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Preoperative Respiratory Assessment

In this article, we will discuss the Preoperative Respiratory Assessment. So, let’s get started.

Respiratory Assessment

The followings should be assessed in detail:

  • Chest deformities: Kyphosis, kyphoscoliosis, pes excavatum and pectus carinatum
  • Breathing pattern: Normal rate of respiration 12-16 breaths/min. Inspiration:expiration- 1:2
  • Abnormal breathing patterns: Pursed lip breathing, apnea, hypoapnea, Cheynesokes respiration, ataxic breathing, apneuistic breathing
  • Chest movements: Symmetry of chest movements, depth of respiration, accessory muscle involvement
  • Chest expansion: It can be assessed both by observation and palpation
  • Dyspnea/breathlessness: It is known as increased work of breathing and can be assessed using “The New York Heart Association Scale of Dyspnea”

I- No symptoms with ordinary activities/No breathlessness with exertion

II- Symptoms with ordinary exercise

III- Symptoms with mild exertion

IV- Symptoms at rest

  • Orthopnea: Breathlessness while lying flat.
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Clinical Features of Corrosive Acid Poisoning

In this article, we will discuss the Clinical Features of Corrosive Acid Poisoning. So, let’s get started.

Clinical Features

The clinical manifestations depend on the concentration and quantity of acid consumed. The symptoms and signs given below:

A. Ingestional Poisoning

1. Mouth and Oropharynx

Symptoms

  • Pain in mouth, throat and drooling of saliva
  • Difficulty in speech (hoarseness or dysphonia) due to edema of glottis
  • Choking and stridor
  • Constant cough, dyspnea

Signs

  • Skin and oropharyngeal burns, ulcers, edema, necrosis, discoloration of mouth
  • Deep mucosal burns may produce anesthesia
  • Drooling of saliva over lips produce charring of skin over angles of mouth, chin and chest
  • In severe cases, the tongue is shapeless, a pulpy mass
  • Teeth may become chalky white and loose shine in severe poisoning (corrosion of teeth)

2. Esophagus

Symptoms

  • Painful swallowing, retrosternal pain, neck pain/tenderness
  • Haematemesis (vomiting with altered blood and mucus)

Signs

  • Esophageal burns and ulcers. The mucosa is red and swollen

3. Stomach

Symptoms

  • Epigastric pain, burning and tenderness
  • Vomiting. It is strongly acidic, will cause effervescence on coming in contact with earth and will stain clothes

Signs

  • Gastric burns

4. Respiratory tract (due to aspiration)

Symptoms

  • Cough and dyspnea
  • Hoarseness and dysphonia
  • Labored breathing

Signs

  • Tracheitis and pneumonia
  • Pleural effusion may develop

Inhalation poisoning (inhalation of gases i.e. chlorine, fluorine, bromine, iodine, etc)

Symptoms

  • Upper respiratory obstruction, cough, dyspnea

Signs

  • Non-cardiogenic pulmonary edema (rales, crackles)

Commonly used Benzodiazepines

In this article, we will discuss the Commonly used Benzodiazepines. So, let’s get started.

Benzodiazepines

Long-acting

  • Chlordiazepoxide
  • Clonazepam
  • Diazepam
  • Flurazepam
  • Nitrazepam
  • Prazepam
  • Quazepam

Short-acting

  • Alprazolam
  • Lorazepam
  • Oxazepam

Ultra-short acting

  • Estazolam
  • Midazolam
  • Temazepam
  • Triazolam

Definition of March Fracture

March Fracture

In this article, we will discuss the Definition of March Fracture. So, let’s get started.

It is defined as the fracture of distal 1/3rd of one of the metatarsals (commonly occurring in the second and third metatarsal) as a result of recurrent stress injury. It is more common in soldiers, hikers and individuals who perform long standing work. Symptoms include sharp pain in the foot as soon as the individual takes off his/her shoes and there is associated local edema on the dorsal aspect of the affected foot. March fracture is one of the common cause of foot pain, especially after sudden increase in activities.

Treatment includes reduction/restriction of movements for 6-12 weeks. Wooden-soled shoes or cast as supportive orthosis and conservative pain management (rest, pain killers, hot/cold compression packs).

Clinical Manifestations and Diagnosis of Acute Coronary Syndrome

In this article, we will discuss the Clinical Manifestations and Diagnosis of Acute Coronary Syndrome. So, let’s get started.

Clinical Manifestations/Diagnosis

The diagnosis of non-ST-elevation ACS (unstable angina) is based on clinical presentation. It is diagnosed when chest discomfort is severe and has at least one of the three following features:

1. Pain/discomfort occurs at rest or with minimal exertion lasting >10 minutes

2. It is of recent onset (<2 weeks)

3. It has crescendo pattern, i.e. it is more severe, prolonged and more frequent than previous episodes.

The diagnosis is confirmed by elevated levels of biomarkers of myocardial necrosis (CPK-MB and troponins)

There is usually no physical sign but patients with rest pain frequently develop third or fourth heart sound during the episodes, and in some instances exhibit transient left ventricular failure (murmur of mitral incompetence) due to development of heart failure. Patients with ACS (Acute Coronary Syndrome) should be explored for the precipitating cause such as uncontrolled hypertension, anemia, occult thyrotoxicosis and presence of atherosclerosis (carotid, aortic or peripheral artery disease).

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