ABSTRACT
Children are not small adults. They have certain anatomical & physiological differences as compared to adults. Paediatric patients have limited body reserve and so they deteriorate very fast. Anaesthetising paediatric patient requires good clinical judgment and thorough knowledge of paediatric anatomy and physiology. Anaesthetising an infant who has respiratory distress preoperatively increases risk several folds. Also the cause of respiratory distress is vital and that can have an important anaesthetic implications. Here we report a case of a gasping infant operated for emergency neck exploration under anaesthesia, where the cause of respiratory distress was unknown, making the case further interesting and challenging.
ABSTRACT
Objective To analyze the timing and frequency of spontaneous gasping during cardiopulmonary resuscitation in a rat model,and evaluate its value bearing some relation to duration of cardiac arrest (CA ) in predicting the severity of post-resuscitation myocardial dysfunction.Methods Twenty-seven healthy Sprague-Dawley rats were randomly (random number)divided into 3 groups according to different durations of CA:CA 4 min (n=9),CA 6 min (n=9)and CA 8 min (n=9).CA of rats was electrically induced and untreated for 4,6 or 8 min respectively in the corresponding groups,and then cardiopulmonary resuscitation (CPR)was initiated and continued for 8 min in all animals.The emergence timing and frequency of spontaneous gasping during cardiopulmonary resuscitation and resuscitation outcomes were documented.Myocardial function such as cardiac output,ejection fraction and Tei index was measured by echocardiography prior to CA and at 1 h,2 h and 4 h post-resuscitation.Results The earliest appearance of gasping with highest frequency was observed in the CA 4 min group during CPR.Gasping appeared later with decreased frequency observed following longer duration of CA.There were statistically significant differences in the timing and frequency of gasping among the 3 groups.In the CA 4 min group with frequent gasping,all animals were successfully resuscitated with 8-min CPR with the least number of defibrillation,which was significantly better than that in the CA 8 min group.During the evaluation of post-resuscitation myocardial function,cardiac output,ejection fraction and myocardial work index (Tei index) were better in the CA 4 min group with frequent gasping,worse in the CA 6 min group and worst in the CA 8 min group, showing statistically significant differences in cardiac function among the 3 groups. Conclusions The spontaneous gasping appeared sooner with higher frequency during cardiopulmonary resuscitation indicated shorter duration of CA,and predicted better success of resuscitation and post-resuscitation myocardial function.
ABSTRACT
Reflex gasping when hanging leads to passive and vigorous vomiting, the mechanical force of which causes gastric mucosa laceration. Mallory-Weiss syndrome is a tear in the gastro-esophageal junction or its adjacent mucosa, and this can occur due to nausea or vomiting that is caused by various etiologic factors. Gastric fundus is the most common site of gastric mucosa lacerations. We report a case of a 41-year-old man, who tried to hang himself and, as a result, caused multiple gastric mucosa lacerations that were treated by an endoscopic hemostatic procedure in the emergency room.
Subject(s)
Adult , Humans , Emergencies , Gastric Fundus , Gastric Mucosa , Lacerations , Mallory-Weiss Syndrome , Mucous Membrane , Nausea , Reflex , VomitingABSTRACT
Objective To explore the clinical significance of interleukin (IL)- 17 in nasopharyngeal secretions (NPS) and serum of wheezing children under 5 years old. Methods Fifty-three children with recurrent wheezing under 5 years old were divided into wheezing group Ⅰ (with atopic high risks,27 cases)and wheezing group Ⅱ (without atopic high risks, 26 cases) ;20 children without infectious diseases such as hernia and renal calculus were enrolled as control group. After collecting and dealing their NPS and serum,the levels of IL-17 were measured by double-antibody sandwich enzyme-linked immunosorbent assay (ELISA). Results The levels of IL-17 in serum and NPS in wheezing group Ⅰ [(1469.32 ± 978.30),(1473.70 ±974.35) ng/L],and wheezing group Ⅱ [(263.34 ± 131.80), (788.28±132.40) ng/L] were significantly higher than those in control group [(36.48 ± 2.00), (36.45 ± 5.00) ng/L] (P ＜ 0.01 ), and the levels of IL- 17 in wheezing group Ⅰ were higher than those in wheezing group Ⅱ (P ＜ 0.05 ); the expression of IL- 17 in NPS and serum had a positive correlation (r = 0.313,P ＜ 0.05). Conclusion The detections of IL-17 in NPS can be used as laboratory index to distinguish wheezing children who have a tendency to persistent wheezing, and early intervention and treatment should be given.