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Suárez-Bustamante Huélamo M, Alonso-Cadenas JA, Guillén Lozada E, Retuerta Oliva A, Gaitero Tristán J, Leoz Gordillo I, de la Torre Espí M. Critical Stenosis Because of Vocal Cord Synechiae in a Child. J Pediatr Health Care 2024; 38:86-89. [PMID: 37598326 DOI: 10.1016/j.pedhc.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 08/21/2023]
Abstract
Stridor is a clinical sign of an underlying disease and a common reason for pediatric emergency department (PED) consultation. Patients presenting with stridor must be evaluated to determine the origin of this abnormality. We present the case of a 7-year-old female patient who presented to our Pediatric Emergency Department with a history of recurrent episodes of stridor with increasing frequency over the previous 4 years, for this reason she was previously admitted to the pediatric intensive care unit. Findings from the otorhinolaryngologic assessment with flexible fiber-optic endoscopy led to a diagnosis of congenital synechia of the vocal cords. The cervical CT scan evidenced critical stenosis of the airway. An initial cordectomy and placement of a silicone device for fixation were performed. Subsequently, the patient required 6 additional interventions for progressive dilation of the glottic space at the level of the vocal cords and injections of mitomycin C injections (an antineoplastic that inhibits collagen proliferation). This case highlights the importance of additional studies (especially examination of the upper airway) when atypical or recurrent findings are revealed by the clinical history, physical examination, or disease course in patients with croup to prioritize cases severe enough to require pediatric intensive care unit admission.
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Affiliation(s)
| | - Jose Antonio Alonso-Cadenas
- Pediatrician, Pediatric Emergency Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain; Pediatrician, Instituto de Investigación Sanitaria Hospital La Princesa (IiSHLPR), Hospital Universitario La Princesa, Madrid, Spain
| | - Enrique Guillén Lozada
- Otorhinolaryngologist, Othorhinolaryngolgy Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Azucena Retuerta Oliva
- Pediatrician, General Pediatrics Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Jara Gaitero Tristán
- Pediatrician, Pediatric Emergency Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain; Pediatrician, Pediatric Emergency Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain; Pediatrician, Instituto de Investigación Sanitaria Hospital La Princesa (IiSHLPR), Hospital Universitario La Princesa, Madrid, Spain
| | - Inés Leoz Gordillo
- Pediatrician, Pediatric Intensive Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Mercedes de la Torre Espí
- Pediatrician, Pediatric Emergency Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain; Pediatrician, Instituto de Investigación Sanitaria Hospital La Princesa (IiSHLPR), Hospital Universitario La Princesa, Madrid, Spain
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2
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Chen X, Xia Y, Shen S, Wang C, Zan R, Yu H, Yang S, Zheng X, Yang J, Suo T, Gu Y, Zhang X. Research on the Current Application Status of Magnesium Metal Stents in Human Luminal Cavities. J Funct Biomater 2023; 14:462. [PMID: 37754876 PMCID: PMC10532415 DOI: 10.3390/jfb14090462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 09/28/2023] Open
Abstract
The human body comprises various tubular structures that have essential functions in different bodily systems. These structures are responsible for transporting food, liquids, waste, and other substances throughout the body. However, factors such as inflammation, tumors, stones, infections, or the accumulation of substances can lead to the narrowing or blockage of these tubular structures, which can impair the normal function of the corresponding organs or tissues. To address luminal obstructions, stenting is a commonly used treatment. However, to minimize complications associated with the long-term implantation of permanent stents, there is an increasing demand for biodegradable stents (BDS). Magnesium (Mg) metal is an exceptional choice for creating BDS due to its degradability, good mechanical properties, and biocompatibility. Currently, the Magmaris® coronary stents and UNITY-BTM biliary stent have obtained Conformité Européene (CE) certification. Moreover, there are several other types of stents undergoing research and development as well as clinical trials. In this review, we discuss the required degradation cycle and the specific properties (anti-inflammatory effect, antibacterial effect, etc.) of BDS in different lumen areas based on the biocompatibility and degradability of currently available magnesium-based scaffolds. We also offer potential insights into the future development of BDS.
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Affiliation(s)
- Xiang Chen
- School of Medicine, Anhui University of Science and Technology, Huainan 232000, China;
| | - Yan Xia
- School of Stomatology, Anhui Medical College, Hefei 230601, China;
| | - Sheng Shen
- Department of Biliary Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China; (S.S.); (R.Z.); (T.S.)
- Shanghai Engineering Research Center of Biliary Tract Minimal Invasive Surgery and Materials, Shanghai 200032, China;
| | - Chunyan Wang
- Shanghai Engineering Research Center of Biliary Tract Minimal Invasive Surgery and Materials, Shanghai 200032, China;
- Department of General Surgery, Shanghai Xuhui Central Hospital, Shanghai 200031, China
| | - Rui Zan
- Department of Biliary Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China; (S.S.); (R.Z.); (T.S.)
- Shanghai Engineering Research Center of Biliary Tract Minimal Invasive Surgery and Materials, Shanghai 200032, China;
| | - Han Yu
- State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China; (H.Y.); (S.Y.)
| | - Shi Yang
- State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China; (H.Y.); (S.Y.)
| | - Xiaohong Zheng
- Department of Hepatopancreatobiliary Surgery, Huainan Xinhua Hospital Affiliated to Anhui University of Science and Technology, Huainan 232000, China; (X.Z.); (J.Y.)
| | - Jiankang Yang
- Department of Hepatopancreatobiliary Surgery, Huainan Xinhua Hospital Affiliated to Anhui University of Science and Technology, Huainan 232000, China; (X.Z.); (J.Y.)
| | - Tao Suo
- Department of Biliary Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China; (S.S.); (R.Z.); (T.S.)
- Shanghai Engineering Research Center of Biliary Tract Minimal Invasive Surgery and Materials, Shanghai 200032, China;
| | - Yaqi Gu
- School of Medicine, Anhui University of Science and Technology, Huainan 232000, China;
- Department of Hepatopancreatobiliary Surgery, Huainan Xinhua Hospital Affiliated to Anhui University of Science and Technology, Huainan 232000, China; (X.Z.); (J.Y.)
| | - Xiaonong Zhang
- State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China; (H.Y.); (S.Y.)
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3
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Alkaabi N, Aljahdali N, Algouhi A, Asiri M. Delayed Presentation of Thermal Epiglottitis in a Toddler: A Case Report. Cureus 2023; 15:e36555. [PMID: 37095791 PMCID: PMC10122076 DOI: 10.7759/cureus.36555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 04/26/2023] Open
Abstract
A minor insult to the pediatric airway can have a devastating result. Unfortunately, the signs and symptoms of obstruction might not be present immediately and take some time to develop. Therefore, physicians should have a higher index of suspicion for airway obstruction in children that present with a history of ingestion of scalding liquid. Signs and symptoms of infectious vs noninfectious epiglottis do overlap and the key to differentiate is by careful history and physical exam, especially in nonverbal children. A secondary bacterial infection might complicate thermal epiglottis and make the picture a bit confusing. Therefore, a coordinated approach through a multidisciplinary team is indicated from the start and these cases should be managed and referred to a higher center.
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Affiliation(s)
- Nouf Alkaabi
- Ministry of National Guards Health Affairs (MNGHA), King Abdulaziz Medical City Riyadh, Riyadh, SAU
- Pediatric Emergency Medicine, King Abdullah Specialist Children Hospital, Riyadh, SAU
| | - Nouf Aljahdali
- Ministry of National Guards Health Affairs (MNGHA), King Abdulaziz Medical City Riyadh, Riyadh, SAU
- Pediatric Emergency Medicine, King Abdullah Specialist Children Hospital, Riyadh, SAU
| | - Amani Algouhi
- Ministry of National Guards Health Affairs (MNGHA), King Abdulaziz Medical City Riyadh, Riyadh, SAU
- Otolaryngology, King Abdullah Specialist Children Hospital, Riyadh, SAU
| | - Mohammed Asiri
- Ministry of National Guards Health Affairs (MNGHA), King Abdulaziz Medical City Riyadh, Riyadh, SAU
- Otolaryngology, King Abdullah Specialist Children Hospital, Riyadh, SAU
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White JJ, Cambron JD, Gottlieb M, Long B. Evaluation and Management of Airway Foreign Bodies in the Emergency Department Setting. J Emerg Med 2023; 64:145-155. [PMID: 36806432 DOI: 10.1016/j.jemermed.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 11/03/2022] [Accepted: 12/13/2022] [Indexed: 02/19/2023]
Abstract
BACKGROUND Airway foreign body can be a life-threatening issue in pediatric and adult patients, and the majority of these patients will first present to the emergency department. OBJECTIVE This article provides a narrative review of the diagnosis and management of airway foreign bodies for the emergency clinician. DISCUSSION Foreign bodies in the upper and lower airways are potentially life threatening. This affects all age groups but is more common in pediatric patients. A history of a witnessed ingestion or aspiration event should raise the clinical suspicion for an aspirated foreign body. Patients with upper-airway foreign bodies are more likely to present in respiratory distress when compared with lower-airway foreign bodies, which often present with more subtle signs. Stridor, drooling, and wheezing suggest respiratory distress, but the presenting clinical picture is often unclear and may only include a cough. Immediate intervention is required in the patient with hemodynamic instability or respiratory distress. Airway management including laryngoscopy, fiberoptic bronchoscopy, and cricothyrotomy may be needed in these patients, with the emphasis on removing the obstructing foreign body and securing the airway. Specialist consultation can assist in retrieving the foreign body and managing the airway. If the patient is stable, imaging and specialist consultation for potential operating room intervention should be considered. CONCLUSIONS An understanding of the presentation, evaluation, and management of the patient with an airway foreign body is essential for emergency clinicians.
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Affiliation(s)
- Joshua J White
- Department of Emergency Medicine, Christus Spohn Shoreline, Corpus Christi, Texas
| | - John D Cambron
- Department of Emergency Medicine, Christus Spohn Shoreline, Corpus Christi, Texas
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas
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High risk and low prevalence diseases: Adult epiglottitis. Am J Emerg Med 2022; 57:14-20. [PMID: 35489220 DOI: 10.1016/j.ajem.2022.04.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 12/31/2022] Open
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Mayorathan U, Manikkavasakar S, Pranavan S. Accidental Choking in Children: An Area To Be Focused on. Cureus 2022; 14:e22459. [PMID: 35345707 PMCID: PMC8942174 DOI: 10.7759/cureus.22459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 11/05/2022] Open
Abstract
Choking is one of the important modes of death in young children who are dying of unintentional injuries. Anatomical and physiological characteristics while eating could increase the incidence of choking in children under four years. Here, we have described two classical cases of choking in young children and discussed the important areas to be addressed. Parental awareness and education will be the important strategy that can prevent the incidence of choking.
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7
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Iemura-Kashiwagi M, Kikuchi M, Okuyama H, Tanaka S. Surgical Management of Congenital Nasal Pyriform Aperture Stenosis: A Case Report. Cureus 2022; 14:e21761. [PMID: 35251832 PMCID: PMC8890608 DOI: 10.7759/cureus.21761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2022] [Indexed: 11/10/2022] Open
Abstract
Congenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of respiratory distress in newborns. This paper reports a case of severe CNPAS that required endotracheal intubation immediately after birth, and eventually, surgical intervention. At birth, the width of the pyriform aperture was only 4 mm, and the patient was completely unable to breathe through his nose. We performed tracheostomy at 23 days of age and waited for the patient to grow, but at 56 days of age, the width of the pyriform aperture was not sufficient (6 mm) for the patient to breathe through his nose. Therefore, surgical dilation of the pyriform aperture by a sublabial approach was performed on day 79 after birth, and the width was increased to 14 mm. Postoperative stent placement was performed for two weeks. After the removal of the stents, the patient could finally breathe through his nose, and the postoperative course was uneventful, with no restenosis after four months. CNPAS is a rare cause of nasal obstruction, but it can cause respiratory distress in infants because they are dependent on nasal breathing. Conservative treatments are initially recommended for CNPAS; however, in severe cases where conservative treatments are ineffective, surgical treatment is recommended.
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Allen DZ, Liu LX, Turner K, Greives MR, Nguyen PD, Roy S. Soft palatal mass containing heterotopic neural tissue causing airway obstruction in a Pierre-Robin sequence patient. J Surg Case Rep 2022; 2021:rjab510. [PMID: 34992764 PMCID: PMC8718372 DOI: 10.1093/jscr/rjab510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 10/20/2021] [Indexed: 11/14/2022] Open
Abstract
Pierre-Robin sequence (PRS) patients frequently exhibit symptoms of airway obstruction due to multiple etiologies, predominantly from glossoptosis and tongue base obstruction. Rarely, these patients can have palatal mass and even rarer is one of neural origin. To date, there are few reports of heterotopic neural tissue causing airway obstruction in literature, and there are only two reports related to PRS. The objective of this report is to detail a PRS patient with obstructive airway symptoms that resolved after removal of a right-sided soft palatal mass containing heterotopic neural tissue. A 5-month-old boy with a past medical history of cleft palate, PRS status-post-mandibular distraction osteogenesis was hospitalized after continuing respiratory distress. Imaging showed a cystic submucosal mass that arose from the right soft palate. Trans-palatal and trans-oral approaches were applied for the removal. The patient tolerated the procedure well and his obstructive events have resolved at follow-up.
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Affiliation(s)
- David Z Allen
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Lucy X Liu
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kelly Turner
- Department of Pediatric Plastic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Matthew R Greives
- Department of Pediatric Plastic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Phuong D Nguyen
- Department of Pediatric Plastic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Soham Roy
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
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Lee HK, Lim JG, Park JS, Shin SH, Kwon SK, Suh DI. An infant with subglottic cysts presenting as abruptly-progressed stridor and respiratory distress 2 months after extubation. ALLERGY ASTHMA & RESPIRATORY DISEASE 2022. [DOI: 10.4168/aard.2022.10.2.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Ha Kyung Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Gyu Lim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Soo Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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Behboudi F, Pouralizadeh M, Yeganeh MR, Roushan ZA. The effect of education using a mobile application on knowledge and decision of Iranian mothers about prevention of foreign body aspiration and to relieve choking in children: A quasi-experimental study. J Pediatr Nurs 2022; 62:e77-e83. [PMID: 34334255 DOI: 10.1016/j.pedn.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 07/07/2021] [Accepted: 07/10/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this study was to determine the effect of mobile-based education on mothers' knowledge and decisions about prevention of foreign body (FBA) aspiration and to relieve choking in preschool children. METHODS This is a quasi-experimental study in which 88 mothers whose children were registered in each selected kindergarten of the city of Rasht (in Iran) were selected by multi-stage cluster sampling. All mothers were educated through lectures. Then, in the control group, an educational booklet and CDs were used, and in the intervention group, a mobile application was used. Mothers' knowledge and decision were measured by a researcher-made questionnaire before and after the lecture and four weeks after providing the interventions. Mann-Whitney, Wilcoxon, and Friedman tests were used to analyze the data. The level of significance was p < 0.05. RESULTS The results showed that the mean scores of knowledge (n = 44, M = 13.47, SD = 1.84) and decision (n = 44, M = 8.52, SD = 1.30) of participants immediately and mean scores of knowledge (n = 44, M = 14.68, SD = 1.98) and decision of participants (n = 44, M = 9.56, SD = 2.15) four weeks after the educational interventions, in the intervention group, were statistically significantly higher than the control group. Intragroup comparison of the mean scores of knowledge and decision immediately and four weeks after educational interventions, showed that only in the intervention group did the mean scores have statistically significant increase, (p < 0.05). CONCLUSION Mobile-based education was more effective in improving mothers' knowledge and decision about prevention of foreign body aspiration and to relieve choking in children than other educational methods. PRACTICE IMPLICATIONS Mobile applications may be a new and effective method for providing education to parents.
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Affiliation(s)
- Faezeh Behboudi
- Medical Education Research Center, Education development Center, Guilan University of Medical Sciences, Rasht, Islamic Republic of Iran; Department of Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Islamic Republic of Iran
| | - Moluk Pouralizadeh
- Department of Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Islamic Republic of Iran.
| | - Mohammad Reza Yeganeh
- Department of Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Islamic Republic of Iran
| | - Zahra Atrkar Roushan
- Department of Biostatistics, Medical School, Guilan University of Medical Sciences, Rasht, Islamic Republic of Iran
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Debuigne M, Chesnel M. Life‐threatening pharyngeal oedema secondary to severe perianaesthetic regurgitation in a French bulldog: Management with topical adrenaline and nasotracheal tube. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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12
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Ali Akbari Ghavimi S, Gehret PM, Aronson MR, Schipani R, Smith KW, Borek RC, Germiller JA, Jacobs IN, Zur KB, Gottardi R. Drug delivery to the pediatric upper airway. Adv Drug Deliv Rev 2021; 174:168-189. [PMID: 33845038 DOI: 10.1016/j.addr.2021.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 03/22/2021] [Accepted: 04/06/2021] [Indexed: 11/25/2022]
Abstract
Pediatric upper airway disorders are frequently life-threatening and require precise assessment and intervention. Targeting these pathologies remains a challenge for clinicians due to the high complexity of pediatric upper airway anatomy and numerous potential etiologies; the most common treatments include systemic delivery of high dose steroids and antibiotics or complex and invasive surgeries. Furthermore, the majority of innovative airway management technologies are only designed and tested for adults, limiting their widespread implementation in the pediatric population. Here, we provide a comprehensive review of the most recent challenges of managing common pediatric upper airway disorders, describe the limitations of current clinical treatments, and elaborate on how to circumvent those limitations via local controlled drug delivery. Furthermore, we propose future advancements in the field of drug-eluting technologies to improve pediatric upper airway management outcomes.
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13
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Herpes simplex laryngitis: Comparison between pediatric and adult patients. Int J Pediatr Otorhinolaryngol 2021; 142:110596. [PMID: 33434698 DOI: 10.1016/j.ijporl.2020.110596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Infection with herpes simplex virus (HSV) typically causes limited oral and genital symptoms, however HSV can also affect the larynx and result in severe aerodigestive symptoms. Due to the rarity of HSV laryngitis, the symptoms and clinical course of are not well understood. This study aims to more completely characterize HSV laryngitis in order to aid clinicians in understanding and recognition of HSV laryngitis. METHODS Comprehensive literature search of MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews to identify articles relating to HSV laryngitis. Patient demographics, presenting signs and symptoms, treatment and clinical course were extracted from the selected manuscripts. RESULTS There were 31 studies on HSV laryngitis that identified 36 patients (17 pediatric, 19 adult). The average age for pediatric patients was 11 months (9 M, 8F) and 52 years for adults (11 M, 8F). In the pediatric population, stridor was more common at presentation in comparison to the adult population (p < .01). Adults more commonly presented with dysphagia (p = .03) and dysphonia (p < .01) Adult patients were significantly more likely to undergo tracheotomy than pediatric patients (p = .047). The mean length of inpatient hospital stay was 21.2 days in pediatric patients and 15.8 days for adult patients. CONCLUSION HSV laryngitis has a unique presentation in pediatrics and adults, but is nonspecific in both populations leading to delays in diagnosis and treatment. HSV laryngitis is associated with significant morbidity including multi-week hospital stay and risk for needing tracheostomy in both adults and pediatric population which demonstrates need for clinical awareness of this complication of HSV infection.
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Mitteroecker P, Stansfield E. A model of developmental canalization, applied to human cranial form. PLoS Comput Biol 2021; 17:e1008381. [PMID: 33591964 PMCID: PMC7909690 DOI: 10.1371/journal.pcbi.1008381] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 02/26/2021] [Accepted: 01/14/2021] [Indexed: 11/26/2022] Open
Abstract
Developmental mechanisms that canalize or compensate perturbations of organismal development (targeted or compensatory growth) are widely considered a prerequisite of individual health and the evolution of complex life, but little is known about the nature of these mechanisms. It is even unclear if and how a “target trajectory” of individual development is encoded in the organism’s genetic-developmental system or, instead, emerges as an epiphenomenon. Here we develop a statistical model of developmental canalization based on an extended autoregressive model. We show that under certain assumptions the strength of canalization and the amount of canalized variance in a population can be estimated, or at least approximated, from longitudinal phenotypic measurements, even if the target trajectories are unobserved. We extend this model to multivariate measures and discuss reifications of the ensuing parameter matrix. We apply these approaches to longitudinal geometric morphometric data on human postnatal craniofacial size and shape as well as to the size of the frontal sinuses. Craniofacial size showed strong developmental canalization during the first 5 years of life, leading to a 50% reduction of cross-sectional size variance, followed by a continual increase in variance during puberty. Frontal sinus size, by contrast, did not show any signs of canalization. Total variance of craniofacial shape decreased slightly until about 5 years of age and increased thereafter. However, different features of craniofacial shape showed very different developmental dynamics. Whereas the relative dimensions of the nasopharynx showed strong canalization and a reduction of variance throughout postnatal development, facial orientation continually increased in variance. Some of the signals of canalization may owe to independent variation in developmental timing of cranial components, but our results indicate evolved, partly mechanically induced mechanisms of canalization that ensure properly sized upper airways and facial dimensions. Developmental mechanisms that canalize or compensate perturbations of organismal development are a prerequisite of individual health and the evolution of complex life. However, surprisingly little is known about these mechanisms, partly because the “target trajectories” of individual development cannot be directly observed. Here we develop a statistical model of developmental canalization that allows one to estimate the strength of canalization and the amount of canalized variance in a population even if the target trajectories are unobserved. We applied these approaches to data on human postnatal craniofacial growth. Whereas overall craniofacial size was strongly canalized during the first 5 years of age, frontal sinus size did not show any signs of canalization. The relative dimensions of the nasopharynx showed strong canalization and a reduction of variance throughout postnatal development, whereas other shape features, such as facial orientation, continually increased in variance. Our results indicate evolved, partly mechanically induced mechanisms of canalization that ensure properly sized upper airways and facial dimensions.
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Affiliation(s)
- Philipp Mitteroecker
- Department of Evolutionary Biology, University of Vienna, Vienna, Austria
- * E-mail:
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15
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Cheng T, Farah J, Aldridge N, Tamir S, Donofrio‐Odmann JJ. Pediatric respiratory distress: California out-of-hospital protocols and evidence-based recommendations. J Am Coll Emerg Physicians Open 2020; 1:955-964. [PMID: 33145546 PMCID: PMC7593477 DOI: 10.1002/emp2.12103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/22/2020] [Accepted: 04/28/2020] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Prehospital protocols vary across local emergency medical service (EMS) agencies in California. We sought to develop evidence-based recommendations for the out-of-hospital evaluation and treatment of pediatric respiratory distress, and we evaluated the protocols for pediatric respiratory distress used by the 33 California local EMS agencies. METHODS Evidence-based recommendations were developed through an extensive literature review of the current evidence regarding out-of-hospital treatment of pediatric patients with respiratory distress. The authors compared the pediatric respiratory distress protocols of each of the 33 California local EMS agencies with the evidence-based recommendations. Our focus was on the treatment of 3 main pediatric respiratory complaints by presentation: stridor (croup), wheezing < 24 months (bronchiolitis), and wheezing > 24 months (asthma). RESULTS Protocols across the 33 California local EMS agencies varied widely. Stridor (croup) had the highest protocol variability of the 3 presentations we evaluated, with no treatment having uniform use among all agencies. Only 3 (9.1%) of the local EMS agencies differentiated wheezing in children < 24 months of age, referencing this as possible bronchiolitis. All local EMS agencies included albuterol and epinephrine (intravenous/intramuscular) in their pediatric wheezing (asthma) treatment protocols. The least common treatments for wheezing (asthma) included nebulized epinephrine (3/33) and magnesium (2/33). No agencies included steroids in their treatment protocols (0/33). CONCLUSION Protocols for pediatric respiratory distress vary widely across the state of California, especially among those for stridor (croup) and wheezing in < 24 months (bronchiolitis). The evidence-based recommendations that we present for the prehospital treatment of these conditions may be useful for EMS medical directors tasked with creating and revising these protocols.
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Affiliation(s)
- Tabitha Cheng
- Department of Emergency MedicineUniversity of California San Diego (UCSD)San DiegoCaliforniaUSA
| | - Jennifer Farah
- Department of Emergency MedicineUniversity of California San Diego (UCSD)San DiegoCaliforniaUSA
| | - Nicholas Aldridge
- Department of Emergency MedicineUniversity of California San Diego (UCSD)San DiegoCaliforniaUSA
| | - Sharon Tamir
- Department of PediatricsUCSDSan DiegoCaliforniaUSA
- Rady Children's Hospital of San DiegoSan DiegoCaliforniaUSA
| | - J. Joelle Donofrio‐Odmann
- Department of Emergency MedicineUniversity of California San Diego (UCSD)San DiegoCaliforniaUSA
- Department of PediatricsUCSDSan DiegoCaliforniaUSA
- Rady Children's Hospital of San DiegoSan DiegoCaliforniaUSA
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A rare cause of acute severe upper airway obstruction that required endotracheal intubation: adenoid hypertrophy. Turk Arch Pediatr 2020; 55:199-202. [PMID: 32684767 PMCID: PMC7344138 DOI: 10.14744/turkpediatriars.2018.89156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 11/08/2019] [Indexed: 11/26/2022]
Abstract
Adenoid hypertrophy is one of the common causes of upper airway obstruction in children. It usually presents with sleep-related breathing disorders and associated findings generally occur around the age of 4 years. However, the development of acute upper airway obstruction due to adenoid hypertrophy is extremely rare. Acute upper airway obstruction due to adenoid hypertrophy in a patient aged under 1 year is an extremely unexpected condition. The aim of this case report was to contribute to the literature by reporting the presence of adenoid hypertrophy causing severe acute airway obstruction leading to endotracheal intubation in a 7-month-old male patient.
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Wu X, Wu L, Chen Z. The Important Role of Endoscopy in Management of Pediatric Pseudomembranous Necrotizing Tracheitis. Front Pediatr 2020; 8:360. [PMID: 32733826 PMCID: PMC7363969 DOI: 10.3389/fped.2020.00360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 05/29/2020] [Indexed: 11/30/2022] Open
Abstract
Pseudomembranous necrotizing tracheitis is a rare, but life-threatening cause of central airway obstruction. Here, we reported three cases of pediatric pseudomembranous necrotizing tracheitis. The infectious etiologies were Staphylococcus aureus secondary to influenza A virus and Aspergillus fumigatus. Endoscopy was used in diagnosis and management of all patients and two patients survived. The improvement in mortality rate of these diseases need early recognition and prompt treatment with mechanical debridement by endoscope and early initiation of broad spectrum antibiotics. Endoscopy is a promising tool to diagnose and remove the pseudomembrane, therefore relieving central airway obstruction.
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Affiliation(s)
- Xiling Wu
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Lei Wu
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Zhimin Chen
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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Abstract
Stridor is a high-pitched respiratory sound that signals upper airway obstruction. It can be encountered by clinicians in a variety of clinical settings and requires a team-based, interdisciplinary approach. Early recognition is crucial, as the differential diagnosis can be broad, and causes range from benign to life-threatening. This article reviews the most commonly encountered causes of chronic congenital stridor in infants, focusing on the diagnostic approach, pathophysiology, clinical presentation, and management strategies.
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Ali S, Moodley A, Bhattacharjee A, Chang E, Kabaroff A, Lobay K, Allain D. Prehospital dexamethasone administration in children with croup: a medical record review. Open Access Emerg Med 2018; 10:141-147. [PMID: 30410413 PMCID: PMC6200067 DOI: 10.2147/oaem.s168728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objectives Croup is one of the most common childhood respiratory illnesses. Early dexamethasone administration in croup can improve patient outcomes. The objective of this study was to assess the clinical impact of prehospital administration of dexamethasone to children with croup. Methods A medical record review that included children between 6 months and 6 years, who were brought via emergency medical services (EMS) to the emergency department (ED) with a final diagnosis of croup, between January 2010 and December 2012, was conducted. Data were collected regarding prehospital management and ED management, length of stay (LOS), final disposition, and patient demographics. Results A total of 188 patients with an ED diagnosis of croup were enrolled, 35.1% (66/188) of whom received a prehospital diagnosis of croup. The mean age of the participants was 32.96±17.18 months and 10.6% (20/188) were given dexamethasone in the prehospital setting by EMS, while 30.3% (57/188) were given epinephrine nebulizations. Out of the 66 patients with a prehospital diagnosis of croup, 10.6% (7/66) were given dexamethasone by EMS. In ED, dexamethasone was administered to 88.3% (166/188) while 29.8% of participants (56/188) received epinephrine nebulizations. There was no significant difference in ED LOS between those who received prehospital dexamethasone (2.6±1.6 hours, n=18) and those who did not (3.3±2.7 hours, n=159) (P=0.514). The number of in-hospital epinephrine doses per patient was significantly influenced by the administration of prehospital dexamethasone (P=0.010). Conclusions Prehospital administration of dexamethasone results in less ED epinephrine use and may reflect dexamethasone's positive influence on the severity and short-term persistence of croup symptoms.
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Affiliation(s)
- Samina Ali
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada, .,Women and Children's Health Research Institute, Edmonton, AB, Canada,
| | - Aaron Moodley
- Department of Pediatrics, Faculty of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Eddie Chang
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Allison Kabaroff
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Kevin Lobay
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Dominic Allain
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
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Is Peripheral Oxygen Saturation a Reliable Predictor of Upper Airways Air-Flow Limitation? J Emerg Med 2018; 55:627-634. [PMID: 30170833 DOI: 10.1016/j.jemermed.2018.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 06/29/2018] [Accepted: 07/02/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Dyspnea secondary to acute upper airways airflow limitation (UAAFL) represents a clinical emergency that can be difficult to recognize without a suitable history; even when etiology is known, parameters to assess the severity are unclear and often improperly used. OBJECTIVES The aim of this study was to assess the role of peripheral oxygen saturation (SpO2) as a predictor of severity of upper airway obstruction. METHODS The authors propose an experimental model of upper airway obstruction by a progressive increase of UAAFL. Ten healthy volunteers randomly underwent ventilation for 6 min with different degrees of UAAFL. SpO2, heart rate, respiratory rate (RR), tidal volume, accessory respiratory muscle activation, and subjective dyspnea indexes were measured. RESULTS In this model, SpO2 was not reliable as the untimely gravity index of UAAFL. Respiratory rate, visual analogue scale (VAS), and Borg dyspnea scale were statistically correlated with UAAFL (p < 0.0001 for RR and p < 0.05 for VAS and Borg scale). No significant changes were observed on heart rate (p > 0.05) and tidal volume (p > 0.05); a RR ≤ 7 breaths/min; VAS and Borg scale showed statistically significant parameters changes (p < 0.05). CONCLUSIONS RR, VAS, and Borg dyspnea scales are sensitive parameters to detect and stage, easily and quickly, the gravity of an upper airways impairment, and should be used in emergency settings for an early diagnosis of a UAAFL. SpO2 is a poorer predictor of the degree of upper airways flow limitation.
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Abstract
Several conditions that manifest as stridor can mimic asthma. When there is an initial failure in therapy, other diagnoses should be considered. The absence of witnessed choking does not exclude an inhaled/ingested foreign body. http://ow.ly/bqRD30kJcgI.
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Affiliation(s)
- Marta Celmina
- Children's Clinical University Hospital, Riga, Latvia
- University of Latvia, Riga, Latvia
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Kens OV, Gnateyko OZ, Lukyanenko NS, Vishtak NV, Bergtravm VI. Analysis of molecular genetic study on the polymorphic C-159T locus of the CD14 gene in children with increased risk of recurrent episodes of acute obstructive bronchitis. CYTOL GENET+ 2017. [DOI: 10.3103/s0095452717050036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Schwermer M, Längler A, Fetz K, Ostermann T, Zuzak TJ. Anthroposophic medicine in the treatment of pediatric pseudocroup: A systematic review. Complement Ther Med 2017; 40:185-190. [PMID: 30219446 DOI: 10.1016/j.ctim.2017.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/21/2017] [Accepted: 09/01/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND In Europe only few integrative pediatric wards exists and there are two German hospitals focusing on anthroposophic medicine as part of complementary and alternative medicine (CAM). Whilst the most common pediatric diseases are treated here, pseudocroup patients make up a large group in these hospitals, receiving conventional as well as anthroposophic therapies. However, effectiveness of these therapy concepts mostly based on physicians' experiences but clinical studies are hitherto missing. METHODS A systematic literature search identifying therapy approaches for pseudocroup in children was conducted in general electronic databases (Cochrane Library, PubMed, OVID) and in CAM-specific databases (CAMbase, CAM-QUEST®, Anthromedics). Search results were screened for anthroposophic therapy options. In addition, anthroposophic guidebooks were handsearched for relevant information. RESULTS Among 157 articles fulfilling search criteria one retrospective study, and five experience reports describing anthroposophic treatments were identified. Several medications for the treatment of pseudocroup were mentioned such as Aconitum, Apis, Bryonia, Hepar sulfuris, Lavender, Pyrit, Sambucus and Spongia. During appropriate use no adverse effects were reported. CONCLUSION Anthroposophic medicine harbors a broad spectrum of remedies for the treatment of pseudocroup in children. In particular, Aconitum, Bryonia and Spongia are frequently recommended; however, clinical trials investigating the effectiveness are sparse. Therefore, development and validation of therapy strategies are required.
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Affiliation(s)
- Melanie Schwermer
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Gerhard-Kienle-Weg 4, 58313 Herdecke, Germany
| | - Alfred Längler
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Gerhard-Kienle-Weg 4, 58313 Herdecke, Germany; Professorship for Integrative Pediatrics, Institute for Integrative Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
| | - Katharina Fetz
- Department of Psychology, Chair of Research Methodology and Statistics in Psychology, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
| | - Thomas Ostermann
- Department of Psychology, Chair of Research Methodology and Statistics in Psychology, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
| | - Tycho Jan Zuzak
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Gerhard-Kienle-Weg 4, 58313 Herdecke, Germany; Department of Pediatric Oncology and Hematology, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany.
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Abstract
INTRODUCTION Emergency Departments are inundated by patients with respiratory illness during the winter months. Emergency physicians are required to quickly identify critically ill patients among the large volume of patients with mild upper respiratory illness. Among these life-threatening conditions is acute epiglottitis. CASE PRESENTATION We report a rare series of four adult patients who presented to our Emergency Department during a period of only one week in April 2015 and were ultimately diagnosed with acute epiglottitis. Three of the patients improved with conservative measures and were observed in the intensive care unit. One patient required an emergent tracheostomy. DISCUSSION This series of patients is unique in that all four patients presented to a single Emergency Department within a few days of each other and, despite a myriad of presenting chief complaints, the patients were eventually found to have the same potentially life-threatening diagnosis.These cases reinforce the variability of presenting symptoms and physical examination findings that can occur in patients with epiglottitis. They also highlight clinical findings and adjunctive testing that can help identify patients who would most benefit from intervention.
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Affiliation(s)
- Benjamin Lindquist
- Former Emergency Medicine Resident in the Stanford/Kaiser Emergency Medicine Residency Program in Stanford, CA.
| | - Sybil Zachariah
- Emergency Medicine Resident in the Stanford/Kaiser Emergency Medicine Residency Program in Stanford, CA.
| | - Anita Kulkarni
- Emergency Physician at the Santa Clara Medical Center in CA.
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The introduction of emergency cricothyroidotomy simulation training in Zimbabwe contributed to the saving of two lives. The Journal of Laryngology & Otology 2016; 130:923-927. [PMID: 27608941 DOI: 10.1017/s0022215116008719] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In developing countries with limited access to ENT services, performing emergency cricothyroidotomy in patients with upper airway obstruction may be a life-saving last resort. An established Danish-Zimbabwean collaboration of otorhinolaryngologists enrolled Zimbabwean doctors into a video-guided simulation training programme on emergency cricothyroidotomy. This paper presents the positive effect of this training, illustrated by two case reports. CASE REPORTS A 56-year-old female presented with upper airway obstruction due to a rapidly progressing infectious swelling of the head and neck progressing to cardiac arrest. Cardiopulmonary resuscitation was initiated and a secure surgical airway was established via an emergency cricothyroidotomy, saving the patient. A 70-year-old male presented with upper airway obstruction secondary to intubation for an elective procedure. When extubated, the patient exhibited severe stridor followed by respiratory arrest. Re-intubation attempts were unsuccessful and emergency cricothyroidotomy was performed to secure the airway, preserving the life of the patient. CONCLUSION Emergency cricothyroidotomy training should be considered for all surgeons, anaesthetists and, eventually, emergency and recovery room personnel in developing countries. A video-guided simulation training programme on emergency cricothyroidotomy in Zimbabwe proved its value in this regard.
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Bush A, Kabra SK. Editorial: Advances in Pediatric Pulmonology. Indian J Pediatr 2015; 82:715-6. [PMID: 26088548 DOI: 10.1007/s12098-015-1799-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 05/19/2015] [Indexed: 11/24/2022]
Affiliation(s)
- Andrew Bush
- Department of Pediatrics, Imperial College, London, UK; Department of Pediatric Respiratory Medicine, National Heart and Lung Institute, London, UK and Department of Pediatric Respiratory Medicine, Royal Brompton & Harefield NHS Foundation Trust, London, UK
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