathophysiology of this relationship are not known, but families of children with colds might need to be particu
Long-term stress may produce chronic immune dysfunction and the susceptibility to common cold and other upper respiratory viruses is increased in those with work 'burnout', job strain, unemployment and refugee status (Glaser et al., 2000 Sabioncello et al., 2000). These latter effects appear to involve the neuro-immuno-endocrine pathway.
Hydrocortisone treatment is taken t.d.s., with fludrocortisone in the morning and evening. Parents need clear instructions about what to do in case of illness. In the short term, any illness should lead the parents to seek medical advice, particularly if the infant is vomiting, or refusing feeds, and there should be open access to the hospital. Thereafter parents should be advised to double hydrocortisone if the child is slightly unwell (e.g. upper respiratory tract infection), and treble the dose if febrile. Parents must be given hydrocortisone intramuscular (IM) injection to take home at the time
Acute infection of the upper respiratory tract is a common but mainly benign disease. The most typical manifestation, 'the common cold', presents with coryza, irritation of the throat, lacrimation and mild constitutional upset. Local complications may occur with secondary bacterial infection and involvement of the paranasal sinuses and the middle ear. Infection may spread to the larynx, trachea and bronchi.
The classical form of histoplasmosis due to Histoplasma capsulatum presents a variety of clinical manifestations. Infection is mostly asymptomatic, being detected only on immunological tests. On first exposure there may be an acute benign respiratory illness, which tends to be self-limiting, healing with or without calcification. Progressive disseminated lesions may occur with widespread involvement of the reticulo-endothelial system without treatment this form may have a fatal outcome. The incubation period is from 1 to 21 weeks. H. duboisii, a variant confined to tropical Africa produces distinct clinical and pathological features. Little is known about its reservoir, mode of transmission or other epidemiological factors.
The first widely used dopaminergic agent used to treat prolactinomas was bromocriptine. Response rate is over 80-90 . PRL serum levels show a drop as early as 24 hours after starting therapy. In patients with macroadenomas, improvement in visual symptoms starts a few days to two weeks after therapy is initiated. Over 80 of patients will have a reduction in tumor size. The most common side effects are GI related (nausea and vomiting). Other side effects are orthostatic hypotension, nasal congestion, and occasionally, psychotic symptoms. Side effects can be minimized by starting with a lower dose at bedtime and gradually increasing it to BID dosing. If side effects persist, switch from oral to vaginal administration. Pro-lactin levels should be checked 4 weeks after starting therapy as well as 4 weeks after adjusting the dose. In amenorrheic patients who desire pregnancy, bromocriptine is the drug of choice due to its established fetal safety profile.
Type I reactions are IgE mediated and cause manifestations of allergic symptoms due to the release of immune mediators such as histamine or leukotrienes. These reactions typically occur within minutes of drug exposure and may manifest as generalized pruritus, urticaria, angioedema, anaphylaxis, rhinitis, or conjunctivitis (21). Anaphylaxis can result from exposure to any antigen (e.g., penicillin) and may be fatal in the absence of prompt medical intervention.
Depression is seen in all social classes, races, and ethnic groups. It is so pervasive that it has been called the common cold of mental illness in the popular press. It is approximately twice as common among women as it is among men. Depression is seen among all occupations, but it is most common among people in the arts and humanities. Famous individuals such as American president Abraham Lincoln and British prime minister Winston Churchill had to cope with depression Churchill called the affliction the black dog. More recently, United States senator Thomas Eagleton and astronaut Edwin Buzz Aldrin were known to have bouts of serious depression.
This process is exacerbated in the presence of concomitant diabetes or hypertension. Recurrent diseases may also aggravate renal dysfunction, such as recurrent glomerulosclerosis or glomerulonephritis in renal recipients, or glomerulonephritis and cryoglobulinemia in liver recipients with recurrent hepatitis C. Several medications compete with cyclosporine A and tacrolimus for cytochrome P450 metabolism, producing nephrotoxic levels of calcineurin inhibitors. Such medications include fluconazole, diltiazem, and verapamil. A common mistake is to administer erythromycin, often in combination with a nonsteroidal anti-inflammatory drug, to transplant recipients with upper respiratory tract infections both drugs increase calcineurin inhibitor nephrotoxicity. Drugs that increase cytochrome P450 metabolism, such as many anticonvulsants, can cause nep-hrotoxicity if they are discontinued abruptly. Management of calcineurin inhibitor nephrotoxicity may include dose reduction...