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Strategies used for the withdrawal of humidified high flow nasal cannulae (HHFNC) in preterm infants | Cochrane

Background: Humidified high flow nasal cannula (HHFNC) is a form of respiratory support used in the treatment of preterm infants. Potential risks of HHFNC include damage to the nose and leaking of air from the lungs. Infants on HHFNC require more nursing care and the use of extra equipment (when compared to not being on any support). However, potential complications of removing HHFNC from babies too early include increased episodes of forgetting to breathe, increased oxygen needs, increased effort of breathing, the need to restart HHFNC, and the need for a breathing tube with mechanical ventilation. Any of these complications can be seen as a "failure" and are potentially distressing to staff and family. The best way to withdraw HHFNC once it has been started is unknown. Options include simply stopping, weaning the flow, increasing the time off HHFNC each day, or combinations of both.  
cochrane.org
over 6 years ago
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Critical Care

Intrinsic positive end-expiratory pressure (PEEPi) is a “threshold” load that must be overcome to trigger conventional pneumatically-controlled pressure support (PSP) in chronic obstructive pulmonary disease (COPD). Application of extrinsic PEEP (PEEPe) reduces trigger delays and mechanical inspiratory efforts. Using the diaphragm electrical activity (EAdi), neurally controlled pressure support (PSN) could hypothetically eliminate asynchrony and reduce mechanical inspiratory effort, hence substituting the need for PEEPe. The primary objective of this study was to show that PSN can reduce the need for PEEPe to improve patient-ventilator interaction and to reduce both the “pre-trigger” and “total inspiratory” neural and mechanical efforts in COPD patients with PEEPi. A secondary objective was to evaluate the impact of applying PSN on breathing pattern.  
ccforum.com
over 6 years ago
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Preoperative skin antiseptic for prevention of surgical wound infections after clean surgery | Cochrane

Patients' skin at the operation site is routinely cleansed with antiseptic solutions in the operating theatre before surgical incisions are made. This skin cleansing with an antiseptic aims to reduce the microorganisms present on the skin and therefore reduce the risk that the surgical wound will become infected. It is not known whether one antiseptic treatment is better than any other(s) at preventing infection, so our team examined the evidence for antiseptic skin preparation prior to clean surgery (i.e. surgery that does not involve the breathing system, gut, genital or urinary tract or any part of the body with an existing infection) to see if there are differences between preoperative antiseptic treatments. Unfortunately there is very little good quality research around skin cleansing before surgery and we cannot say whether one antiseptic is better than another at preventing wound infections. More research is required to show whether one antiseptic is better than the others at preventing wound infection after clean surgery.  
cochrane.org
almost 7 years ago
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SGEM#62: Take My (Shortness of) Breath Away – Nebulized Furosemide for COPD

Case Scenario: 73yo man presents to the emergency department with an exacerbation of his COPD. He quit smoking two days ago when his breathing got worse. He has a history of hypertension but no history of congestive heart failure. He has been taking all his medication and puffers as prescribed. Vital signs are BP165/85, HR 95, Temp 37.2C, RR 22 and O2 Sat 92% on room air.  
thesgem.com
almost 7 years ago
Sinaiem dark
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lump-in-my-throat

A 19-year-old-male with no known past medical history, presents in progressive respiratory distress shortly after undergoing a tooth extraction about 6 hours prior to presentation. Symptoms began initially as “a lump in his throat” and difficulty swallowing, but eventually progressed to mild dyspnea after 1-2 hours. Denies FB or allergies. On arrival he appears anxious and is breathing at 18 breaths per minute with an O2 saturation of 100%. There is no stridor at presentation. There is no intra-oral, facial, or obvious neck swelling. There is no skin involvement or abdominal pain, nausea, vomiting or diarrhea. You suspect allergic reaction and give IM epi, IV steroids, benadryl and pepcid. ENT is consulted for scope.  
sinaiem.org
almost 7 years ago
Aprv demonstration
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APRV Lung Demonstration | Resus Review

Unlike spontaneous breathing or conventional ventilation, the time spent at maximal inflation is typically much longer than time deflated. Time low is minimized to prevent collapse of alveoli and barotrauma. The video below shows shows treated pig lungs being ventilated with typical APRV settings.  
resusreview.com
almost 7 years ago
Www.bmj
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Telling stories with images

This photograph by Mark Bartley of Cambridge University Hospitals NHS Foundation Trust captures an elderly woman with kyphosis. The condition can cause back pain and breathing difficulties and sometimes requires surgical intervention.  
feeds.bmj.com
almost 7 years ago
Www.bmj
1
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Telling stories with images

This photograph by Mark Bartley of Cambridge University Hospitals NHS Foundation Trust captures an elderly woman with kyphosis. The condition can cause back pain and breathing difficulties and sometimes requires surgical intervention.  
bmj.com
almost 7 years ago
Www.bmj
1
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Telling stories with images

This photograph by Mark Bartley of Cambridge University Hospitals NHS Foundation Trust captures an elderly woman with kyphosis. The condition can cause back pain and breathing difficulties and sometimes requires surgical intervention.  
bmj.com
almost 7 years ago
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Physiology - Physiological Anatomy, Mechanics of respiration Part 01

The online lecture series for medical students. On demand streaming video lectures. www.mdcrack.tv Owner: MD CRACK  
YouTube
over 7 years ago
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239

Every bug, its presentation, virulence, and treatment (NOW AMENDABLE)

**** https://docs.google.com/spreadsheets/d/1eiZPODEIzH2uZxMMaLlGgGvTvxeA-QtMX8JaOfFbD0g/edit?usp=sharing **** Hey guys, So many of you have added this excel sheet to your board, but apparently haven't been able to amend, cut, paste, or embellish any of its contents. Therefore, I've created the following Google Drive link: **** https://docs.google.com/spreadsheets/d/1eiZPODEIzH2uZxMMaLlGgGvTvxeA-QtMX8JaOfFbD0g/edit?usp=sharing **** This should allow you to not only see the document in its full glory, but to help me make it extra awesome. I would love it if you all contributed something in order to make this a living, breathing microbiological masterpiece. Thanks and happy studying! Brian **** https://docs.google.com/spreadsheets/d/1eiZPODEIzH2uZxMMaLlGgGvTvxeA-QtMX8JaOfFbD0g/edit?usp=sharing ****  
Brian Cox
over 7 years ago
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Watching stressful films can endanger weak hearts - BBC News

Watching a stressful film can trigger heart changes, increase blood pressure and breathing, which could be dangerous for patients with weak hearts.  
BBC News
over 7 years ago