Pulmonary Embolism and Negative Pressure Pulmonary Edema - Assignment Example

Pulmonary embolism and negative pressure pulmonary edema affiliation Task Pulmonary embolism (PE) commonly ascend from thrombi that start in the deep arterial system of the lower extremities. However they infrequently originate in the right heart chambers, upper extremity veins, renal, or pelvic. To stretch to the lungs, thromboembolic travels through the heart’s right side. After they reach the lungs, large thrombi may lodge at the junction of the main pulmonary vein or the lobar branches and bring about hemodynamic compromise. It is caused by the obstruction of a vein in the lungs. The vein can be obstructed most commonly by a blood clot. Further, causes that are less common are clumps of tumor cells or parasites, amniotic fluid, fat droplets, or fat droplets (Ouellette & Patocka, 2012). Moreover, pulmonary embolism is not a disease in and of itself; instead it is a problem of underlying artery thrombosis. An individual is likely to develop this condition if his or her family have a history of clotting disorders or blood clots. This condition might happen after childbirth, stroke, heart surgery, brain surgery, bone surgery, joint surgery and heart attack. Additionally, after or during a long car or plane ride one can develop PE. In addition, remaining in a one posture, or a long bed rest are also factors that may lead to this condition. Lastly, those individuals suffering from cancer and those who take estrogen therapy or birth control pills are also at high risk. The signs and symptoms of PE comprise of chest pain, coughing up blood, mysterious shortness of breath, coughing, or problems breathing. Additionally, an irregular heartbeat (arrhythmia) might also be a sign of PE. Occasionally, the signs and symptoms are only linked to deep vein thrombosis (DVT). These consist of discolored or red skin on the affected leg, swelling of an artery in the leg or the whole leg, increased warmth in the region where the leg has swollen, and tenderness or pain in the leg. However, it is even possible for an individual to have this condition and still have no signs and symptoms. Additionally, certain individuals having PE might have feelings of dread or anxiety, fainting or light-headedness, increased heart rate, and sweating. To determine the likelihood of PE most hospitals have been using perfusion/ventilation (V/Q) imaging in the past 40 years (McRae, 2010). This method consists of injecting a radioactive tracer and at the same time having the patient breathe in the radioactive gas. If the airflow viewed on the ventilation scan match with the flow of blood as viewed at the perfusion scan, then the lungs are working well. However, in the present days CT angiography is the new trend for diagnose PE in numerous hospitals and is replacing V/Q scans. CT is faster than V/Q and produces images that are sharper making the results easier for interpretation. Further, the CT scans are available 24/7 as compared to the V/Q where the nuclear medicine specialists may not be available more so on weekends and at night. Most deaths occurring from PE arise from the right-sided heart failure. CT openly pictures the heart and enables the evaluation of the right-sided heart function, thus assisting to identify patients with a dysfunction of the right-sided heart and direct therapeutic decisions (Takach Lapner & Kearon, 2013). Task 3 Tuberculosis is a bacterial infection that attacks lungs most of the time; however, it can attack other parts of the body too. Mycobacterium tuberculosis is the most common causative agent of the infection in most instances. Tuberculosis is transmitted through droplets when people are suffering from active tuberculosis sneeze, cough or carry their respiratory fluids through the air. Thus, the major method of prevention should focus on minimizing the transfer of respiratory fluids from one patient to the public. At the same time, it is of the essence that people focused on enhancing and maintaining a healthy immune system. According to Lumb et al (2011), most tuberculosis infections do not present with symptoms, in fact, one in ten people suffering from latent tuberculosis end up developing active tuberculosis with 50 percent mortality rate if left untreated. Tuberculosis classic symptoms of active tuberculosis infection are comprised of a chronic cough accompanied by fever, weight loss, night sweats and blood-tinged sputum. Extra pulmonary tuberculosis that establishes outside the lungs, mostly affects the immune suppressed patients. The occurrence of this type of tuberculosis is up to 50 % among people living with HIV. The most common site of infection extra pulmonary includes the central nervous system, pleura, genitourinary system, lymphatic system and joints/bones. Tuberculosis in Australia has seen a steady increase over time in the recent years. However, most of the infected people are those born abroad. Even though, Australia presents the lowest incidences of tuberculosis in the world today. In fact, out of, the 1385 active tuberculosis cases reported in Australia in the year 2011, 88 percent of them were made up of the immigrants or those born overseas. This translates to about 6.2 people per 100000 in the country (Barry et al 2012). These rates are much lower when compared to those presented in most African countries where the incident rate is 50 per 100000 people. Some of the major risk factors of tuberculosis in Australia include HIV, people using injectable illicit drugs, smokers (Patterson, et al 2012). On the other hand, some diseases also accelerated the development of tuberculosis, and they include diabetes mellitus, chronic lung dieses, and alcoholism. Using some medications like infliximab an anti-alpha tumor necrosis factor and corticosteroids is also one of the major factors. Australia rate of multidrug-resistant strains tuberculosis is still high is Australia. Hence, this makes it difficult in eliminating the condition within a short period. The primary treatment regimen is made up of quadruple therapy (Ethambutol, Pyrazinamide, Isoniazid, and Rifampicin) to eliminate the mycobacterium with minimal resistance. For curative treatment, the patients take these medications for a period of six months to ensure that the mycobacterium is eliminated. At the same time, there is increased advocacy for people to seek timely medical care upon suspecting of the condition. Moreover, there is a number of health education programs put in place to prevent infection in the community. This includes the hygienic measures and adequate aeration to prevent concentration of droplets carrying the microorganism. Task 5 Negative pressure pulmonary edema (NPPE) is a hazardous and possibly deadly ailment with a multifactorial pathogenesis. Moore first revealed it in the year 1927 in dogs that were breathing impulsively. They were exposed to resistive burden. Conferring to Bhaskar & Fraser, (2011), NPPE progresses in 11% of all patients needing active intervention for severe upper airway blockage. Moreover, the Australian monitoring research of 4000 incidents of laryngospasm in the course of anesthesia and it indicated that NPPE happens in 4% of all laryngospasm incidents. NPPE is classified as type 1 or type 2. Type 1 develops instantly after the beginning of severe airway blockage and type two progresses after the relief of long-lasting upper airway blockage. Additional risk factors that augment type 1 NPPE are choking, epiglottis, strangulation, croup, and upper airway tumors, among others whereas in type 2 the risk factors are choanal stenosis, and hypertrophic redundant uvula, among others. Regularly, NPPE is a manifestation of the upper airway blockage, and the enormous negative intrathoracic force brought about by forced stimulation against a blocked airway is believed to be the main mechanism that is involved. This negative pressure causes an augmentation on pulmonary capillary transmural pressure and pulmonary vascular volume, establishing a risk of interruption of the alveolar (capillary membrane). NPPE is a medical entity of great significance in intensive care and anesthesiology (Lemyze & Mallat, 2014). Furthermore, NPPE presentation can be delayed or immediate that therefore requires instant recognition and cure by anybody directly encompassed in the perioperative upkeep of a patient. Early detection of NPPE signs is very significant to the outcome and treatment of the patient. NPPE is a rare problem of anesthesia that commonly results from laryngospasm for the duration of elimination of the endotracheal tube (ETT). The common individuals who are at a higher risk of developing NPPE are the healthy, athletic, young male patients. NPPE is an illustration of a non-cardiogenic pulmonary edema, meaning that pulmonary edema can develop in spite of the fact that the lungs and the heart are functioning within the anticipated norms. Due to the blockage of the upper airway, a large, intrathoracic, negative pressure is produced by the augmented struggle by the patient to breath. This negative pressure leads to an upsurge in the left ventricular afterload and preload. Additionally, this pressure leads to a decrease in the extramural hydrostatic force. The hypoxia alters pulmonary vascular resistance. Therefore, this leads to dilation of the right ventricle, diastolic dysfunction of the left ventricle, and the shift of the intraventricular septum to the left. All these ailments lead to an augmented left heart loading disorders, and thus improves microvascular intramural hydrostatic pressure. This now enables fluid to move easily from greater to lesser, and hence into the lung interstitium and out of the capillaries. Through this then the negative pressure pulmonary edema develops (Krodel, Bittner, Abdulnour, Brown, & Eikermann, 2011). Task 6 Measles, whooping cough, and mumps, are some of the most common conditions among children when they are not immunized timely. There can be an exponential increase in the number of children suffering from the condition in case there is no timely management and prevention of the condition. These conditions present differently with different complications as discussed. Measles Even with the availability of a cost effective and safe vaccine for this condition, it is still among the leading causes of children’s death. According to World Health Organization (2014), in the year 2013 alone, 145 700 children died from measles globally. This translates to about 16 deaths every hour or 400 deaths within every 24 hours. Measles is a viral infection from the paramyxovirus family. Normally the virus is passed from one person to another through the air and direct contact. The infection begins by invading the mucous membranes before it travels to other parts of the body. Even though the virus is known to be a human disease, it also affects animals. The condition presents with a number of signs and symptoms that include a high fever that starts from the 10 to 12 days post exposure it then goes on for 4 to 7 days. At the same time, the child develops a cough, running nose, white spots on the inside of the cheeks that can come up in the initial stages (Klein et al, 2010). After that, a rush that starts from the face spreads to the limbs within 7 to 18 days post exposure. The severity of the condition is most of the time accelerated by its complications that include blindness, encephalitis, ear infections, and diarrhea with dehydration, severe respiratory infection. Mumps Mumps is a viral infection caused by the mumps virus. The virus infects salivary glands to exhibit various signs and symptoms within two to three weeks post exposure. Mostly common modes of transmission of the virus include airborne droplets emanating from the upper respiratory tract of those infected or through direct contact. The initial symptoms of the condition include muscle pain, headache, and malaise and low-grade fever. After the signs have set in, one then presents with the swelling of one or both the parotid glands. Currently, there is no treatment for the condition apart from immunizations. In cases of an advanced stage of the condition, one can develop complications like orchitis and meningitis. A person gains immunity after being infected by the condition and this has been one of the major natural control mechanisms of deaths from the condition. Pertussis Pertussis also known as whooping cough is a contagious bacterial infection affecting the respiratory track. Bordetella Pertussis causes the condition. The most common signs and symptoms of Pertussis include paroxysmal cough, fainting, inspiratory whoop or vomiting after a severe coughing. According to Centers for Disease Control and Prevention (CDC) (2011) these coughs causes rib fractures, hernias, urinary incontinence, subconjunctival hemorrhage or vertebral dissection. More violent coughing causes pneumothorax secondary to pleural rupture. Some of these complications are the primary causes of its severity and health burden in the country. Apart from immunization, the condition can be managed using antibiotic therapy erythromycin or azithromycin. Also, macrolides can be used because they present lesser side effects. With proper management and immunization of children, there is likelihood that the conditions might be eliminating from the environment. This it is of the essence that families ensure complete immunization for their children against most of the preventable infections. Apart from having their lives, it also leads to a decreased diseases burden at large. References Bhaskar, B., & Fraser, J. (2011). Negative pressure pulmonary edema revisited: Pathophysiology and review of management. Saudi Journal of Anaesthesia, 5(3), 308–313. Barry, C., Waring, J., Stapledon, R., & Konstantinos, A. (2012). Tuberculosis notifications in Australia, 2008 and 2009. Centers for Disease Control and Prevention (CDC). (2011). Epidemiology and prevention of vaccine-preventable diseases. Washington, DC: Public Health Foundation. Klein, N. P., Fireman, B., Yih, W. K., Lewis, E., Kulldorff, M., Ray, P., ... & Weintraub, E. (2010). Measles-mumps-rubella-varicella combination vaccine and the risk of febrile seizures. Pediatrics, 126(1), e1-e8. Krodel, D. J., Bittner, E. a, Abdulnour, R.-E. E., Brown, R. H., & Eikermann, M. (2011). Negative pressure pulmonary edema following bronchospasm. Chest, 140(5), 1351–4. Lemyze, M., & Mallat, J. (2014). Understanding negative pressure pulmonary edema. Intensive Care Medicine, 40(8), 1140–1143. Lumb, R., Bastian, I., Carter, R., Jelfs, P., Keehner, T., & Sievers, A. (2011). Tuberculosis in Australia: bacteriologically confirmed cases and drug resistance, 2008 and 2009 McRae, S. (2010). Pulmonary embolism. Australian Family Physician, 39(7), 462–466. Ouellette, D. W., & Patocka, C. (2012). Pulmonary Embolism. Emergency Medicine Clinics of North America. Patterson, I. Y., Robertus, L. M., Gwynne, R. A., & Gardiner, R. A. (2012). Genitourinary tuberculosis in Australia and New Zealand. BJU international, 109(s3), 27-30. Takach Lapner, S., & Kearon, C. (2013). Diagnosis and management of pulmonary embolism. BMJ (Clinical Research Ed.), 346(February), f757. World Health Organization. (2014). WHO vaccine-preventable diseases: monitoring system: 2014 global summary. Read More