tailieunhanh - CURRENT ESSENTIALS OF CRITICAL CARE (PART 4)

Giai đoạn cấp tính hoặc mãn tính tái phát trên khuôn mặt, màng niêm mạc da, sưng, có thể thu hẹp trên đường hô hấp Có thể kết hợp với mày đay cấp tính liên quan đến thuốc (enzyme chuyển đổi angiotensin (ACE) Các chất ức chế), NSAID, aspirin mãn tính bẩm sinh (tính trạng trội C1 esterase chất ức chế thiếu | 84 Current Essentials of Critical Care Angioedema Essentials of Diagnosis Acute or chronic recurrent episodes of facial cutaneous mucosal membrane swelling may have narrowing of upper airways May be associated with urticaria Acute related to medications angiotensin converting enzyme ACE inhibitors NSAIDs aspirin Chronic congenital autosomal dominant C1 esterase inhibitor deficiency rarely acquired chronic angioedema Mechanisms similar to anaphylaxis but different mediators and precipitating events Associated conditions include malignancy collagen vascular disease infections allergic phenomena Differential Diagnosis Anaphylaxis Acute asthma exacerbation Upper airway obstruction including acute epiglottis foreign body retropharyngeal abscess Allergic transfusion reactions Treatment Maintain patent airway Assess severity anticipate further complications Discontinue suspected drugs especially ACE inhibitors Administer epinephrine antihistamines corticosteroids as for anaphylaxis Long-term therapy for hereditary angioedema may include recombinant C1 inhibitor concentrate fresh frozen plasma dana-zol Pearl Angioedema from angiotensin-converting enzyme inhibitors can occur anytime after the drug is started even after years without side effects now also reported with angiotensin-receptor blockers as well. Reference Cohen EG et al Changing trends in angioedema. Ann Otol Rhinol Laryngol 2001 110 701. PMID 11510724 Chapter 7 Pulmonary Disease 85 Chest Tube Thoracostomy Essential Concepts Bedside procedure performed to remove fluid or air from pleural space or to instill agents to ablate pleural space May require ultrasound or CT imaging to guide tube placement if loculated fluid or air collection No absolute contraindication exists but care should be taken in patients with coagulopathies bullae large effusions due to main airway occlusion previous thoracotomy pleurodesis Essentials of Management Chest tube size depends on type of material to be aspirated smaller caliber tubes