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Cough fracture

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201. Gastrointestinal Complications (PDQ®): Health Professional Version

anesthesia and pudendal blocks. Diet Inadequate fluid intake.* Altered bowel habits Repeatedly ignoring defecation reflex. Excessive use of laxatives and/or enemas. Prolonged immobility* and/or inadequate exercise Spinal cord injury or compression, fractures, fatigue, weakness, or inactivity (including bedrest). Intolerance with respiratory or cardiac problems. Bowel disorders Irritable colon, diverticulitis, or tumor.* Neuromuscular disorders (disruption of innervation leads to atony of the bowel (...) abdominal distention occurs, movement of the diaphragm is compromised, leading to insufficient aeration with subsequent hypoxia and left ventricular dysfunction. Hypoxia can, in turn, precipitate angina or tachycardia. If the vasovagal response is stimulated by the pressure of impaction, the patient may become dizzy and hypotensive. Movement of stool around the impaction may result in diarrhea, which can be explosive. Coughing or activities that increase intra-abdominal pressure may cause leakage

2018 PDQ - NCI's Comprehensive Cancer Database

202. Management of lung cancer

receptive at this time to consider cessation. Without additional treatment support, 95% of those who try to give up smoking will be smoking again within six months. 19 Effective pharmacological therapies and behavioural approaches exist to help smokers quit, ranging from brief opportunistic interventions to more intense programmes provided by local specialist cessation services. 6 Cancer patients, and particularly those with lung cancer, can suffer from weight loss, anorexia, breathlessness, and cough

2014 SIGN

203. Back pain - low (without radiculopathy): Red flag symptoms and signs

fracture. Red flags include: Sudden onset of severe central spinal pain which is relieved by lying down. A history of major trauma (such as a road traffic collision or fall from a height), minor trauma, or even just strenuous lifting in people with osteoporosis or those who use corticosteroids. Structural deformity of the spine (such as a step from one vertebra to an adjacent vertebra) may be present. There may be point tenderness over a vertebral body. Cancer. Red flags include: The person being 50 (...) years of age or more. Gradual onset of symptoms. Severe unremitting pain that remains when the person is supine, aching night pain that prevents or disturbs sleep, pain aggravated by straining (for example, at stool, or when coughing or sneezing), and thoracic pain. Localised spinal tenderness. No symptomatic improvement after four to six weeks of conservative low back pain therapy. Unexplained weight loss. Past history of cancer — breast, lung, gastrointestinal, prostate, renal, and thyroid cancers

2018 NICE Clinical Knowledge Summaries

204. Sciatica (lumbar radiculopathy): Red flag symptoms and signs

fracture. Red flags include: Sudden onset of severe central spinal pain which is relieved by lying down. There may be a history of major trauma (such as a road traffic collision or fall from a height), minor trauma, or even just strenuous lifting in people with osteoporosis or those who use corticosteroids. Structural deformity of the spine (such as a step from one vertebra to an adjacent vertebra) may be present. There may be point tenderness over a vertebral body. Cancer. Red flags include (...) : The person being 50 years of age or more. Gradual onset of symptoms. Severe unremitting pain that remains when the person is supine, aching night pain that prevents or disturbs sleep, pain aggravated by straining (for example, at stool, or when coughing or sneezing), and thoracic pain. Localised spinal tenderness. No symptomatic improvement after four to six weeks of conservative low back pain therapy. Unexplained weight loss. Past history of cancer — breast, lung, gastrointestinal, prostate, renal

2018 NICE Clinical Knowledge Summaries

205. Neck lump: History

. Unexplained fever. Weight loss. Generalized itching. Breathlessness. Unexplained bruising or bleeding. Unexplained persistent or recurrent infections. Bone pain (particularly back pain), unexplained fracture. Alcohol-induced lymph node pain. Generalized lymphadenopathy. Hepatosplenomegaly. Consider other features in the history suggesting a specific cause: The person's age — have a higher index of suspicion for malignancy if the person is 40 years of age or older. Symptoms indicative of an upper (...) respiratory tract infection causing lymphadenopathy — fever, cough, and sore throat. Other local potential causes of lymphadenopathy — for example earache, toothache, headlice. Recent travel, insect bites, or exposure to pets or other animals — suggestive of an inflammatory or infectious cause of neck lump. Smoking, heavy alcohol use, or previous radiation to the neck — increase the risk of malignancy. Trauma — may indicate haematoma, or if time has elapsed since the traumatic incident, fibrosis

2018 NICE Clinical Knowledge Summaries

206. Nasojejunal (NJ) and orojejunal (OJ) management

obstruction oesophageal atresia/stenosis significant upper GI bleeding oesophageal varicies recent fundoplication extensive short gut Consideration for orojejunal rather than nasojejunal tube: basal skull fracture maxillo facial abnormalities nasopharyngeal abnormalities The decision to place the tube in the duodenum (the first section of the small bowel) or the jejunum (the second section of the small bowel) depends on the clinical condition of the child ( ). Jejunal feeding may be initiated in any age (...) to Distance A has been inserted. Never advance the tube against resistance, to avoid the risk of perforation. If the child shows signs of breathlessness or severe coughing, remove the tube immediately as the tube may have been passed into the trachea. Lightly secure the tube with tape, or have an assistant hold the tube in place until the position has been checked. Initial testing to ensure the NJ tube has reached the stomach At this point the position must be checked using the for NGT placement checks

2015 Publication 1593

207. CRACKCast E044 – Neck Trauma

trauma. Usually the distal cervical segment ***important to find esophageal injuries early: Spillage of orogastric contents into mediastinum = potential severe inflammation and infection very often a missed injury – with a 20% mortality rate There are NO pathognomonic signs of esophageal injury: Soft signs: Hematemesis / blood in saliva/NGT Odynophagia / dysphagia Subcutaneous Emphysema Dyspnea / hoarseness / stridor / cough Pain / neck tenderness / resistance to neck movement ***physical exam (...) (think Cspine injury!) Fractures of the cricoid cartilage can lead to DEATH due to complete airway obstruction Children do not have a calcified larynx – so it will not be seen on plain film: The degree of airway obstruction after blunt trauma is inversely related to the degree of cartilage calcification – children are at highest risk!! Clinical signs: Bubbling of any neck wound Massive subcutaneous Air Bony crepitus Clothesline mechanism of injury Soft signs: Dysphonia / aphonia / dyspnea / stridor

2016 CandiEM

208. Clinical practice guidelines for the treatment of lung cancer

Practice point(s) The study on which the above recommendation is based prescribed whole brain radiotherapy for all patients. However is no longer recommended following surgical resection or radiosurgery for brain metastases. Last reviewed December 2015 Recommendation Grade Patients who have pain from bony metastases (not at risk of pathological fracture) should be offered palliative radiotherapy. Last reviewed December 2015 A A single fraction of 8Gy is recommended if the clinical endpoint is pain (...) relief. Last reviewed December 2015 A Patients who have had orthopaedic fixation of a pathological fracture may be considered for adjuvant radiotherapy. Last reviewed December 2015 C Practice point(s) Patients at risk of pathological fracture should be referred for prophylactic fixation prior to radiotherapy. The Mirel score is a useful tool in assessing this but patient factors should also be taken into account. Last reviewed December 2015 Recommendation Grade Patients who have spinal cord

2016 MHRA Drug Safety Update

209. By Any Other Name

By Any Other Name By Any Other Name – Clinical Correlations Search By Any Other Name May 4, 2016 5 min read By Kathy May Tran Peer Reviewed Six weeks ago, Mr. S had fever, chills, cough, and rhinorrhea, which ultimately self-resolved. Two weeks later, he noticed right-sided neck pain that radiated towards his ear. When the pain progressively worsened, he presented to the emergency department. On physical exam, Mr. S was febrile to 100.5°F, tachycardic, diaphoretic, and in obvious pain. His (...) cyanotic heart disease due to ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy, and aortic dextroposition rather than using the eponym “tetralogy of Fallot.” It is unwieldy to discuss a dorsally displaced, angulated extra-articular distal radius fracture rather than using the eponym “Colles’ fracture.” Eponyms simplify verbose phraseology by creating a distinctive, unique name to set apart clinical terms in the vast sea of information that is medical knowledge. Eponyms add

2016 Clinical Correlations

210. Persistent Pain with Breastfeeding

and gestational age at birth B Birth weight, weight gain, and general health B Behavior at the breast (pulling, squirming, biting, coughing, shortness of breath, excessive sleepiness) B Fussiness B Gastrointestinal problems (re?ux symptoms, bloody stools, mucous stools) B Medical conditions/syndromes B Previous diagnosis of ankyloglossia; frenotomy B Medications Examination should include the following: Mother B General appearance (pale [anemia], exhaustion) B Assessment of nipples (skin integrity (...) clavicle fractures, torticollis, head/neck or facial trauma, mandibular asymmetry, 16 oral defensiveness or aversion (e.g., infantsforce-fedwithridgednipples[teats]),tonicbite re?ex, nasal congestion, a response to an overactive milk ejection re?ex, and teething. (III) 2. Breast pump trauma/misuse Because of the widespread use of breast pumps in many countries and the variability of consumer edu- cation, literacy, and support, there is signi?cant po- tential for harm from breast pump use. In a survey

2016 Academy of Breastfeeding Medicine

213. Thoracic Trauma, Blunt, Pain Management of

the use of intercostal nerve blocks for blunt thoracic trauma. Truitt et al. [15] examined 102 patients who were treated with intercostal nerve block catheters for three or more rib fractures. Postblock pain scores were significantly lower with coughing, and maximal sustained inspiration was statistically significantly higher postblock. When compared with 75 matched historical control patients who received epidural analgesia, mean hospital length of stay was reduced significantly (2.9 days (...) with significant morbidity. [1–3] In particular, rib fractures occur in up to 10% of hospitalized trauma patients and may be associated with a mortality of 3% to 13%. [1][4][5] Injuries caused by blunt thoracic trauma are frequently associated with pulmonary complications such as pneumonia and severe pain, prolonging both hospital and intensive care unit (ICU) stay and significantly increasing healthcare costs, especially in elderly patients. [6][7] Pain is acknowledged as a contributing element for much

2016 Eastern Association for the Surgery of Trauma

215. Chylothorax Treatment Planning

chylothorax complicates up to 4% of esophageal resections [1,2,4-7]. Lung cancer resections, cardiovascular surgeries, and ACR Appropriateness Criteria ® 6 Chylothorax Treatment Planning spinal surgeries can also be complicated by chylothorax, although at a lesser rate. Noniatrogenic causes of traumatic chylothorax include penetrating trauma, fracture-dislocation of the spine, and hyperflexion injuries [1,6,7]. Generally, the causative etiology is known in the traumatic setting. Sampling the pleural (...) . Approximately 9% of all chylous effusions are idiopathic [1,2,6,7]. Imaging a patient with either a nontraumatic chylothorax or a chylothorax of unknown etiology serves to narrow the differential diagnosis, further characterize the underlying cause and its severity, and assist in treatment planning. Most patients with nontraumatic chylothoraces or chylothoraces of unknown etiologies present with acute respiratory illness (ARI), which consists of 1 or more of the following: cough, sputum production, chest

2016 American College of Radiology

216. Corticosteroid treatment of duchenne muscular dystrophy

<28% or LVEF <45%) by 18 years of age (several Class III studies). What are the side effects of corticosteroid treatment? Two Class II studies , and 22 Class III studies , , , , , , , , , , , , , , , addressed this question, comparing corticosteroid side effects with those of no treatment or placebo. See table e-5 for the adverse events (AEs) seen in 2 Class II studies. Conclusions. In patients with DMD, corticosteroids probably have the AEs of short stature, behavioral changes, fractures (...) JM , Pestronk A , et al . Long-term benefit from prednisone therapy in Duchenne muscular dystrophy . 25. Daftary AS , Crisanti M , Kalra M , Wong B , Amin R . Effect of long-term steroids on cough efficiency and respiratory muscle strength in patients with Duchenne muscular dystrophy . 26. Henricson EK , Abresch RT , Cnaan A , et al ; CINRG Investigators . The Cooperative International Neuromuscular Research Group Duchenne Natural History Study: glucocorticoid treatment preserves clinically

2016 American Academy of Neurology

217. British Association of Dermatologists' guidelines for the safe and effective prescribing of methotrexate for skin disease

discussing with gastroenterologist New or increasing dyspnoea or dry cough Withhold/decrease dose of MTX; repeat chest X-ray and pulmonary function tests and discuss with respiratory team Severe sore throat, abnormal bruising Withhold MTX; check FBC immediately WBC, white blood cells; MTX, methotrexate; MCV, mean corpuscular volume; AST, aspartate aminotransferase; ALT, alanine transaminase; LFT, liver function test; FBC, full blood count. © 2016 British Association of Dermatologists British Journal (...) with consistently normal PIIINP values. 119 In a similar study comparing serial PIIINP measure- ments and liver histology in 70 patients with psoriasis moni- tored for up to 11 years, normal serial PIIINP measurement was associated with an absence of liver ?brosis; in all four patients in whom ?brosis was detected on liver histology, serial PIIINP values had been abnormal. 118 PIIINP may be raised as a result of active bone remodelling following orthopaedic surgery, skeletal fractures, erosive psori- atic

2016 British Association of Dermatologists

218. Chronic Obstructive Pulmonary Disease: Screening

on postbronchodilator spirometry, which detects fixed airway obstruction; a forced expiratory volume in 1 second to forced vital capacity (FEV 1 /FVC) ratio of less than 0.70 is the current criterion for a positive COPD diagnosis. Persons with COPD often, but not always, have symptoms such as dyspnea (difficulty breathing or shortness of breath), chronic cough, and chronic sputum production. Patients often have a history of exposure to risk factors such as cigarette smoke or heating fuels or occupational exposure (...) such as chronic cough, sputum production, dyspnea, or wheezing. It also does not apply to persons with a family history of α 1 -antitrypsin deficiency. Risk Assessment Exposure to cigarette smoke or toxic fumes increases the risk for COPD. Epidemiological studies have found that 15% to 50% of smokers develop COPD. More than 70% of all COPD cases occur in current or former smokers. Occupational exposure to toxins, dusts, or industrial chemicals contributes an estimated 15% of all COPD cases. Environmental

2016 U.S. Preventive Services Task Force

219. Suction

parameters. Poor cough and inability to effectively clear secretions independently It is also important that other causes of respiratory distress and possibly an alteration in blood gases that do not require suction are considered; for example a pneumothorax, fluid overload or a misplaced artificial airway ( ). Contraindications Suctioning should not be carried out if any of the contraindications are present, unless assessed on an individual basis and with the agreement of the medical team. Unexplained (...) haemoptysis or deranged clotting Laryngospasm (stridor) Bronchospasm Basal skull fractures and other causes of Cerebrospinal fluid (CSF) leakage (for nasal suction only) Recent oesophageal or tracheal anastomosis Occluded nasal passages Unexplained nasal bleeding Severe hypoxaemia/hypoxia Raised Intracranial pressure (ICP) Cardiovascular system instability (Association of Paediatric Chartered Physiotherapists (APCP) 2015) Preparation Perform hand hygiene ( ). Ensure the patient, and the family

2014 Publication 1593

220. Nasopharyngeal airway (NPA)

is to be sized correctly in patients: if the airway is too short it will fail to separate the soft palate from the pharynx and if too long it can pass into the larynx and aggravate cough and gag reflexes ( ). The NPA primarily acts as a 'splint' which maintains patency of the airway, or keeps the tongue from falling back on the posterior pharyngeal wall and occluding the airway, therefore preventing airway obstruction, hypoxia and asphyxia ( ). NPAs are generally well tolerated by conscious children (...) with symptoms of upper airway obstruction, feeding difficulties and failure to thrive. Post-craniofacial mid-facial advancement surgery This surgery is carried out to advance the facial skeleton and involves multiple facial fractures and post-operative oedema ( ). The NPA is sutured in place and supports the airway and acts as a barrier between the nasal mucosa and dura of skull base – which may prevent nasal bacteria infiltrating the dura. Do not attempt to reinsert the NPA in this group of children

2014 Publication 1593

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