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Remedy Your Sore Throat - Help & Advice
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Sore throat, dysphagia, stiffness in back of neck, and dyspnea following tricyclic antidepressant ov
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Antibiotic Prescribing In Children With Sore Throat
Group A beta-hemolytic streptococci (GABHS) are found in 15 to 36 percent of children presenting with sore throat. Numerous .....
A 40-year-old woman is recovering from a tricyclic antidepressant overdose and is about to be transferred out of the ICU. She complains of sore throat, dysphagia, stiffness in back of the neck, and dyspnea. Even though she required endotracheal intubation and mechanical ventilation during treatment and the intubation had been difficult, she was successfully extubated 48 h before without any respiratory complaints. Temperature is 39[degrees]C, BP is 150/88 mm Hg, pulse rate is 98 beats/min, and respirations are 22 breaths/min. With the exception of bilateral coarse breath sounds and neck stiffness, the rest of the physical examination is unremarkable. Kernig and Brudzinski signs are absent. Which of the following studies should be done next?Group A beta-hemolytic streptococci (GABHS) are found in 15 to 36 percent of children presenting with sore throat. Numerous .....
A. Lumbar puncture
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B. Head CT scan with contrast
C. Sinus CT scan
Bad Breath In Throat
Most bad breath, or halitosis, originates in the mouth, specifically at the back of the tongue - if you sense bad breath in .....
Most bad breath, or halitosis, originates in the mouth, specifically at the back of the tongue - if you sense bad breath in .....
D. Blood cultures
E. Lateral neck radiograph
Answer: E. Lateral neck radiograph.
Because the patient has a retropharyngeal abscess secondary to trauma during endotracheal intubation, a lateral neck radiograph should be done next. While lower cuts of sinus and head CT scans might fortuitously pick up the abnormality, the lateral neck radiograph is most likely to lead to the correct diagnosis. Clues to this diagnosis were the history of a difficult intubation, dysphagia, dyspnea, fever, and neck stiffness. While fever and neck stiffness also suggest the possibility of meningitis, it is the dysphagia and dyspnea and negative Kernig and Brudzinski signs that should focus the clinician's attention on the upper airway.
Sore Throat, Dysphagia, Stiffness In Back Of Neck, And Dyspnea Following Tricyclic Antidepressant Ov
A 40-year-old woman is recovering from a tricyclic antidepressant overdose and is about to be transferred out of the ICU. .....
Kernig sign is assessed as follows: with the patient supine, the hip is flexed to 90[degrees] while the knee is flexed at approximately 90[degrees]; then, with the hip kept in flexion, the knee is extended. If this produces pain in the hamstrings and resistance to further extension, the sign is positive and consistent with meningeal irritation, herniated disk, or tumors of the cauda equina. Brudzinksi sign is assessed as follows: with the patient supine and the chest held firmly to the bed, attempts are made to passively flex the neck. With meningeal irritation, this maneuver causes involuntary flexion of the hips.A 40-year-old woman is recovering from a tricyclic antidepressant overdose and is about to be transferred out of the ICU. .....
None of the other choices listed will lead to the correct diagnosis. While blood cultures will not be helpful in diagnosing a retropharyngeal abscess, they may help modify the initial, empiric antibiotic treatment regimen if they become positive.
The lateral neck radiograph (Fig 1) showed marked swelling of the prevertebral soft tissues extending from the base of the skull to the base of the neck, with bulging and anterior displacement of the airway. There is mild reversal of the normal lordosis of the cervical spine secondary to muscle spasm. Normally, the prevertebral soft tissues should extend no more than 7 mm in all age groups at the C2 (retropharyngeal) level and < 14 mm in children or 22 into in adults at the C6 (retrotracheal) level. While our patient had an abscess, the differential diagnosis of retropharyngeal swelling also includes tumor (eg, thyroid, lymphoma), hematoma, edema secondary to a cervical spine fracture, or tendonitis of the prevertebral muscles.
Aromatherapy : A Scent Away For Great Relationships
Is it possible that a scent can make you more mellow and increase dramatically the relation with you and your mate' Can you calm the .....
[FIGURE 1 OMITTED]
Although fungi and mycobacteria have been occasionally recovered from retropharyngeal abscesses, the bacteria that normally comprise the oral flora are chiefly responsible for deep cervical infections. They become pathogenic when mucosal barriers are interrupted. These infections are usually due to a mixture of anaerobic and aerobic organisms (eg, approximately 88% are polymicrobial), with anaerobes predominating in a ratio of 3:1 to 6:1. Because our patient has been hospitalized and intubated and sustained trauma, facultative Gram-negative bacilli and Staphylococcus aureus will also need to be initially covered by the empiric antibiotic regimen. The antibiotic regimen can be narrowed once Gram stain and cultures from surgical drainage are performed. Although conventional teaching has been that surgical drainage is almost never avoidable with infections involving the retropharyngeal space, this practice has not been based on controlled clinical trials.
SELECTED READINGS
Bad Breath Because Of Tonsils
Bad breath because of tonsils is a different condition from bad breath caused by bacteria living on the tongue and breaking down cells and .....
Barratt GE, Koopman CF, Coulthard SW, Retropharyngeal abscess: a ten-year experience. Laryngoscope 1984; 94:455-463Bad breath because of tonsils is a different condition from bad breath caused by bacteria living on the tongue and breaking down cells and .....
Chong VF, Fan YF. Radiology of the retropharyngeal space. Clin Radiol 2000; 55:740-748
Haug RH, Wible RT, Lieberman J. Measurement standards for the prevertebral region in the lateral soft-tissue radiograph of the neck. J Oral Maxillofacial Surg 1991; 49:1149-1151
Health LK, Pierce TH. Retropharyngeal abscess following endotracheal intubation. Chest 1977:72:776-777
Smoking: Myths And Reality
According to some popular researches, vogues of the moment are founded on the conception that smoking and losing weight at .....
According to some popular researches, vogues of the moment are founded on the conception that smoking and losing weight at .....
Tannebaum RD. Adult retropharyngeal abscess: a case report and review of the literature. J Emerg Med 1996:14:147-158
* From the ACCP-SEEK program, reprinted with permission. Items are selected by Department Editors Richard S. Irwin, MD, FCCP, and John G. Weg, MD, FCCP. For additional information about the ACCP-SEEK program, phone 1-847-498-1400.
Sore Throats Can Be A Real Pain
In the midst of cold and flu season, sore throats can be a real pain in the butt. There are so many sore throat remedies on the market, .....
In the midst of cold and flu season, sore throats can be a real pain in the butt. There are so many sore throat remedies on the market, .....
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