Respiratory care clinics of North America
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Asthma is the most common chronic inflammatory disease of childhood. While specialists should care for the most severe individuals with this disease, the bulk of pediatric asthma care rests in the hands of the primary care physician. This Article details information that should be incorporated into the evaluation and management of the pediatric asthma patient in the ambulatory setting. Through the adoption of proper assessment and monitoring techniques in conjunction with optimal treatment strategies, our pediatric asthma patients should be able to attain the quality of life that all children deserve.
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Children with asthma frequently receive care in the emergency department (ED). The factors associated with presentation to the ED are complex and must be considered when developing a treatment plan and disposition. ⋯ Objective measures should be used where possible to assess the response to therapy and determine readiness for discharge. This Article reviews the essential components of diagnosis, assessment, and treatment of pediatric asthma in the ED, and it reviews the key elements of discharge planning.
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Respir Care Clin N Am · Mar 2000
ReviewMechanical ventilation for children with status asthmaticus.
Status asthmaticus is the most common diagnosis leading to hospital admission in childhood. Most of these patients respond well to oxygen, steroids, beta-agonists, anticholinergics, and other medications. ⋯ This Article discusses the pathophysiology of asthma and how that relates to appropriate ventilator management. Alternative therapies are briefly discussed.
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Airway mucus is the secretory product of the mucous cells. The mucus is a variable mixture of water, mucous glycoproteins, low molecular weight ions, proteins, and lipids, the physical properties of which are important for airway defense. ⋯ In vitro results suggest potential benefit from the additive effects of selected combinations of mucoactive medications. Further studies are required to confirm these findings, to perform direct assessments of mucus clearability, and to extend the observations to patients with various types of pulmonary diseases for which mucoactive treatments are required.
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Respir Care Clin N Am · Jun 1999
ReviewHyperbaric oxygen in the treatment of life-threatening soft-tissue infections.
Necrotizing soft-tissue infections are rapidly spreading bacterial infections that account for a relatively small proportion of infections, but are aggressive in nature and nearly uniformly fatal if left untreated. Prompt recognition, antibiotic therapy, aggressive surgical debridement, and hyperbaric oxygen (HBO) therapy have reduced the mortality resulting from these infections. ⋯ During the healing process, hyperoxia causes increased formation of capillaries for oxygen, nutrient, and antibiotic delivery, leading to increased efficacy of some antibiotics in the high oxygen environment, and possibly more rapid overall wound healing. Although there are no randomized trials of HBO in these infections, in vitro data and meta-analysis of clinical cases strongly support the use of HBO.