American journal of otolaryngology
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While the incidence of ACEI-induced angioedema is low, ACEI use will continue to increase its frequency. Emergency physicians and otolaryngologists should play a key role in identifying patients with angioedema associated with ACEIs. ⋯ The physician must be aware of the fact that a moderate swelling can rapidly develop to a massive swelling, which requires an intubation or even a coniotomy. Thus, in any of these cases, the patient should be observed at least for 24 hours in the clinic or until the edema subsided almost completely.
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Two alternatives to physician-assisted suicide are ethically supported and legally permitted by American law. They are proper pain management and the forgoing of life-sustaining treatment. Correct understanding of pain management in the context of the dying patient shows that it is always medically possible, and, assuming that the proper decision-maker agrees, it is always legally permitted to eliminate physical pain in an imminently dying patient. ⋯ These alternatives significantly reduce, though they do not eliminate, the perceived need for suicide and euthanasia. Neither euthanasia nor physician-assisted suicide should be made legal, although they may be morally right in cases in which adequate pain control is unavailable. Reasons for this conclusion are discussed.
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Case Reports
Haemophilus influenzae type B epiglottitis after immunization with HbOC conjugate vaccine.
US Food and Drug Administration (USFDA) has licensed four Haemophilus influenzae type B (Hib) vaccines for use in children. Haemophilus influenzae type B is by far the most common pathogen in childhood epiglottitis and it is hoped that with the introduction of the Hib vaccine that a corresponding decrease in epiglottitis cases will be appreciated. ⋯ The incidence of Haemophilus influenzae type B epiglottitis at our regional Children's hospital has decreased since the introduction of the Hib vaccine. Reasons for vaccine failure are postulated.