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Esophageal Rupture

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203. Immune Modulating Therapies in Pregnancy and Lactation

treatment during pregnancy may increase the risk of hypertension, preeclampsia, weight gain, hyperglycemia, immunosuppression, gastrointestinal ulceration, prelabor rupture of membranes (also referred to as premature rupture of membranes), and intrauterine growth restriction, but if these risks exist the magnitude is not known ( ). Early data suggested that first trimester exposure to glucocorticoids may be associated with an increased risk of fetal oral clefts ( ), but more recent data have failed (...) in an increase in circulating T regulatory cells and a restored capacity to inhibit cytokine production ( ). With the exception of certolizumab, all TNF-α inhibitors are transferred across the placenta. Placental transfer of certolizumab does not occur because it lacks an Fc portion required for active transport. Initial reports of an association between TNF-α inhibitors and fetal VACTERL (Vertebral anomalies, Anal atresia, Cardiac defects, Tracheoesophageal fistula, Esophageal atresia, Renal anomalies

2019 American College of Obstetricians and Gynecologists

204. CRACKCast E199 – Adult Resuscitation

Tension pneumothorax Pulmonary embolus Abdomen Distended and dull Ruptured abdominal aortic aneurysm or ruptured ectopic pregnancy Distended, tympanitic Esophageal intubation Gastric insufflation Rectal Blood, melena GI Bleed Extremities Asymmetrical pulses Aortic dissection Arteriovenous shunt or fistula Hyperkalemia (think Renal Failure Pt) Skin Needle tracks Intravenous drug abuse Burns Smoke inhalation Electrocution [2] Discuss the process of deterioration to cardiac arrest with respiratory (...) Tension pneumothorax Cardiac tamponade Pulmonary embolus Tracheal deviation Tension pneumothorax Chest Median sternotomy scar Underlying cardiac disease Lungs Unilateral breath sounds Tension pneumothorax Right mainstem intubation Aspiration Distant or no breath sounds or no chest expansion Esophageal intubation Airway obstruction Severe bronchospasm Wheezing Aspiration Bronchospasm Pulmonary edema Rales Aspiration Pulmonary edema Pneumonia Heart Diminished heart tones Hypovolemia Cardiac tamponade

2019 CandiEM

205. Spontaneous rupture of middle thoracic esophagus: thoracoscopic treatment. (Abstract)

Spontaneous rupture of middle thoracic esophagus: thoracoscopic treatment. Spontaneous rupture of the esophagus (so-called Boerhaave's syndrome) is considered a medical emergency. It carries a significant mortality rate and requires prompt treatment. The treatment of choice involves surgical repair of the esophageal defect, usually accomplished via laparotomy, thoracotomy, or both to accomplish esophageal repair and mediastinal debridement. We have treated an elderly patient with severe

2010 Surgical endoscopy

207. Sirens to Scrubs: Acute Coronary Syndrome – Beyond Door-to-Balloon

to the formation of coronary plaque. 1–9 The pain experienced by patients suffering from stable angina is a direct result of the continued growth of this coronary plaque, without rupture or erosion. Angina pain develops when the body requires more oxygen (i.e. exertion or stress), causing the heart to work harder, but the now partially occluded coronary arteries are unable to vasodilate themselves to increase their own oxygen delivery. If this plaque is eroded or disrupted, the subendothelial layer (...) , depending on where you read this from) is not a diagnostic tool so do not use it as such. Pain caused by ACS may be refractory to nitroglycerin therapy, whilst the pain caused by oesophageal spasm (for example), can be relieved with nitrates. 12 13 For a good review of the positive and negative predictive values of clinical exam findings for myocardial infarction, see the JAMA Rational Clinical Examination series, What if the ECG is Normal!? Time for risk stratification! Scores such as the HEART Score

2018 CandiEM

208. Management of Acute Myocardial Infarction in patients presenting with ST-segment elevation (Full text)

phase 39 8.3.1 Supraventricular arrhythmias 39 8.3.2 Ventricular arrhythmias 40 8.3.3 Sinus bradycardia and atrioventricular block 41 8.4 Mechanical complications 42 8.4.1 Free wall rupture 42 8.4.2 Ventricular septal rupture 42 8.4.3 Papillary muscle rupture 42 8.5 Pericarditis 42 8.5.1 Early and late (Dressler syndrome) infarct-associated pericarditis 42 8.5.2 Pericardial effusion 42 9. Myocardial infarction with non-obstructive coronary arteries 42 10. Assessment of quality of care 42 11. Gaps

2017 European Society of Cardiology PubMed abstract

211. Naloxone (Nyxoid) - Opioid-Related Disorders

changes indicative of toxicity and did not cause any macroscopic or microscopic lesions in the nasal cavity and related tissues (oesophagus, larynx, lungs with bronchi, nasopharynx, olfactory bulbs, stomach and trachea). Minor clinical signs i.e. salivation (at all doses) and gasping (in a single male animal at mid dose) were observed. Salivation was considered a secondary effect, most likely induced by small quantities of the test article migrating into the oral cavity following dosing

2017 European Medicines Agency - EPARs

212. CRACKCast E178 – Co-Morbird Medical Emergencies During Pregnancy

. Maternal—variable changes in seizure frequency; alterations in AEM levels; increased seizure frequency secondary to voluntary medication noncompliance; abruption, anemia, hyperemesis gravidarum, preeclampsia, possible need for labor induction and cesarean section, premature rupture of membranes. (AEM = antiepileptic medications) Management of status epilepticus is the same as for the nonpregnant patient. The newer AEM levetiracetam has demonstrated a lower incidence of birth defects and has equal (...) affect labor? Beta agonists are tocolytics and often halt labour. [2] Which types of valvular heart disease cause the most problems during pregnancy? Mitral stenosis > class 1 fcor Advanced aortic stenosis Aortic or mitral lesions associated with pulmonary hypertension or ventricular dysfunction Mechanical prosthetic valves requiring anticoagulation See Table 179.5 in Rosen’s 9 th Edition Ddx of chest pain in pregnancy: Pulmonary embolus, reflux esophagitis, biliary colic, and aortic dissection

2018 CandiEM

213. Neonatal stabilisation for retrieval

Streptococcal disease ETT Endotracheal tube FBC Full blood count HIE Hypoxic ischaemic encephalopathy IM Intramuscular IPPV Intermittent positive pressure ventilation IV Intravascular LBW Low birth weight NBM Nil by mouth NEC Necrotising enterocolitis PIP Peak inspiratory pressure RSQ Retrieval Services Queensland UVC Umbilical vein catheter VSD Ventricular septal defect Definitions Replogle tube Double lumen tube inserted through the baby’s mouth or nares into the blind ending oesophageal pouch and used (...) to drain secretions. VATER/VACTERL association Vertebral defects, anal atresia, cardiac anomalies, tracheo-oesophageal fistula, renal anomalies, limb anomalies. CHARGE association Coloboma of the eye, heart defects, choanal atresia, growth restriction, genital anomalies and ear anomalies. Queensland Clinical Guideline: Neonatal stabilisation for retrieval Refer to online version, destroy printed copies after use Page 7 of 40 Table of Contents 1 Introduction 10 1.1 Indications for transfer or retrieval

2018 Clinical Practice Guidelines Portal

214. Resuscitation - neonatal

Positive pressure ventilation PPROM Preterm prelabour rupture of membranes RhD Rh Blood Type D (Rh positive) SpO2 Peripheral capillary oxygen saturation UVC Umbilical venous catheter Definitions Acrocyanosis Blue hands and feet due to inadequate circulation of blood and oxygen to the extremities normally found in the first few hours after birth. Cold stress Temperature between 36.0 °C and 36.4°C Corrected age Gestation plus postnatal age in weeks Hyperthermia Temperature greater than 37.5 °C Mild (...) the baby at risk of requiring resuscitation at birth. The list is not exhaustive and the magnitude of the risk varies depending on the number and severity of the problem. 1 Table 3 Risk factors Aspect Consideration Maternal 1 · Prolonged rupture of membranes (greater than 18 hours) · Bleeding in second or third trimester · Hypertension in pregnancy · Substance use · Prescribed medication (e.g. lithium, magnesium, adrenergic blocking agents, narcotics) · Diabetes mellitus · Chronic illness (e.g. anaemia

2018 Queensland Health

215. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm (Full text)

. ---- | ---- Fig 5 Algorithm for management of the patient with a suspected or confirmed ruptured abdominal aortic aneurysm ( AAA ). CT, Computed tomography; IVs, intravenous lines. ---- | ---- Fig 6 Referring hospital checklist for the patient with a suspected or confirmed ruptured aneurysm. ---- | Fig 7 Receiving hospital personnel alert checklist for management of the patient with a suspected or confirmed ruptured aneurysm. Hide Pane Expand all Collapse all Article Outline Abstract Background Decision (...) -making related to the care of patients with an abdominal aortic aneurysm (AAA) is complex. Aneurysms present with varying risks of rupture, and patient-specific factors influence anticipated life expectancy, operative risk, and need to intervene. Careful attention to the choice of operative strategy along with optimal treatment of medical comorbidities is critical to achieving excellent outcomes. Moreover, appropriate postoperative surveillance is necessary to minimize subsequent aneurysm-related

2018 Society for Vascular Surgery PubMed abstract

216. Tide Pod Challenge: Managing caustic laundry pod ingestions

is converted to lactic acid, causing a lactic acidosis. CNS: Ethanol and propylene glycol in the pods are hypothesized to contribute to altered mental status ( ). GI: Pharyngeal and esophageal burns may occur due to caustic burn. These may lead to rupture from liquefaction necrosis in severe cases. GI irritation associated with vomiting, while the long chain polymers are associated with diarrhea. Renal: Dehydration secondary to vomiting and diarrhea, combined with propylene glycol thought to cause renal (...) for surgery include esophageal perforation, peritoneal signs and free intraperitoneal air. Relative indications include large volume (>150 mL) ingestions, signs of shock, respiratory distress, persistent lactic acidosis, ascites and pleural fluid. COMPLICATIONS Overall, short term prognosis is worst with Grade 3 (severe) GI injury, systemic complications, and age >65 years. Long term complications include esophageal strictures, which can form from scar tissue after mucosal remodeling. These strictures can

2018 CandiEM

217. CRACKCast E168 – Pediatric Respiratory Emergencies: Upper Airway Obstruction and Infections

and management. Shownotes – Rosen’s In Perspective: Big categories for upper airway obstruction: Infectious, congenital, foreign body (IN THE AIRWAY OR ESOPHAGUS!) Congenital causes: Think of progressive stridor or feeding difficulties. In addition to the onset and duration of symptoms, ask about: DROOLING NECK STIFFNESS/TORTICOLLIS EXACERBATING FACTORS CHOKING EPISODES Try to think out loud with the team: Is this resp distress or resp failure? Respiratory failure is identified by the presence of extreme (...) with resultant: Clinical distress/toxicity of the patient Degree of airway obstruction Get help from an experienced ENT; These are difficult airways – may be distorted and at risk for rupturing! Features that suggest abscess and require surgical intervention include: imaging findings of scalloping of the abscess wall, rim enhancement, and lesions larger than 2 cm. The decision to admit and provide a trial of antibiotic therapy should be made between the emergency clinician and otolaryngology consultant

2018 CandiEM

218. Imaging Guidelines

is not necessary in abdominopelvic MDCT for blunt trauma; however, IV contrast is required for visceral and vascular enhancement to identify visceral injury and vascular hemorrhage. Oral contrast may be beneficial in penetrating thoracoabdominal trauma to distend the esophagus and stomach if this is of clinical concern. Each center needs MDCT trauma protocols for each body region. Optimal diagnostic abdominopelvic MDCT for trauma includes IV contrast. Delayed scans are performed selectively when the initial (...) scan is positive or inconclusive for the purpose of: 4 z Evaluating collecting system rupture in the setting of renal trauma, or z Evaluating for active bleeding and formation of hematomas. Delayed scans are focused on the area of interest and are performed with a lower dose than the initial scan. MDCT must be readily available 24/7/365 in trauma centers. Technology advances have reduced acquisition times and improved image quality. Consequently, MDCT has replaced conventional diagnostic

2018 American College of Surgeons

219. CRACKCast E172 – Pediatric Gastrointestinal Disorders

to suction Labs, cultures, Glucose replacement Vasoactive agents as needed Broad spectrum ABX (See box 171.2) Consult surgery – in consideration of possible GERD GERD occurs as a result of an incompetent lower esophageal sphincter. GER is classified as a disease aka GERD if complications occur. For example, chronic reflux of gastric contents into the esophagus may result in esophagitis, aspiration, and failure to thrive if it is severe. Begins shortly after birth and resolves with time, usually (...) locations of lodging in the esophagus Foreign bodies commonly become lodged in one of three areas of normal physiologic narrowing— Upper esophageal sphincter (cricopharyngeus muscle), thoracic inlet (C6-T1); Aortic arch, tracheal bifurcation (T4-6); Lower esophageal sphincter, diaphragmatic hiatus (T10-11). Of objects that have made it into the stomach, 80% to 90% are passed without complications. [13] List 3 indications for FB removal from stomach. Describe the management of button battery foreign

2018 CandiEM

220. Management of acute (fulminant) liver failure

and subacute/subfulminant Acute/fulminant Vascular Budd Chiari Hypoxic hepatitis Acute/fulminant and subacute/subfulminant Acute/fulminant Pregnancy Pre-eclamptic liver rupture, HELLP, fatty liver of pregnancy Acute/fulminant Other Wilson disease, autoimmune, lymphoma, malignancy, HLH Acute/fulminant and subacute/subfulminant CMV, cytomegalovirus; HSV, Herpes simplex; NSAI, non-steroidal anti-in?ammatory; HELLP, haemolysis, elevated liver enzymes, low platelets; HLH, haemophagocytic lymphohistiocytosis (...) , cardiac or oesophageal Dop- pler; the latter is only applicable in patients who are ventilated. Use of invasive monitoring (such as pulmonary artery catheter or pulse contour analysis), provides measures of cardiac index. Pulse contour analysis also measures volume status and allows prediction of the likely response to ?uid challenge. In ventilated patients use of inspiratory hold can also be used to assess the likely response to volume challenge. Passive leg raise, to investi- gate for an increase

2017 European Association for the Study of the Liver

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