Medical Blog

Acute Respiratory Distress Syndrome
Introduction

Background

Since World War I, it has been recognized that some patients with nonthoracic injuries, severe pancreatitis, massive transfusion, sepsis, and other conditions may develop respiratory distress, diffuse lung infiltrates, and respiratory failure sometimes after a delay of hours to days. Ashbaugh et al described 12 such patients in 1967, using the term adult respiratory distress syndrome to describe this condition.1 However, clear definition of the syndrome was needed to allow research into its pathogenesis and treatment. Such a definition was developed in 1994 by the American-European Consensus Conference (AECC) on acute respiratory distress syndrome (ARDS). The term acute respiratory distress syndrome rather than adult respiratory distress syndrome was used because the syndrome occurs in both adults and children.

ARDS was recognized as the most severe form of acute lung injury (ALI), a form of diffuse alveolar injury. Based on the AECC, ARDS is defined as an acute condition characterized by bilateral pulmonary infiltrates and severe hypoxemia in the absence of evidence for cardiogenic pulmonary edema. By these criteria, the severity of hypoxemia necessary to make the diagnosis of ARDS is defined by the PaO2/FiO2 ration, the ratio of the partial pressure of oxygen in the patient’s arterial blood to the fraction of oxygen in the inspired air. In ARDS, this ratio is less than 200, and in acute lung injury (ALI), this ratio is less than 300. In addition, cardiogenic pulmonary edema must be excluded either by clinical criteria or pulmonary capillary wedge pressure of less than 18 mm Hg in patients with a Swan-Ganz catheter in place.
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Nasal Pack, Posterior Epistaxis
Introduction

Posterior epistaxis is usually treated by an otolaryngologist, but an emergency physician may be called upon to treat this condition in a medical environment with few support services.

Epistaxis is a common problem in the emergency department. It is relatively benign in nature but can produce serious, life-threatening situations. Up to 60% of the population is estimated to have had at least one episode of epistaxis at some point in their lives. Of this group, 6% seek medical care to treat epistaxis, with 1.6 in 10,000 requiring hospitalization.1  Read more…

Foreign Body Removal, Nose
Introduction

Nasal foreign bodies that require removal are relatively common among pediatric patients and may also be seen in adult patients, most often those with psychiatric disease or developmental delay. The patient may present asymptomatically after having been witnessed inserting the item. Alternatively, the patient may have unilateral nasal drainage, foul odor, sneezing, epistaxis, or pain. Patients often deny having placed the foreign body; if the diagnosis is considered, this history should not lower the practitioner’s suspicion.
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Foreign Body Removal, Ear
Introduction

The removal of foreign bodies from the ear is a common procedure in the emergency department. Children older than 9 months often present with foreign bodies in the ear; at this age, the pincer grasp is fully developed, which enables children to maneuver tiny objects.

In adults, insects (eg, cockroaches, moths, flies, household ants) are the foreign bodies most commonly found in the ear. Rarely, other objects have been reported (eg, teeth, hardened concrete sediments, illicit drugs, plant material).1,2,3 Some persons from Mexico and Central America reportedly insert leaves and other plant material into their ears as a form of native remedy.4 Also, some adults with psychiatric disorders present to the emergency department with foreign bodies lodged in their ears as a form of self-mutilation called ear stuffing.5  Read more…

Drainage, Peritonsillar Abscess
Introduction

The peritonsillar abscess (PTA) remains a common clinical entity in the emergency department and in an otolaryngology practice. The exact incidence has been estimated at 30 cases per 100,000 people per year.

PTA is rare in infants and children younger than 12 years. The mean age for this disease is 20-30 years; males and females are affected equally. PTA usually occurs near the superior pole of the palatine tonsil, in the space outside of the tonsillar capsule between the superior constrictor and the palatopharyngeus muscle.1  Read more…

Cerumen Impaction Removal
Introduction

Removal of cerumen (wax) from the ear is a significant amount of the workload of an otolaryngologist and is, therefore, an essential skill to master.1 However, general practitioners, emergency department staff, nurses, audiologists, audiological physicians, and alternative medicine practitioners may all be confronted with the scenario of excess ear wax that causes difficulty in examination, hearing loss, or discomfort.2
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Objective Refractometers and Wavefront Imaging
Historical Perspective

Snellen visual acuity was developed at a time when the only possible refractive correction of the optical system of the eye was spherocylindrical glasses and the surgical techniques of treating eye diseases were less advanced. The 20/20 Snellen visual acuity was considered normal vision and the goal of treatments and surgeries. This measurement of visual function does not suffice for current clinical practice of refractive surgery. Most people have better visual acuity than 20/20 and the real-world visual performance also commonly includes the low contrast objects under low or high illumination. Read more…

Foreign Body Removal, Cornea
Introduction

A corneal foreign body is an object (eg, metal, glass, wood, plastic, sand) either superficially adherent to or embedded in the cornea of the eye. The removal of a corneal foreign body is a procedure commonly performed in the clinic or emergency department setting.1 If corneal foreign bodies are not removed in a timely manner, they can cause prolonged pain and lead to complications such as infection and ocular necrosis.
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Corneal Topography and Imaging
Introduction

Imaging techniques of the cornea are developing rapidly, mainly because of recent advances in refractive surgery. To understand the significance of new imaging techniques, the relevant principles of corneal optics are reviewed. The discussion of the most common clinical method of Placido-based corneal topography emphasizes important concepts of its clinical interpretation. The principles and clinical significance of several emerging technologies are reviewed.
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Anterior Segment and Fundus Photography
External Ocular Photography

Of the several types of ophthalmic photography, external eye photography is the least reliant on sophisticated instrumentation. Readily available components (ie, camera body, lens, flash) can be configured into an apparatus that can be used for virtually all photodocumentation of the external eye and adnexa. Based on the simple system, the external camera can be used for photography of one eye alone, both eyes together, and full face views, in addition to intraoperative photography and even nonmedical imaging (Gibson, 1973).
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