Tag Archives: Acute respiratory distress syndrome

Hysteroscopy

Definition:
Hysteroscopy is the inspection of the uterine cavity by endoscopy. It allows for the diagnosis of intrauterine pathology and serves as a method for surgical intervention (operative hysteroscopy).
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The hysteroscope is a long tube, about the size of a straw, which has a built-in viewing device. Hysteroscopy is useful for diagnosing and treating some problems that cause infertility, miscarriages, and abnormal menstrual bleeding. Sometimes other procedures, such as laparoscopy, are done at the same time as hysteroscopy.

Method:-
The hysteroscope is an optical instrument connected to a video unit with a fiber optic light source, and to the channels for delivery and removal of a distention medium. The uterine cavity is a potential cavity and needs to be distended to allow for inspection. Thus during hysteroscopy either fluids or CO2 gas is introduced to expand the cavity. The choice is dependent on the procedure and the patient’s condition. Fluids can be used for both diagnostic and operative procedures. However, CO2 gas does not allow the clearing of blood and endometrial debris during the procedure, which could make the imaging visualization difficult. Gas embolism may also arise as a complication. Since the success of the procedure is totally depending on the quality of the high-resolution video images in front of surgeon’s eyes, CO2 gas is not commonly used as the distention medium. Electrolytic solutions include normal saline and lactated Ringer’s. Current recommendation is to use the electrolytic fluids in diagnostic cases, and in operative cases in which mechanical, laser, or bipolar energy is used. Since they are conducting electricity, these fluids should not be used with monopolar electrosurgical devices. Non-electrolytic fluids eliminate problems with electrical conductivity, but can increase the risk of hyponatremia. These solutions include glucose, glycine, dextran (Hyskon), mannitol, sorbitol and a mannitol/sorbital mixture (Purisol). Water was once used routinely, however, problems with water intoxication and hemolysis discontinued its use by 1990. Each of these distention fluids is associated with unique physiological changes that should be considered when selecting a distention fluid. Glucose is contraindicated in patients with glucose intolerance. Sorbitol metabolizes to fructose in the liver and is contraindicated if patients has fructose intolerance. High-viscous Dextran also has potential complications which can be physiological and mechanical. It may crystallize on instruments and obstruct the valves and channels. Coagulation abnormalities and adult respiratory distress syndrome (ARDS) have been reported. Glycine metabolizes into ammonia and can cross the blood brain barrier, causing agitation, vomiting and coma. Mannitol 5% should be used instead of glycine or sorbitol when using monopolar electrosurgical devices. Mannitol 5% has a diuretic effect and can also cause hypotension and circulatory collapse. The mannitol/sorbitol mixture (Purisol) should be avoided in fructose intolerant patients.

A hysteroscope is in fact a modification of the traditional resectoscope, which is used for transurethral resection of the prostate. It has a double-channeled sheath allowing for continuous flow of fluid or gas media into the uterus through the larger channel, while allowing for less outflow through the smaller channel. This results in the distention of the uterine cavity. With modern optical technologies, hysteroscopes are getting smaller in diameter yet able to provide larger and brighter images for surgeons’ convenience.

After cervical dilation, the hysteroscope is guided into the uterine cavity and an inspection is performed. If abnormalities are found, an operative hysteroscope with a channel to allow specialized instruments to enter the cavity is used to perform the surgery. Typical procedures include endometrial ablation, submucosal fibroid resection, and endometrial polypectomy. Typically hysteroscopic intervention is done under general endotracheal anesthesia or Monitored Anesthesia Care (MAC), but a short diagnostic procedure can be performed in a gynecologist‘s office with just a paracervical block using the Lidocaine injection in the upper part of the cervix.

Why it is Done:
Hysteroscopy is useful in a number of uterine conditions:

Asherman’s syndrome (ie. intrauterine adhesions). Hysteroscopic adhesiolysis is the technique of lysing adhesions in the
*uterus using either microscissors (recommended) or thermal energy modalities. Hysteroscopy can be used in conjunction with laparascopy or other methods to reduce the risk of perforation during the procedure.
*Endometrial polyp. Polypectomy.
*Gynecologic bleeding
*Uterine fibroids. Myomectomy.
*Congenital Uterine malformations (also known as Mullerian malformations). Eg.septum,
*Evacuation of retained products of conception in selected cases.

Hysteroscopy has the benefit of allowing direct visualization of the uterus, thereby avoiding or reducing iatrogenic trauma to delicate reproductive tissue which may result in Asherman’s syndrome.
How do you prepare for the test
The time that you schedule this test can be important. Your gynecologist is able to get the best view of the uterine lining during the week that follows your period. If you have regular cycles, it is helpful for you to anticipate the timing of your next period and plan to have the hysteroscopy done in the following week.

Tell your doctor ahead of time if you have ever had an allergic reaction to lidocaine or the numbing medicine used at the dentist’s office. Discuss different options for anesthesia with your doctor in advance.

If your doctor plans on giving you any anti-anxiety medicines before the procedure, or if you are going to have other tests done at the same time as hysteroscopy, you might be told not to eat or drink for eighthours or more before the test. Just before the test, you should empty your bladder.

Risk Factors:

After the procedure, you may have slight vaginal bleeding and cramps for one or two days. Sometimes a small amount of the gas used to expand the uterus can float up to the top of the abdomen and remain there for a day or two before it dissolves away. This can cause some shoulder pain. Some patients experience nausea from medicines used for anesthesia or anxiety.

Some of the procedures that are done along with hysteroscopy have risks of their own. You should ask your doctor about special risks that might come along with additional procedures planned for you.

A common problem is the uterine perforation when the instrument breaches the wall of the uterus. This can lead to bleeding and damage to other organs. A life-threatening condition is the bowel perforation by the instruments after the uterine perforation, resulting in acute peritonitis which can be fatal. Furthermore, cervical laceration, intrauterine infection (especially in prolonged procedures), electrical and laser injuries, and complications caused by the distention media described above are also not uncommon. The overall complication rate for diagnostic and operative hysteroscopy is 2% with serious complications occurring in less then 1% of cases.

How long is it before the result of the test is known
Your doctor can tell you what was seen through the hysteroscope right away. If a biopsy sample is removed, the analysis might take several days.

Resources:
https://www.health.harvard.edu/fhg/diagnostics/hysteroscopy.shtml
http://en.wikipedia.org/wiki/Hysteroscopy

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ARDS (Acute Respiratory Distress Syndrome)

 

Alternative Names :
Non-cardiogenic pulmonary edema; Increased-permeability pulmonary edema; Stiff lung; Shock lung; Adult respiratory distress syndrome; Acute respiratory distress syndrome; Acute lung injury.

Definition:
Acute respiratory distress syndrome (ARDS) is breathing failure that can occur in critically ill persons with underlying illnesses. It is not a specific disease. Instead, it is a life-threatening condition that occurs when there is severe fluid buildup in both lungs. The fluid buildup prevents the lungs from working properly—that is, allowing the transfer of oxygen from air into the body and carbon dioxide out of the body into the air.

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In ARDS, the tiny blood vessels (capillaries) in the lungs or the air sacs (alveoli (al-VEE-uhl-eye)) are damaged because of an infection, injury, blood loss, or inhalation injury. Fluid leaks from the blood vessels into air sacs of the lungs. While some air sacs fill with fluid, others collapse. When the air sacs collapse or fill up with fluid, the lungs can no longer fill properly with air and the lungs become stiff. Without air entering the lungs properly, the amount of oxygen in the blood drops. When this happens, the person with ARDS must be given extra oxygen and may need the help of a breathing machine.

Breathing failure can occur very quickly after the condition begins. It may take only 1 or 2 days for fluid to build up. The process that causes ARDS may continue for weeks. If scarring occurs, this will make it harder for the lungs to take in oxygen and get rid of carbon dioxide.

In the past, only about 4 out of 10 people who developed ARDS survived. But today, with good care in a hospital’s intensive or critical care unit, many people (about 7 out of 10) with ARDS survive. Although many people who survive ARDS make a full recovery, some survivors have lasting damage to their lungs.

How the Lungs Work

To understand acute respiratory distress syndrome (ARDS), it is helpful to understand how your lungs work.

Normal Lung Function

A slice of normal lung looks like a pink sponge—filled with tiny bubbles or holes. Around each bubble is a fine network of tiny blood vessels. These bubbles, which are surrounded by blood vessels, give the lungs a large surface to exchange oxygen (into the blood where it is carried throughout the body) and carbon dioxide (out of the blood). This process is called gas exchange. Healthy lungs do this very well.

Here’s how normal breathing works:

  • You breathe in air through your nose and mouth. The air travels down through your windpipe (trachea) through large and small tubes in your lungs called bronchial (BRON-kee-ul) tubes. The larger tubes are bronchi (BRONK-eye), and the smaller tubes are bronchioles (BRON-kee-oles). Sometimes, we use the word “airways” to refer to the various tubes or passages that air uses to travel from the nose and mouth into the lungs. The airways in your lungs look something like an upside-down tree with many branches.
  • At the ends of the small bronchial tubes, there are groups of tiny bubbles called air sacs or alveoli. The bubbles have very thin walls, and small blood vessels called capillaries are next to them. Oxygen passes from the air sacs into the blood in these small blood vessels. At the same time, carbon dioxide passes from the blood into the air sacs.

Causes:
The causes of acute respiratory distress syndrome (ARDS) are not well understood. It can occur in many situations and in persons with or without a lung disease.

ARDS can be caused by any major lung inflammation or injury. Some common causes include pneumonia, septic shock, trauma, aspiration of vomit, or chemical inhalation. ARDS develops as inflammation and injury to the lung and causes a buildup of fluid in the air sacs. This fluid inhibits the passage of oxygen from the air into the bloodstream.

The fluid buildup also makes the lungs heavy and stiff, and the lungs’ ability to expand is severely decreased. Blood concentration of oxygen can remain dangerously low in spite of supplemental oxygen delivered by a mechanical ventilator (breathing machine) through an endotracheal tube (breathing tube).

Typically patients require care in an intensive care unit (ICU). Symptoms usually develop within 24 to 48 hours of the original injury or illness. ARDS often occurs along with the failure of other organ systems, such as the liver or the kidneys. Cigarette smoking and heavy alcohol use may be risk factors.

There are two ways that lung injury leading to ARDS can occur: through a direct injury to the lungs, or indirectly when a person is very sick or has a serious bodily injury. However, most sick or badly injured persons do not develop ARDS.

Direct Lung Injury

A direct injury to the lungs may result from breathing in harmful substances or an infection in the lungs. Some direct lung injuries that can lead to ARDS include:

  • Severe pneumonia (infection in the lungs)
  • Breathing in vomited stomach contents
  • Breathing in harmful fumes or smoke
  • A severe blow to the chest or other accident that bruises the lungs

Indirect Lung Injury

Most cases of ARDS happen in people who are very ill or who have been in a major accident. This is sometimes called an indirect lung injury. Less is known about how indirect injuries lead to ARDS than about how direct injuries to the lungs cause ARDS. Indirect lung injury leading to ARDS sometimes occurs in cases of:

  • Severe and widespread bacterial infection in the body (sepsis)
  • Severe injury with shock
  • Severe bleeding requiring blood transfusions
  • Drug overdose
  • Inflamed pancreas

It is not clear why some very sick or seriously injured people develop ARDS, and others do not. Researchers are trying to find out why ARDS develops and how to prevent it.

Pollution: Checking the Damages Caused to the Respiratory System

Symptoms:

*Shortness of breath
*Fast, labored breathing
*A bluish skin color (due to a low level of oxygen in the blood)
*A lower amount of oxygen in the blood
*Labored, rapid breathing
*Low blood pressure or shock (low blood pressure accompanied by organ failure)
Often, persons affected by ARDS are so sick they are unable to complain of symptoms.

Doctors and other health care providers watch for these signs and symptoms in patients who have conditions that might lead to ARDS. People who develop ARDS may be too sick to complain about having trouble breathing or other related symptoms. If a patient shows signs of developing ARDS, doctors will do tests to confirm that ARDS is the problem.

ARDS is often associated with the failure of other organs and body systems, including the liver, kidneys, and the immune system. Multiple organ failure often leads to death.

Effects of ARDS

In ARDS, the tiny blood vessels leak too much fluid into the lungs. This results from toxins (poisons) that the body produces in response to the underlying illness or injury. The lungs become like a wet sponge, heavy and stiffer than normal. They no longer provide the effective surface for gas exchange, and the level of oxygen in the blood falls. If ARDS is severe and goes on for some time, scar tissue called fibrosis may form in the lungs. The scarring also makes it harder for gas exchange to occur.

People who develop ARDS need extra oxygen and may need a breathing machine to breathe for them while their lungs try to heal. If they survive, ARDS patients may have a full recovery. Recovery can take weeks or months. Some ARDS survivors take a year or longer to recover, and some never completely recover from having ARDS.

Who Is At Risk for ARDS?

Acute respiratory distress syndrome (ARDS) usually affects people who are being treated for another serious illness or those who have had major injuries. It affects about 150,000 people each year in the United States. ARDS can occur in people with or without a previous lung disease. People who have a serious accident with a large blood loss are more likely to develop ARDS. However, only a small portion of people who have problems that can lead to ARDS actually develop it.

In most cases, a person who develops ARDS is already in the hospital being treated for other medical problems. Some illnesses or injuries that can lead to ARDS include:

  • Serious, widespread infection in the body (sepsis)
  • Severe injury (trauma) and shock from a car crash, fire, or other cause
  • Severe bleeding that requires blood transfusions
  • Severe pneumonia (infection of the lungs)
  • Breathing in vomited stomach contents
  • Breathing in smoke or harmful gases and fumes
  • Injury to the chest from trauma (such as a car accident) that causes bruising of the lungs
  • Nearly drowning
  • Some drug overdoses

Diagnosis:

Doctors diagnose acute respiratory distress syndrome (ARDS) when:

  • A person suffering from severe infection or injury develops breathing problems.
  • A chest x ray shows fluid in the air sacs of both lungs.
  • Blood tests show a low level of oxygen in the blood.
  • Other conditions that could cause breathing problems have been ruled out.

ARDS can be confused with other illnesses that have similar symptoms. The most important is congestive heart failure. In congestive heart failure, fluid backs up into the lungs because the heart is weak and cannot pump well. However, there is no injury to the lungs in congestive heart failure. Since a chest x ray is abnormal for both ARDS and congestive heart failure, it is sometimes very difficult to tell them apart.

Exams and Tests :

Chest auscultation (examination with a stethoscope) reveals abnormal breath sounds, such as crackles that suggest fluid in the lungs. Often the blood pressure is low. Cyanosis (blue skin, lips, and nails caused by lack of oxygen to the tissues) is frequently seen.

Tests used in the diagnosis of ARDS include:

  • Chest X-ray
  • Arterial blood gas
  • CBC and blood chemistries
  • Evaluation for possible infections
  • Cultures and analysis of sputum specimens

Occasionally an echocardiogram (heart ultrasound) or Swan-Ganz catheterization may need to be done to exclude congestive heart failure, which can have a similar chest X-ray appearance to ARDS.

Treatment: Patients with acute respiratory distress syndrome (ARDS) are usually treated in the intensive or critical care unit of a hospital. The main concern in treating ARDS is getting enough oxygen into the blood until the lungs heal enough to work on their own again. The following are important ways that ARDS patients are treated.

The objective of treatment is to provide enough support for the failing respiratory system (and other systems) until these systems have time to heal. Treatment of the underlying condition that caused ARDS is essential.

The main supportive treatment of the failing respiratory system in ARDS is mechanical ventilation (a breathing machine) to deliver high doses of oxygen and a continuous level of pressure called PEEP (positive end-expiratory pressure) to the damaged lungs.

The high pressures and other breathing machine settings required to treat ARDS often require that the patient be deeply sedated with medications.

This treatment is continued until the patient is well enough to breathe on his or her own. Medications may be needed to treat infections, reduce inflammation, and eliminate fluid from the lungs.

Modern Medications:

Many different kinds of medicines are used to treat ARDS patients. Some kinds of medicines often used include:

  • Antibiotics to fight infection
  • Pain relievers
  • Drugs to relieve anxiety and keep the patient calm and from “fighting” the breathing machine
  • Drugs to raise blood pressure or stimulate the heart
  • Muscle relaxers to prevent movement and reduce the body’s demand for oxygen

Other Treatment

With breathing tubes in place, ARDS patients cannot eat or drink as usual. They must be fed through a feeding tube placed through the nose and into the stomach. If this does not work, feeding is done through a vein. Sometimes a special bed or mattress, such as an airbed, is used to help prevent complications such as pneumonia or bedsores. If complications occur, the patient may require treatment for them.

Results

With treatment:

  • Some patients recover quickly and can breathe on their own within a week or so. They have the best chance of a full recovery.
  • Patients whose underlying illness is more severe may die within the first week of treatment.
  • Those who survive the first week but cannot breathe on their own may face many weeks on the breathing machine. They may have complications and a slow recovery if they survive.

ARDS Treatment

Acute Respiratory Distress Syndrome

Prognosis :

The death rate in ARDS is approximately 30%. Although survivors usually recover normal lung function, many individuals suffer permanent, usually mild, lung damage.

Many people who survive ARDS suffer memory loss or other problems with thinking after they recover. This is related to brain damage caused by reduced access to oxygen while the lungs were malfunctioning.

After going home from the hospital, the ARDS survivor may need only a little or a lot of help. While recovering from ARDS at home, a person may:

  • Need to use oxygen at home or when going out of the home, at least for a while
  • Need to have physical, occupational, or other therapy
  • Have shortness of breath, cough, or phlegm (mucus)
  • Have hoarseness from the breathing tube in the hospital
  • Feel tired and not have much energy
  • Have muscle weakness

Calling Your Health Care Provider

Usually, ARDS occurs in the setting of another illness, for which the patient is already in the hospital. Occasionally, a healthy person may develop severe pneumonia that progresses to ARDS. If breathing difficulty develops, call the local emergency number (such as 911) or go to the emergency room.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://www.nlm.nih.gov/medlineplus/ency/article/000103.htm
http://www.nhlbi.nih.gov/health/dci/Diseases/Ards/Ards_WhatIs.html

First aid In Fever

Fever is one of your body’s reactions to infection. What’s normal for you may be a little higher or lower than the average temperature of 98.6 F (37 C). That’s why it’s hard to say just what a fever is. But a “significant” fever is usually defined as an oral or ear temperature of 102 F or a rectal temperature of 103 F. For very young children and infants, however, even slightly elevated temperatures may indicate a serious infection. In newborns, a subnormal temperature   rather than a fever   also may be a sign of serious illness.

Don’t treat fevers below 101 F with any medications unless advised to do so by your doctor. If you have a fever of 101 F or higher, your doctor may suggest taking over-the-counter medications such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others). Adults may also use aspirin. But don’t give aspirin to children. It may trigger a rare, but potentially fatal, disorder known as   Reye’s syndrome.

How to take a temperature
You can choose from several types of thermometers. Today most have digital readouts. Some take the temperature quickly from the ear canal and can be especially useful for young children and older adults. Other thermometers can be used rectally, orally or under the arm. If you use a digital thermometer, be sure to read the instructions, so you know what the beeps mean and when to read the thermometer. Under normal circumstances, temperatures tend to be highest around 4 p.m. and lowest around 4 a.m.

Because of the potential for mercury exposure or ingestion, glass mercury thermometers have been phased out and are no longer recommended.

Rectally (for infants)
To take your child’s temperature rectally:

* Place a dab of petroleum jelly or other lubricant on the bulb.
* Lay your child on his or her stomach.
* Carefully insert the bulb one-half inch to one inch into the rectum.
* Hold the bulb and child still for three minutes. To avoid injury, don’t let go of the thermometer while it’s inside your child.
* Remove and read the temperature as recommended by the manufacturer.
* A rectal temperature reading is generally 1 degree F higher than an oral reading.

Orally
To take your temperature orally:

* Place the bulb under your tongue.
* Close your mouth for the recommended amount of time, usually three minutes.
* If you’re using a nondigital thermometer, remove it from your mouth and rotate it slowly until you can read the temperature accurately.

Under the arm (axillary)
Although it’s not the most accurate way to take a temperature, you can also use an oral thermometer for an armpit reading:

* Place the thermometer under your arm with your arm down.
* Hold your arms across your chest.
* Wait five minutes or as recommended by your thermometer’s manufacturer. Then remove the thermometer and read the temperature.
* An axillary reading is generally 1 degree F less than an oral reading

Get medical help for a fever in these cases:

* If a baby is younger than 2 months of age and has a rectal temperature of 100.4 F or higher. Even if your baby doesn’t have other signs or symptoms, call your doctor just to be safe.
* If a baby is older than 2 months of age and has a temperature of 102 F or higher.
* If a newborn has a lower-than-normal temperature — less than 95 F rectally.
* If a child younger than age 2 has a fever for longer than one day, or a child age 2 or older has a fever for longer than three days. If your child has a fever after being left in a very hot car, seek medical care immediately.
* If an adult has a temperature of more than 104 F or has had a fever for more than three days.

Call your doctor immediately if any of these signs or symptoms accompanies a fever:

* A severe headache
* Severe swelling of the throat
* Unusual skin rash
* Unusual eye sensitivity to bright light
* A stiff neck and pain when the head is bent forward
* Mental confusion
* Persistent vomiting
* Difficulty breathing or chest pain
* Extreme listlessness or irritability
* Abdominal pain or pain when urinating
* Any other unexplained symptoms

Source:MayoClinic.Com