5 yrs old male child presented to emergency department with complaints of hoarseness of voice for 2 yrs, dyspnea for 1 week and cyanotic spells since last night. The vitals on admission were HR 140/min, BP 122/90mm Hg, O2 saturation 95% on room air with respiratory rate of 38/min. On examination, subcostal recessions were present. Decreased bilateral air entry and wheeze with tracheal tug was found on chest auscultation. He had unremarkable birth and developmental history and rest of the systemic examination was normal. CT scan head and neck showed laryngeal stenosis due to presence of papillomas on left vocal cord. He was rushed to operating room for emergency tracheostomy and direct laryngoscopy (DL) ± biopsy. The findings of CT scan were confirmed about presence of papillomas and then patient was shifted to the pediatric intensive care unit (PICU). The patient was successfully weaned off from the ventilator and shifted out of ICU.
LASER assisted excision of laryngeal papillomas was planned as best treatment option for this child. As laser surgery has recently started at our ins...
The risk factors that Jessica presented with are a history that is positive for smoking, bronchitis and living in a large urban area with decreased air quality. The symptoms that suggest a pulmonary disorder include a productive cough with discolored sputum, elevated respiratory rate, use of the accessory respiratory muscles during quite breathing, exertional dyspnea, tachycardia and pedal edema. The discolored sputum is indicative of a respiratory infection. The changes in respiratory rate, use of respiratory muscles and exertional dyspnea indicate a pulmonary disorder since there is an increased amount of work required for normal breathing. Tachycardia may arise due to the lack of oxygenated blood available to the tissue stimulating an increase in heart rate. The pedal edema most probably results from decreased systemic blood flow.
The EB’s case study said the female patient is 50 years old with symptoms of fever, chills, congestion, three weeks of coughing, shortness of breath when walking. The study implies that the patient is now seeking medical advice due to vital signs recording and the noting of decreased breath sounds and wheezing. She denies smoking and not taking any chronic medication.
Croup: Croup is another common airway inflammation caused by virus that can affect the trachea, larynx and possibility the bronchi (Murray, Sidani, & Zoorob, 2011) thus causing infection in the upper respiratory tract. Murray et al. describes it as the most common illness in children under the age of 6 to 36 months and cause for cough mostly when a child cries; acute stridor and hoarseness in febrile children (Murray et al., 2011). It can be a life-threatening situation in the life of the young infant and the family. Croup symptoms exhibit as hoarseness, barking cough, inspiratory stridor, and respiratory distress. I chose this diagnosis as my first preference because when I read the mother’s subjective report it matches that of croup symptoms: a barking cough, no fever, severe at night and when the baby cries, fatigue due to excessiveness of the tears, pain due to inflames and swollen of the airway. Murray et al., led us to understand that the etiologies of this viral causing agent can be traced to the parainfluenza viruses, type 1. (2011). This virus is commonly spread through contact or droplet secretion.
Gentian reports a history of childhood asthma and frequent upper respiratory tract infections. Over the last couple of years, he has been aware of intermittent wheeze, a cough productive of small amounts of thick discoloured phlegm and intermittent dyspnoea. There has also been sino-nasal congestion with post-nasal drip. Gentian does not report typical allergic rhinitis symptoms. He also experiences frequent reflux symptoms.
Jennifer is a 28yo, G2 P0010, who is currently 23 weeks 0 days. She felt an impalpable mass on her neck and has had work-up. She has since been referred to ENT. Thyroid studies are normal with a TSH of 1.8 and a free T4 of .94 indicating a cold nodule per her report. An ultrasound performed recently was suspicious for a thyroglossal duct cyst. She is scheduled to have a biopsy on December 28, 2017. She was referred today to discuss the nodule.
I believe that if you asked a group of people to list off issues regarding an emergency department then they would say long wait times throughout the process and being moved around to different areas of the emergency department. From what I have heard the long waits can be associated with waiting to get back to a room, waiting to see a nurse, waiting to see a doctor, waiting to go to radiology or lab, waiting on results, waiting to be discharged, or waiting to be admitted. All of these things in my opinion add up to one main problem, which is patient flow through an emergency department. In my opinion being able to have a controlled patient flow allows for improved wait times and decreased chaos for patients. So there are a few things
Patients with atelectasis will vary in their manifestations, depending on the degree of area affected. Typically, breath sounds will be reduced or diminished on the side of the alveolar collapse and oxygen saturation will be decreased because air is unable to fill the alveolar sacs where the process of ventilation-perfusion is supposed to take place (Lewis et al., 2014). According to Porth (2015), the patient may also exhibit tachypnea, diminished chest expansion, intercostal retractions, dyspnea, and tachycardia. These symptoms demonstrate how the body reacts and its attempt to compensate for the lack of oxygen. This lack of oxygenation to tissues results in cyanosis (Porth, 2015). An individual undergoing such difficulty to breath will present distressed and anxious. A thorough assessment of the patient and presence of some of these manifestations contribute to the diagnosis of atelectasis, which would be supplemented by a chest radiograph for confirmation (Porth, 2015). Most post-operative patients who fall victim to atelectasis and present with the signs and symptoms described, usually have risk factors that increase their probability of acquiring the
A 41-year-old manwith a history of DM was brought to emergency department (ED)due to difficulty in breathing. It was associated with fever, severe sore throat and muffled voice for 2 days duration. He visited a...
Her blood pressure earlier is 130/70. Her heart rate is irregularly irregular at about 115 beats a minute, SpO2 on two liters is 96, although her respiratory rate is 26. Temp is normal. Head, eyes, ears, nose and throat reveal no abnormalities. No temporal artery tenderness. Neck is supple. I see no JVD. I hear no carotid bruits. There is coarse rhonchi and wheezes bilaterally. I do not hear a rub. Consolidation is not well heard. Heart rhythm is irregular regular. PMI is displaced lateral on mid clavicular line. Abdomen is soft and nontender. The low ribcage impacts on the superior iliac crest bilaterally. No organomegaly is detected. There is a midline scar. There is trace ankle edema bilaterally and no calf tenderness. Peripheral pulses are reduced.
Other symptoms are breathing frequent and superficial, the fever and then can often present a noise very particular in the chest area, which is heard through the stethoscope. The symptom picture is completed by shortness of breath, sobs, anemia and decreased body weight.
At hours on June 7, 2016, I, Cpl. Lessane along with Deputy Ayer, with the Hampton County Sheriff’s Office, responded to Hampton Emergency Room, in the Hampton area of Hampton County, in regards to an assault that occurred on Bryan Road, in the Hampton area of Hampton County. Upon arrival, Hampton County Sheriff’s Deputies made contact with the complainant, Ta’shanae Smith, who stated she was assaulted by her boyfriend, Antquon Robins. Ms. Smith was in Mr. Robin’s vehicle, a black Crown Victoria when a verbal dispute occurred when she received a telephone call from a male friend. She advised the dispute led to her ear being slice with an unknown blunt object. Ms. Smith was being treated by the local emergency staff.
Children’s healthcare of Atlanta is a nonprofit hospital and clinics that specialize in pediatrics. To improve patients’ healthcare quality, the organization worked on measuring patient satisfaction and outcomes. This was assessed through a survey after patient’s visits. The survey involved everything ranging from the time patients entered the hospital at the time of exit. The survey responses were in turn used to improve the quality of care offered by CHDA and also encouraged patients to share any ideas they may have on how care can be improved. The organization developed a process to improve the products and services it receives from its medical devices and equipment suppliers. Through this process, staffs were encouraged to share their likes
Our first task was to meet with the Infectious Disease and the Quality Improvement Teams of Children's Mercy Hospital to learn about their project and needs. Through discussion we were able to find a consensus of what needs they had that we could meet, primarily the education of nurses about the new Clinical Practice Guideline being developed and implemented in several specific departments. Our second task was to educate ourselves on the diagnosis and treatment of Group A Streptococcal Pharyngitis utilizing information provided to us by the CMH teams and through our own research. We then developed teaching objectives which then guided our quiz development. We then submitted our quiz to the Quality Improvement Team for feedback and then revised
Cardinal Glennon Children’s Medical Center is a 190 bed hospital located in the heart of Saint Louis, Missouri. The non for profit organization, named after Archbishop John Cardinal Glennon opened in the summer of 1956. The patients that seek medical attention from this hospital are primarily from Missouri and Illinois, but it is not uncommon for families who seek a very specific kind of treatment to travel from even farther away. The hospital also has a program that will fly children in from around the world so they can get the life-saving surgery or treatment that they need. The hospital is religiously affiliated and the mission statement reads: “Through our exceptional health care services, we reveal the healing presence of God.
Mondays in the emergency room (ER) are typically busy. Most of the patients contributing to this volume have dealt with a medical issue all weekend, cannot get into their primary care provider or both. Of course, there are the typical emergent patients that have no other choice but to be seen immediately, and they make up the rest of the volume. The aforementioned reasons often cause increased stress and frustration among these patients. So, as an emergency room nurse, it is understood that our encounters with patients might not be the best, as these people are probably not having their best day. When family members accompany these patients, this has the potential to add even more stress to the environment.