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Epiglottitis occurs mainly in children and is a rare form of upper respiratory tract infection in adults. Epiglottitis refers to acute inflammation and edema of the epiglottis and aryepiglottic folds. It can cause airway compromise and death, especially in children over the age of 2 years. Haemophilus influenzae type В is the most common bacterial cause. In adults, Streptococcus pneumoniae, Staphylococcus aureus, and Klebsiella species may also cause epiglottitis.Epiglottitis classically manifests with acute onset of dyspnea, dysphagia, dysphonia, and drooling. Cough is usually not a prominent feature. High fever may also be present. Adults and young children (<10 years) may have less severe symptoms. Physical examination may reveal an erythematous epiglottis. A tongue blade should not be used because it can precipitate total airway obstruction. A lateral neck radiograph may show an enlarged epiglottis (the “thumb sign”). However, even a patient with severe epiglottitis can be present with a normal appearing radiograph. An emergency consultation with an otorhinolaryngologist should be requested, and the diagnosis can be confirmed with laryngoscopy.The most important issue in the treatment of epiglottitis is to secure the airway. In children, it is recommended that intubation be performed to ensure airway patency. Intubation for adults must be decided on an individual basis, and careful observation during the first day is crucial. Antibiotics are required for the treatment of epiglottitis. Antibiotics should cover H. influenzae, S. pneumoniae, S. aureus and Klebsiella species. Appropriate choices of antibiotics include ceftriaxone, cefuroxime, cefotaxime, or ampicillin/sulbactam. Consultation with an infectious diseases physician is recommended.*39/348/5*

Comments (0) Jun 29 2011

Speaking of dependency, anyone working with alcohol-troubled people is bound to hear this one some time: “Sending someone to AA just creates another dependency.” The implication of this is that you are simply moving the dependency from the bottle to AA, and ducking the real issue. That the dependency shifts from alcohol to AA or a counselor for the newcomer is probably true. We think that is a plus. We also think no one should get stuck there. By “there,” we mean in a life-style just as alcohol-centered as before. The only difference is that the center is “not drinking” instead of “how to keep drinking.” Granted, physical health is less threatened, traumatic events are less frequent, and maybe even job and family stability have been established. Nonetheless, it is a recovery rut (maybe even a trench!). That some do get stuck is unfortunately true, but that is no reason to condemn the whole process. After all, weaning takes time, and no one implies it is easy or without the possibility of some setbacks. The infant doesn’t usually go from the breast to the coffee mug in one easy jump.Many factors probably account for the “stuckness.” One might be an “I never had it so good, so I won’t rock the boat” feeling, a real fear of letting go of the life preserver even when safely ashore. Another factor is that some recovering alcoholics, particularly those who began drinking as teenagers, have spent the bulk of their adult lives as active alcoholics. Therefore, they have no baseline of adult healthy behaviors to return to. They are confronted with gaining sobriety, growing up, and functioning as adults simultaneously. This is a tall order that can be an overwhelming prospect. To make it more manageable, it may well be tempting for these recovering alcoholics to keep their world narrowed down to alcoholism recovery. The only thing they now feel really competent to do, the only area where they have had support and a positive sense of self, is in getting sober. Giving up the status of “newcomer” to be replaced by that of “sober responsible adult” may be scary, so a relapse or drinking episode may ensue. They then can justify and ensure that they can keep doing the only thing they feel they do well—being a client, an AA newcomer, a recovering alcoholic.Another factor could be that some counselors (and some AA members) are better equipped to deal with the crisis period of getting sober than with the later issues of growth and true freedom. Time constraints are too often the cause of the counselor’s inability to encourage the letting go—stretching phase. They are quite often overwhelmed with numbers of clients truly in crisis. They simply have no time or energy to put out for the clients who are “getting along okay.” Counselors who are not content with their clients’ just getting by could aid the process by referring them to extra types of therapy and groups that promote personal exploration and growth. This is a delicate situation; the adjunctive treatments are not to be seen as substituting for whatever has worked so far. Rather, they are an addition to it, whether it is AA, individual counseling, or some other regimen.The counselor who does have time and does work with clients on a long-term basis should beware of getting stuck in back-patting behavior. The phrase, “Well, I didn’t do much today, but at least I stayed sober,” is okay once in awhile. When it becomes a client’s standard refrain, over a long period of time, it should be questioned as a satisfactory life-style. Those who work around treatment facilities are all too aware of groups of alcoholics who hang around endlessly, drinking coffee, talking to other alcoholics exclusively, and clearly going nowhere. For some who, for instance, may have suffered brain damage or some other disability, this may be the best that can be hoped for. However, we suspect that many are there simply because they are not being helped and encouraged to proceed any further. These are the alcoholics most clearly visible to the health care professionals; thus, they may be one reason for the low expectations professionals have for recovering alcoholics. They don’t see the ones who are busy, involved, highly functioning individuals. Our contention is that counselors and caregivers can increase the number of the latter and unstick more and more, if they are sensitive to this issue.*107\331\2*

Comments (0) Jun 16 2011

Complex Partial SeizuresBecause the functions located in the temporal lobe and in the frontal lobe are complex, seizures beginning there can be very complex. There are, in addition, many interconnections of both frontal and temporal lobes to areas of the brain—centrally located—that control alertness and awareness. Thus seizures beginning in the temporal or frontal lobe may alter consciousness. If they do, they are termed “complex partial seizures.”With Simple Partial OnsetA simple partial seizure may spread quickly to the areas that affect consciousness and result in staring, confusion, loss of alertness, or aimless movements. These are called complex partial seizures “with simple partial onset.” They are simple partial seizures with a secondary spread sufficiently slow so that we can recognize where they started. These seizures are most likely to begin in the temporal lobe.*71\208\8*

Comments (0) Jun 05 2011