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Paul A. Baker 《Anaesthesia and Intensive Care Medicine》2019,20(1):42-51
Although it is essential to take a history and examine every child prior to airway management, preoperative anticipation of a difficult airway is not totally reliable and therefore it is wise to be prepared for the unexpected difficult airway. Information about the airway can be gained from previous medical records, current history, physical examination and other tests. A natural consequence of airway assessment is development of an airway plan. Important anatomical and physiological features may be identified in an airway assessment which can then have a direct influence on the subsequent airway plan. Managing the predicted difficult airway is usually elective. This allows proper preparation of equipment, assistants, expertise and the environment required for the airway plan. This article will discuss paediatric airway assessment, outline those features that contribute to airway difficulty, and identify indications and risk factors associated with various airway techniques. Key objectives for an airway management plan are to maintain oxygenation and avoid trauma. This involves adopting techniques that avoid hypoxia and provide a high success rate with minimum attempts. 相似文献
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Stephanie A. Leonard Stefano Miceli Sopo Mary Grace Baker Alessandro Fiocchi Robert A. Wood Anna Nowak-Węgrzyn 《Annals of allergy, asthma & immunology》2021,126(5):482-488.e1
ObjectiveAcute food protein-induced enterocolitis syndrome (FPIES) is characterized by delayed repetitive vomiting after ingestion of a trigger food, and severe reactions may lead to dehydration, hypotension, and shock. We provide recommendations on management of FPIES emergencies in a medical facility and at home.Data SourcesThis review summarizes the literature on clinical context, pathophysiology, presentation, and treatment of FPIES emergencies.Study SelectionsWe referred to the 2017 International Consensus Guidelines for the Diagnosis and Management of FPIES and performed a literature search identifying relevant recent primary articles and review articles on clinical management.ResultsManagement of FPIES emergencies in a medical facility is based on severity of symptoms and involves rehydration, ondansetron, and corticosteroids. A proactive approach for reactions occurring at home involves prescribing oral ondansetron and providing an individualized treatment plan based on the evolution of symptoms and severity of past reactions. A better understanding of the pathophysiology of FPIES and randomized trials on ondansedron and cocorticosteroid use could lead to more targeted treatments.ConclusionChildren with FPIES are at risk for severe symptoms constituting a medical emergency. Management of FPIES emergencies is largely supportive, with treatment tailored to the symptoms, severity of the patient’s condition, location of reaction, and reaction history. 相似文献
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Objectives
Iatrogenic injury of the Profunda Femoris Artery (PFA) at time of hip fixation surgery can increase morbidity and mortality and prolong the hospital stay. This is an injury that tends to pass unnoticed as a cause of postoperative deterioration despite being frequently reported in the literature. Our study aims to describe the anatomy of the PFA in relation to the medial femoral cortex with specific emphasis on its orientation relative to the position of a sliding hip screw side plate construct. By doing so we are able to present clear guidance to orthopaedic surgeons on how to avoid iatrogenic PFA injury at the time of hip fracture fixation.Methods
Using Computed Tomography Angiographic (CTA) studies, the course of the PFA in relation to the medial femoral cortex was traced in 44 patients (28 males and 16 females) with mean age of 65.6 years. Coronal and axial CT sections were cross-linked to specify the position of the PFA at 1?cm intervals.Results
The course of the artery could be divided into three parts relative to a fixed reference point. Proximal and distal parts of the artery were in a safer position in comparison to the middle part of the artery that was found very close to the femoral cortex and along the coronal axis of the femur (mean angle 2.9° from the femoral coronal axis and 13.8?mm from the medial femoral cortex). Using the commercially available side plate constructs, this part of the artery corresponded to the distal part of the plate (third and fourth holes).Conclusion
Special attention needs to be practiced by the operating surgeon while drilling into the third and fourth holes of the side plate. 相似文献9.
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Miriam B. G. Morrell Rebecca Baker Abigail Johnson Ruth Santizo Diane Liu Karen Moody 《Pediatric blood & cancer》2019,66(10)
Data regarding micronutrient deficiencies in children with cancer are lacking. We measured micronutrients in a subset of children with cancer (n = 23) participating in a randomized trial of the neutropenic diet. Ninety‐six percent of children had ≥1 micronutrient deficiency and 39% had ≥3 micronutrient deficiencies. Eighty‐six percent of children had vitamin C deficiency, 87% had 25‐hydroxyvitamin D deficiency, 50% had zinc deficiency, and 13% had vitamin A deficiency. Dietary intake did not correlate with micronutrient deficiency status. More data are needed regarding the prevalence and etiology of micronutrient deficiencies in children with cancer to further understand their implications and treatment. 相似文献