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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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Baby Cold Symptoms And How To Give Care
Baby Cold Symptoms and How to Give Care
Remember how miserable you felt when you last had a cold' Can you imagine what your baby .....
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?Baby Cold Symptoms and How to Give Care
Remember how miserable you felt when you last had a cold' Can you imagine what your baby .....
A. Lumbar puncture
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B. Head CT scan with contrast
Docs Giving Wrong Rx To Kids With Sore Throats?
For years, there has been concern that antibiotics are overprescribed, and with good cause. Despite clear guidelines calling for .....
For years, there has been concern that antibiotics are overprescribed, and with good cause. Despite clear guidelines calling for .....
C. Sinus CT scan
D. Blood cultures
E. Lateral neck radiograph
Answer: E. Lateral neck radiograph.
Chronic Fatigue System - How Does It Affect Sleep?
Chronic Fatigue System - How does it affect sleep'
Or to turn it around - How does improving your sleep lessen the symptoms of chronic .....
Chronic Fatigue System - How does it affect sleep'
Or to turn it around - How does improving your sleep lessen the symptoms of chronic .....
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.
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.
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.
How Indoor Humidity Levels Are Affecting Your Health
The ideal indoor humidity level is either 35% to 45% or 40% to 50% depending on who you ask. Thankfully, the human body is quite flexible and you do .....
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.The ideal indoor humidity level is either 35% to 45% or 40% to 50% depending on who you ask. Thankfully, the human body is quite flexible and you do .....
[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.
Smoking: Myths And Reality
According to some popular researches, vogues of the moment are founded on the conception that smoking and losing weight at the same time doesn’t .....
According to some popular researches, vogues of the moment are founded on the conception that smoking and losing weight at the same time doesn’t .....
SELECTED READINGS
Barratt GE, Koopman CF, Coulthard SW, Retropharyngeal abscess: a ten-year experience. Laryngoscope 1984; 94:455-463
Rowan Jelly (Mountain Ash - Pyrus Aucuparia)
Chong VF, Fan YF. Radiology of the retropharyngeal space. Clin Radiol 2000; 55:740-748Sharp and sour but sweet and succulent all at the same time, this traditional accompanyment to cold meat is bursting with .....
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
Steroids For A Sore Throat - Brief Article
In many ways, steroids are wonder drugs. They help with pain, swelling, and inflammation. They are the mainstay in treating many .....
Health LK, Pierce TH. Retropharyngeal abscess following endotracheal intubation. Chest 1977:72:776-777In many ways, steroids are wonder drugs. They help with pain, swelling, and inflammation. They are the mainstay in treating many .....
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.
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