Paradoxical Vocal Cord And Its Effects On The Emergency Room With Symptoms Of Respiratory Distress

I have made no changes to Ms. Dahlberg's bronchodilator and inhaled corticosteroid use. She does have a prescription of prednisone at home, as she is well aware of her asthma exacerbation equivalents. She does have a history of steroid use psychosis and I advised her to initiate treatment at 40 mg per day. She should then seek further medical attention after initiating systemic steroids. She should also continue use of her current bronchodilators and inhaled corticosteroids.

"Asthma is a pulmonary disease with the following characteristics: 1) airway obstruction that is reversible in most patients either spontaneously or with treatment; 2) airway inflammation; and 3) increased airway responsiveness to a variety of stimuli" (Enright, 1996, p. 375). There presently exist many varieties of asthma that differ in the severity, means of induction, and methods of treatment. One type is exercise-induced asthma. "Exercise-induced asthma (EIA) is a temporary increase in airway resistance and acute narrowing of the airway that occurs after several minutes of strenuous exercise, usually after the exercise had ceased" (Spector, 1993, p. 571). Perfectly healthy individuals with no

• Presents with shortness of breath, difficulty in breathing, anxiety, confusion, cyanosis, tachycardia, arrhythmia, tachypnea, and hypoxemia

HPI: Margaret Elliot is a 52-year-old Caucasian female that is presenting with shortness of breath that has recently worsen. Mrs. Elliot states that her problems began 20 years ago when she had bronchitis, which she consistently has 2-3 times a year. She said that her symptoms have been getting worse the last 2.5 month, but have severely worsen over the past three days. She states that it has been restricting her daily activities and has been troubling her while sleeping lying down. She states that her symptoms improve alittle when she takes her medications. She also states that her symptoms worsen when she tries to walk across the room

Rationale: L.J. exhibits asthmatic symptoms that include shortness of breath and coughing. Moreover, daily activities trigger the shortness of breath, which could be associated with exercise-triggered asthmatic

Lungs: Clear to auscultation bilaterally. No wheezes, rales, or rhonchi. Symmetric chest expansion. Breathing nonlabored. Diminished breath sounds in all lung fields. Resonant to percussion.

Mr. Joseph is a 56-year-old has 30 smoking pack years. He was diagnosed 10 years ago with asthma/chronic bronchitis, arthritis of the knees, and congestive heart failure (CHF). Mr. Joseph weighs 350 pounds with a height of 6 feet, making his body mass index (BMI) of 47.5, much more than the recommended 25, and in fact his BMI places him in the morbid obesity classification. He takes medicines for his pulmonary conditions, along with a diuretic.

History of Present Illness: Mr. Siegel is a very pleasant 80-year-old gentleman with end stage renal disease, previously on dialysis. He is here today for a formal evaluation of progressive dyspnea on exertion that has been worsening over the last six to eight months. He states that while sitting still, he has no shortness of breath. However, with any exertion at all, he does become winded very quickly. He does note some wheeze with exertion as well as cough. Interestingly there is some association with belching, which was evaluated by GI with a negative workup. He does complain of some chest tightness, as well. Per Ira Schwartz, 's MD note, cardiology evaluation of his ongoing dyspnea is not primarily related to his heart.

A 26-year-old woman went to the emergency department complaining of shortness of breath over the previous three days that had increased in intensity (Nash & Goldfarb, 2006). The patient was at the hospital for over three hours before she was able to see a physician. The physician did a complete exam and ordered blood tests, a chest x-ray, lung scan, and electrocardiogram. The patient waited for three more hours before the physician told her that he believed she had asthma and should follow up with her primary care physician. The

• Injections of botulinum toxin to block the brain signals that cause your vocal cords to spasm. These injections need to be repeated because the effects last only 3–4

Unilateral vocal fold paralysis (UVFP) is the complete immobility of one vocal fold. According to Sapienza and Ruddy (2013), “90% of vocal fold paralysis that occurs is unilateral and caused by damage to the peripheral nervous system” (p. 189). Vocal fold paralysis is typically considered a symptom of a disease or neurologic disruption. In one study, it was found that vocal fold paralysis was caused by surgical trauma, tumors or neoplasms, unknown or idiopathic factors, trauma, central nervous system dysfunction, radiation, inflammatory, cardiovascular, and other causes (Chen, Jen, Wang, Lee, & Lin, 2007). Symptoms of unilateral vocal fold paralysis may include: aphonia, abnormal vocal quality (breathy, hoarse, and/or strained), and dysphagia. Onset of UVFP may be life altering as the individual has to find compensatory strategies for voicing or even alternative methods of communication. The individual is also left susceptible to aspiration due to the lack of airway protection. These factors make it critical to diagnose the impairment so as to provide the appropriate treatment.

Another symptom is pursed-lip breathing. People that suffer in this disease struggles to exhale completely, in an attempt to empty trapped air. Patient pursed his or her lips and leaving only a small opening. When the patient exhaled, the lips blocked the flow of air and this increases the pressure in the collapsed airways, and airways will

To begin with, asthma is defined as a chronic respiratory condition characterized by breathing symptoms of varying intensity and frequency (Plottel 2). The word symptom is defined as what the patient notices, experiences, and reports to his or her treating physician as abnormal or different from usual. Some of the Medical Textbook or “classic” symptoms of asthma may be wheezing, coughing, and abnormal dyspnea. While in the office or clinic on the other hand, some may experience an unusual awareness of breathing, uncomfortable breathing, chest pressure or a feeling of chest discomfort, wheezing or noisy breathing, labored breathing, coughing, mucus production, and breathless with exertion or effort. Dyspnea is an abnormal awareness of breathing; kind of breathless (Plottel 34). According to Plottel,

Pratter MR, Brightling CE, Boulet LP, and Irwin RS. An Empiric Integrative Approach to the Management of Cough: ACCP Evidence-Based Clinical Practice Guidelines. Chest 2006, 129(1_suppl):222S-231S. http://journal.publications.chestnet.org/data/Journals/CHEST/22039/222S.pdf

Respiratory: Lung sounds are clear on auscultation without rales, rhonchi, or wheezes. Respiration unlabored with