ABSTRACT
It is unknown how often choking occurs in geriatric wards and in nursing homes and what the treatment and outcomes are in regular practice. A questionnaire was sent to Dutch geriatricians (N = 130), nursing home physicians (N = 130), and trainees for these disciplines (N = 215), in order to gain information about the experience, practice and competence of physicians in choking in geriatric and nursing home patients. We also analysed to what extent geriatric and nursing home wards were prepared for accurate handling of choking. The response rate was 30%. More than half of the responders had experienced an episode of food choking at least once in the past five years. The mortality rate in the reported cases was high (30%). The majority of the patients who died of choking had not received the Heimlich-manoeuvre. Physicians who had attended resuscitation training long ago felt as competent to manage a choking episode as physicians that had recently attended resuscitation training. Of all geriatric wards and nursing homes, the majority lacked a guideline on how to handle in acute food choking. Geriatric wards and nursing homes do not seem to be well prepared for acute food choking in several aspects. Despite methodological shortcomings of this study, the results underline the necessity of clarification of the terms used, and development and implementation of guidelines for this important problem.
Subject(s)
Airway Obstruction/therapy , Geriatrics/standards , Homes for the Aged , Nursing Homes , Practice Patterns, Physicians' , Acute Disease , Aged , Aged, 80 and over , Airway Obstruction/mortality , Airway Obstruction/prevention & control , Clinical Competence , Humans , Surveys and QuestionnairesABSTRACT
We describe two patients who developed granulocytopenia (granulocyte count < 1.0 x 10(9)/1) after treatment with antithyroid drugs. Although, perhaps, an already known side-effect of these drugs, we present these cases in order to stay alert for this serious complication. The first patient developed granulocytopenia upon reinstitution of propylthiouracil after an uncomplicated first course of ATD-treatment. In the second case we report the use of granulocyte colony-stimulating factor (G-CSF) for treatment of a patient with methimazole-induced granulocytopenia. Furthermore, we discuss current concepts concerning pathophysiology, prevention and therapy.
