Nineteen men and 13 women, whose average age at death was 58.3 years (range 19-80), were included in this study. They died of a variety of severe acute illnesses (Table 1) in one of three specialty units; either medical (20 patients), surgical (six patients), or coronary (six patients) intensive care. The catheters had been in place for an average of 39.9 ± 6.4 (SEM) hours at time of death.
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HRCT scanning was used to evaluate the structural changes caused in the lung by smoke inhalation injury because it has become a major imaging method in the assessment of infiltrative lung dis-ease.” GGO usually reflects avariety of pathologic processes such as mild airspace disease, interstitial lung disease, or both. In patients with ZCSII, the histologic features include pulmonary edema, alveolitis, interstitial and intraalveolar fibrosis, and diffuse alveolar damage, which may be detected as GGOs on HRCT scans.
There have been reports describing ARDS soon after a significant exposure to zinc chloride (smoke bomb) fumes. In contrast, others have reported> some type of delayed ARDS with a slowly progressive clinical course over the ensuing 2 weeks. A discrepancy in the progression to ARDS over time or severity among different investigations may be attributed to the amount of smoke inhalation, to the duration of exposure, and to whether exposure occurred in an open or confined space. In this study, ARDS developed in five of our patients (25%) within 72 h after inhalation. In general, these patients had higher HRCT scan scores, suggesting that they had more severe lung injury soon after inhalation. The exact mechanism by which ARDS is triggered remains unclear, although there is evidence of involvement of the release of proinflammatory cytokines.
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Accessory diaphragm is a rare congenital pulmonary anomaly that may be detected as an isolated roentgeno-graphic finding in asymptomatic individuals or it may present in association with major cardiopulmonary malformations. Usually occurring on the right, the accessory diaphragm is composed of connective and muscular tissue. It arises from the anterior diaphragm and extends cephalad and dorsally to insert on the posterior chest wall. Roentgenographic identification of the accessory diaphragm requires a lateral chest roentgenogram. We present a case of accessory diaphragm occurring in a neonate with transient respiratory distress. The initial chest roentgenograms did not include a lateral view, leading to diagnostic confusion regarding diffuse haziness over the right hemithorax. Continue Reading »
Estimation of Verapamil Dose Deposited in the Lung
To generate a large volume of concentrated aerosol, four identical nebulizers were connected in series and operated simultaneously with compressed air set at 20 psi. With this pressure, each nebulizer discharged aerosol at 7.0 L/min. Therefore, the total aerosol flow from the four nebulizers was 28 L/min. Since the subjects breathed the fresh aerosol from the nebulizer via a Rudolph three-way valve at an average rate of 12 breaths/min with a tidal volume of 500 ml, rate of aerosol inhalation was 6.0 L/min, 21.4 percent of the total aerosol flow from the nebulizers. Aerosol loss in the transit line between the nebulizer outlet and the three-way valve (1.8 cm in diameter and 15 cm long) was estimated at 10 percent, from the experimental data of Kim et al, who studied aerosol loss in transit tubes of different lengths utilizing the nebulizer used in this study. Aerosol loss in the valve was assessed by nebulizing physiologic saline solution containing a small amount of fluorescent dye as a tracer. To know more about Verampil and other drugs you may just in one click. All news that you need at Canadian health care website.
An absolute filter was connected to the inspiratory port of the three-way valve and the aerosol was drawn through the valve and the filter with an inspiratory volume of 500 ml at a rate of 12 breaths/min by means of a Harvard respirator. The same aerosol was then drawn through the filter, with the same breathing pattern, directly from the nebulizer without passing through the valve. The amount of aerosol collected on the filter was measured by using a fluorometer, and aerosol loss in the valve was determined by the difference between the two filter samples. It was found that 47 percent of the inspiratory aerosol was lost in the valve. Therefore, the aerosol dosage actually inhaled would be 21.4 percent X 0.9×0.53 = 10.2 percent of the total amount of aerosol nebulized. Size distribution of the solution droplets initially discharged from the nebulizer was measured by using a seven stage Andersen cascade impactor and found to be in a log-normal form with mass median aerodynamic diameter of 3.2 fim and geometric standard deviation of 2.0. During mouth breathing, about 50 percent of these droplets deposit in the tracheobronchial tree together with the alveolar region. Therefore, deposition dosage of the inhaled aerosol in the lung will be 10.2 percent X0.50=5.6 percent of the total aerosol output. Although each nebulizer was initially filled with 2 ml solution (2.5 mg/ml), only 1 ml could be effectively nebulized because the remaining solution stuck on the nebulizer chamber as drops and film. This was found by the weight difference between a dry nebulizer and a wet nebulizer after completing nebulization of 2 ml solution. Therefore, the total amount of drug actually aerosolized by four nebulizers was 10 mg. Consequently, the total amount of verapamil actually deposited in the lung would be 10 mg x 5.1/100=0.51 mg.
Although the “acute carcinoid syndrome” has been previously reported during flexible fiberoptic bronchoscopy in a patient with an endobronchial carcinoid and was also a clinical consideration in our patient, this cause appears unlikely. Serotonin is reported to cause hypertension in the carcinoid syndrome, whereas hypotension has been attributed to the effects of bradykinin, histamine, and tachykinins. Also, serotonin, as mediated through norepinephrine release, and histamine may induce arrhythmias. These mechanisms appear remote in light of the normal measured values for serotonin and 5-HIAA in our patient and no severe hemodynamic aberration. Continue Reading »
The patient was given dexamethasone (Decadron), 20 mg IVP, and 250 ml of 5 percent albumisol, while a GE-9800 head CT scan, performed without contrast material, was found to be unremarkable. A two-dimensional cardiac echocardiogram showed no thrombus or valvular lesions. A presumed diagnosis of acute air embolism was made. The patient was transferred via helicopter at a reduced altitude, receiving 100 percent 02, to a nearby hyperbaric center. He was treated initially with a US Navy Standard Table No. 6 (maximum depth of 60 ft, with a 1 ft/min ascent) approximately four hours after the event. It was thought that the preferred therapy for an air embolism, a Table No. 6A (maximum depth 165 ft), would be hazardous in view of the residual LLL obstruction and the risk of further embolization during the rapid ascent (26 ft/min) from 165 to 60 ft. Marked improvement in motor function was noted almost immediately on reaching 2.8 atm. Continue Reading »
On the second postoperative day, fiberoptic bronchoscopic study was performed and demonstrated a large, hyperemic endobronchial lesion totally occluding the LLL bronchus. All obtained biopsy specimens were nondiagnostic. A lobectomy was deemed hazardous owing to the recent empyema and risk of developing a stump infection. The patient was therefore transferred to our institution for photoresection and biopsy of the obstructing lesion (presumably an adenoma) to establish patency of the LLL bronchus and to facilitate resolution of the pneumonia. The patient underwent neodymium-YAG laser resection after multiple endobronchial biopsies with frozen sections and Wang needle aspirations of the lesion were obtained. Preoperatively, the patient had received meperidine, hydroxyzine HC1, atropine sulfate, and fentanyl citrate; while anesthesia was maintained with atracurium besylate and isoflurane. Positive-pressure ventilation was maintained using a volume-anesthesia ventilator and a 35 percent fractional inspired Oz. Nd-YAG laser power was used in the range of 40 to 50 W and time exposure of 0.7 to 0.8 second. A total of 1,268 W/s was used to establish patency of the bronchus. Continue Reading »