Archive for the Respiratory Category

Pathology of the Week – High-altitude illness

Posted in Neurological, Pathology of the Week, Respiratory, Technical Rescue with tags , , , on May 7, 2010 by The Beaver Medic

During the past few years I had the opportunity to learn mountaineering and ice/rock climbing from a few storied guides. I even got to climb one of Canada’s sixteen 10,000′-plus peaks. Although neither of us developed any form of high-altitude illness the trip prompted me to research the disease. High-altitude illness encompasses a group of acute pathologies which affect the bodies of individuals not accustomed to altitudes over 2,500m (8,202 feet) above sea level. These are acute mountain sickness (AMS), high-altitude cerebral oedema (HACE) and high-altitude pulmonary oedema (HAPE). AMS is far more common than HAPE and HACE with the latter two occurring in less than 0.1 to 4.0% of ascent cases. AMS equally affects both men & women as well as paediatric & adult patients. Strangely individuals over 50 seem to have a lower risk of developing AMS.  I will reference Basnyat & Murdoch, 2003 (free public access) as well as the Merck page on Altitude Sickness. See also BaseCamp MD.

Signs and Symptoms

Climbing Mt. Baldwin, summit: 10,682 ft

We in Canada actually contributed to the diagnosis of AMS!  The Lake Louise Consensus Group defines AMS as a new onset headache, in an unacclimatized person, who has recently travelled above 2500m as well as at least one of the following: fatigue, nausea, vomiting, loss of appetite, dizziness, and/or sleep disturbances. The symptoms typically begin 6 to 10 h after ascent and spontaneously subside after one to two days. Continue reading

Pathology of the Week – Croup

Posted in Infectious Dx, Paediatric, Pathology of the Week, Respiratory with tags , , , on April 28, 2010 by The Beaver Medic

medicalese: Scotch physician Dr. Francis Home first referred to croup in 1765; probably derived from the anglo-saxon word “kropan” (to cry).

Croup is a common and relatively benign condition in children. It is caused by an inflammation of the upper respiratory tract secondary to viral infection. It occurs almost exclusively in children, aged 6mo to 3y. The disease is more common in boys than girls (about 1.4:1). I will reference the Merck page on Croup, a few subscription-based articles (i.e. Bjornson et al., 2008) as well as a great free public access article by Malhotra & Krilov, 2001.

Signs and Symptoms

The hallmark symptoms of croup are a distinct “bark-like” cough and inspiratory stridor.

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CPR, CPR and more CPR

Posted in Cardiac, CPR, Respiratory with tags , , on January 7, 2010 by The Beaver Medic

A short time ago an awkward adolescent Fire Medic nerd watched his hot swim instructor demonstrate how to pinch the dummy’s nose and perform mouth to mouth respirations. It seems shocking now to consider performing such an intervention without any form of PPE/BSI. Consider other relics of resuscitation procedures. One of my former Chiefs described an 80’s EMS protocol to perform one minute of CPR, move the Px to the lawn, perform an additional minute of CPR and then continue to the ambulance. After three explanatory attempts I still do not understand the compression, ventilation and vital signs check system my Mom was taught in the early 90’s.

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Needle Decompression

Posted in Assessments / Interventions, Respiratory with tags , , , on January 5, 2010 by The Beaver Medic

As he prepared his implement he gazed down at her chest attentively.

“Which is the right spot?” he wondered as nervous sweat beaded over his brow. He was angry with himself for fumbling. He had seen it so many times before on TV and on the internet. What would she think he wondered? What was she thinking? Finally he could wait no more. He drew his breath, beared down and…

BAM! He was in. He had done it. Not even that much blood. Her eyes shot open as she breathed in deeply..

Yes the needle thoracostomy provides… (dirty minds you).

The needle thoracostomy, colloquially known as a needle decompression, is an invasive therapeutic measure commonly indicated for the relief of an acute pneumothorax. It has been depicted on House, MD twice that I know of and was also detailed graphically during the movie Three Kings (the guy with the chest valve).

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