Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0008031 (chest pain)
 17,248 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Venous air embolism is the entrapment of air into the venous system producing signs and symptoms due to obstruction of pulmonary arterial blood flow. We present a healthy, 27-year-old, full-term parturient admitted for postdate induction of labor. Cesarean delivery was required following fetal distress. During delivery, the mother became bradycardic and required advanced cardiac life support for resuscitation. Serial hemoglobin values, electrocardiograms, echocardiograms, and a magnetic resonance image of the head were all normal. No fetal squamous cells were found in the patient's blood. She required 6 days of ventilation, was successfully extubated, and was discharged 14 days after the cesarean delivery. The differential diagnosis in this patient's care centered on a pulmonary embolic event. Thromboembolism was unlikely, based upon the patient's rapid clinical improvement without definitive therapy for thrombotic disease or detection of peripheral thrombosis. Amniotic fluid embolus was unlikely, although not excluded, by the absence of fetal cells in the maternal circulation and the lack of an accompanying intravascular coagulopathy. Air embolism may occur in up to 50% of women undergoing cesarean delivery. A lethal embolism may follow a bolus of 3 to 5 mL/kg of air. Chief among the many symptoms of air embolism are tachypnea, chest pain, and gasping. The diagnosis may be facilitated by precordial Doppler monitoring, transesophageal echocardiography, or by the identification of air when aspirating from a right heart catheter. Management includes optimum patient positioning, aspiration of air, discontinuation of nitrous oxide, administration of 100% oxygen, and flooding the surgical site with saline to avoid further air entry. Preventive strategies are also discussed.
 ...
PMID:Acute circulatory and respiratory collapse in obstetrical patients: a case report and review of the literature. 1175 29

Ruptured diaphragm as a result of blunt trauma can present acutely or late in the disease, process. Late presentation is often a result of herniation of abdominal contents into the thorax. Patients may present with nonspecific symptoms, and may complain of chest pain, abdominal pain, dyspnea, tachypnea, or cough. Clinicians must have a high index of suspicion for prompt diagnosis. Diagnostic tools include chest radiograph, CT scan, and MRI. The treatment for rupture of the diaphragm is surgical. The authors report a case of traumatic rupture of the diaphragm presenting 20 years after an automobile accident with blunt trauma to the abdomen.
 ...
PMID:Delayed presentation of traumatic rupture of the diaphragm. 1273 6

A 20-year old student had suffered since 3 years from diabetes mellitus type I, which was well-controlled by insulin-pump therapy. During a flight from Moscow to Los Angeles, the student all of a sudden had chest pain, dyspnea, and he vomitted repetitively--emergency landing at Zurich airport was necessary. The student presented at the emergency unit in a poor general condition with tachypnea (32/min) and tachycardia (136/min). Arterial blood gas analysis showed severe metabolic acidosis (pH 7.04), while pulmonary or cardiac disease could be ruled out. Diabetic ketoacidosis was caused by the pump running short of insulin. Treatment included rehydration and administration of insulin. Administration of insulin by an insulin-pump allows to continuously and flexibly adjust the dosage according to the requirement of the body. Interruption of insulin administration can cause, however, relatively fast ketoacidosis because exclusively short-acting insulin is used.
 ...
PMID:[Emergency landing due to a passanger with chest pain, dyspnea, and vomiting]. 1533 25

Accidental ingestion and aspiration of hydrocarbons in children are common. Among the various clinical and pathological manifestations of hydrocarbon (HC) poisoning, pneumonitis is the most significant and occurs in up to 40% of children, whereas formation of pneumatoceles is believed to be a rare event. We report two children with HC pneumonitis and pneumatoceles as a reversible complication after ingestion and aspiration of lamp oil with very low viscosity. Patient 1, a 21-month-old boy, started to cough and developed tachypnea, sternal retractions and mild cyanosis immediately after aspiration. Patient 2, a 24-month-old girl, was asymptomatic during the first days after the accident; subsequently, she started to cough and developed fever, dyspnea and chest pain. Chest x-ray and computed tomography revealed multiple patchy infiltrates in both cases; after several days, these confluent infiltrates developed into pneumatoceles. Both children were treated with antibiotics and steroids. They recovered within three and four weeks, respectively, with complete remission of the radiologic abnormalities and had an uneventful follow-up after discharge.
 ...
PMID:Pneumonitis and pneumatoceles following accidental hydrocarbon aspiration in children. 1584 96

Pulmonary embolism is a major cause of morbidity and mortality in the United States. The majority of deaths from pulmonary embolism occur because an accurate diagnosis was not made. It is imperative for clinicians to have a high level of clinical suspicion of pulmonary embolism when patients present with dyspnea, tachypnea, chest pain, hemoptysis, and cough. If pulmonary embolism is diagnosed and treatment initiated, death and recurrence of embolism are uncommon. Beyond correct diagnosis and treatment, the single most effective strategy that can be employed to decrease the high mortality associated with pulmonary embolism is identification of individuals at risk and the institution of prophylactic measures. This article reviews the incidence, risk factors, assessment, physical examination, laboratory, and diagnostic testing for pulmonary embolism.
 ...
PMID:Early recognition of pulmonary embolism: the key to lowering mortality. 1600 Sep 12

Pulmonary embolism is a rare but serious medical condition, with an estimated mortality of 5% to 20%. Many patients receiving physical therapy may be at risk for developing pulmonary embolism, especially after periods of immobilization or surgery. Patients presenting with dyspnea, chest pain, or tachypnea, particularly after trauma or surgery, have an increased likelihood of pulmonary embolism. Clinical prediction rules have been developed, which can aid the practitioners in assessing the risk a patient has for developing pulmonary embolism. The present clinical commentary discusses the existing evidence for screening patients for pulmonary embolism. To illustrate the importance of the screening examination, a patient is presented who was referred to physical therapy 5 days after cervical discectomy and fusion. This patient was subsequently referred for medical evaluation and a confirmatory diagnosis of pulmonary embolism.
 ...
PMID:Pulmonary emboli: the differential diagnosis dilemma. 1629 84

Current trends in global terrorism mandate that emergency medical services, emergency medicine and other acute care clinicians have a basic understanding of the physics of explosions, the types of injuries that can result from an explosion, and current management for patients injured by explosions. High-order explosive detonations result in near instantaneous transformation of the explosive material into a highly pressurized gas, releasing energy at supersonic speeds. This results in the formation of a blast wave that travels out from the epicenter of the blast. Primary blast injuries are characterized by anatomical and physiological changes from the force generated by the blast wave impacting the body's surface, and affect primarily gas-containing structures (lungs, gastrointestinal tract, ears). "Blast lung" is a clinical diagnosis and is characterized as respiratory difficulty and hypoxia without obvious external injury to the chest. It may be complicated by pneumothoraces and air emboli and may be associated with multiple other injuries. Patients may present with a variety of symptoms, including dyspnea, chest pain, cough, and hemoptysis. Physical examination may reveal tachypnea, hypoxia, cyanosis, and decreased breath sounds. Chest radiography, computerized tomography, and arterial blood gases may assist with diagnosis and management; however, they should not delay diagnosis and emergency interventions in the patient exposed to a blast. High flow oxygen, airway management, tube thoracostomy in the setting of pneumothoraces, mechanical ventilation (when required) with permissive hypercapnia, and judicious fluid administration are essential components in the management of blast lung injury.
 ...
PMID:Blast lung injury. 1653 71

Pulmonary embolism is one of the greatest diagnostic challenges in emergency medicine. New techniques and strategies constantly arise for the diagnosis and treatment of this disease. A review of the new diagnostic and treatment modalities for pulmonary embolism (PE) suggests that it should be suspected in any patient with unexplained dyspnea, tachypnea, or chest pain. All patients suspected of PE must be risk stratified, ideally with a criteria-validated clinical decision rule. After assessing pre-test probability, D-dimer assays will reliably exclude PE in the low risk group and no further imaging is warranted. Computed tomography (CT) angiogram is the initial imaging study of choice for stable patients. V/Q scans should be used only when CT is not available or if the patient has a contraindication to CT scans or intravenous contrast. Bedside echocardiography or stabilization of the patient and CT angiogram are the initial tests for suspected massive PE. If PE is confirmed, hypotensive patients should be treated with thrombolytics. Both heparin and low molecular weight heparin are equally effective initial treatments for stable patients with suspected or confirmed PE. Because accurate screening and identification of pulmonary embolism frequently requires more than a single test, knowledge of existing diagnostic techniques allows an evidence-based strategy for diagnosis. New therapeutic choices may benefit patients with confirmed pulmonary embolism.
 ...
PMID:New diagnostic and treatment modalities for pulmonary embolism: one path through the confusion. 1656 95

Unlike other extraintestinal inflammatory manifestations of ulcerative colitis, cardiac involvement is infrequently reported and inadequately characterized, with only 9 previously reported cases of pericardial tamponade associated with inflammatory bowel disease. A 32 year old male with ulcerative colitis, treated with orally administered mesalamine for ten years, developed chronic pericarditis. Extensive clinical and laboratory evaluation failed to find any cause of the pericarditis other than the ulcerative colitis. Although the pericarditis remitted with indomethacin therapy, this medicine had to be discontinued because of a reactivation of ulcerative colitis attributed to this nosteroidal antiinflammatory drug (NSAID). The pericarditis then responded well to high-dose corticosteroid therapy, but the patient represented with chest pain, dyspnea, tachypnea, and engorged neck veins after tapering the corticosteroid therapy. Angiography revealed near equalization of end diastolic pressures in both ventricles, a finding consistent with pericardial tamponade. The patient underwent subtotal pericardiectomy. Thoracotomy revealed a thickened pericardial wall and a large pericardial effusion. The patient's symptoms resolved postpericardiectomy. This case extends the clinical spectrum of pericarditis associated with ulcerative colitis, by describing a case of pericarditis that was chronic, refractory to maintenance medical therapy, caused pericardial tamponade, and was successfully treated by pericardiectomy.
 ...
PMID:Chronic pericarditis and pericardial tamponade associated with ulcerative colitis. 1757 28

Pulmonary embolism (PE) is difficult to diagnose. We investigated the relationship between computed tomography pulmonary angiography (CTPA) with clinical assessments and thrombus localization. 56 patients with the suspicion of PE; 27 male, 29 female were included. They were evaluated by empirical and Wells clinical assessments, tested with D-Dimer. According to the combination of both CTPA was performed where necessary (if one of the clinical assessments was high or intermediate or those with low clinical probability and high D-Dimer) in the algorithm we used. CTPA was regarded as gold standard. Dyspnea, chest pain, tachypnea, crackles were the most common symptoms and signs in patients having PE. Recent surgery within the risk factors was significantly higher in the PE present group. PE was diagnosed in 31 (55.4%) patients with CTPA. According to the empirical assessment 20 (64.5%) of the patients had high, 10 (32.3%) had intermediate and 1 (3.2%) had low clinical probability within 31 PE present group, while with Wells scoring 8 (25.8%) had high, 17 (54.8%) had intermediate and 6 (19.4%) had low clinical probability. Sensitivity of the empirical assessment and Wells scoring was 97%, 80% while the specificity was 16%, 68% respectively. Positive and negative predictive values of empirical assessment were 59%, 80% and these values of Wells scoring were 76%, 73% respectively. Thrombus was localized in main pulmonary arteries in 45.8% of patients with high clinical probability according to the empirical assessment. With Wells scoring in 45.5% of the high probability patients and only in 4.3% of the low probability patients thrombus was there. PE can be diagnosed noninvasively. Since PE can easily be underdiagnosed, empirical assessment which is more sensitive will be appropriate. There is a significant correlation between clinical assessments and presence of PE in CTPA. As the severity of clinical assessment increases, thrombus settles more proximal.
 ...
PMID:[Comparison of clinical assessments with computerized tomography pulmonary angiography results in the diagnosis of pulmonary embolism]. 1760 46


<< Previous 1 2 3 4 5 6 7 8 Next >>