MRSA

Methicillin-resistant Staphylococcus aureus (MRSA) is a type of bacteria that is resistant to certain antibiotics. These antibiotics include methicillin and other more common antibiotics such as oxacillin, penicillin and amoxicillin. Staph infections, including MRSA, occur most frequently among persons in hospitals and healthcare facilities (such as nursing homes and dialysis centers) who have weakened immune systems.

What is Respiratory Alkalosis?

Is Respiratory Alkalosis synonymous with metabolic alkalosis?

Severe Metabolic Alkalosis

Severe metabolic alkalosis (ie, blood pH >7.55) is a serious medical problem. Mortality rates have been reported as 45% in patients with an arterial blood pH of 7.55 and 80% when the pH was greater than 7.65.

Severe alkalosis causes diffuse arteriolar constriction with reduction in tissue perfusion. By decreasing cerebral blood flow, alkalosis may lead to tetany, seizures, and decreased mental status. Metabolic alkalosis also decreases coronary blood flow and predisposes persons to refractory arrhythmias.

Metabolic alkalosis causes hypoventilation, which may cause hypoxemia, especially in patients with poor respiratory reserve, and it may impair weaning from mechanical ventilation.

Alkalosis decreases the serum concentration of ionized calcium by increasing calcium ion binding to albumin. In addition, metabolic alkalosis is almost always associated with hypokalemia, which can cause neuromuscular weakness and arrhythmias, and, by increasing ammonia production, it can precipitate hepatic encephalopathy in susceptible individuals.

Tests for Review and Readings to Complete

Please note this post has been updated!

What are tachycardia and bradycardia?

Look these up!

Spring 2008 Practicum Schedule

Mondays: 8-12 Transitional Care Unit Patient Care
Tuesdays: 8-10:30 TCU Patient Care
10:30-Noon TCU Patient Care Conference
Wednesdays: 8-9 ETIVS Swallowing/Voice Rounds BSB 202
9-12 TCU Patient Care
Thursdays: 8-12 TCU Patient Care

What is an Empyema?

Look up empyema? What is it? Would it have any effect on voice and/or swallowing? Why or why not? Are empyemas usually on the right side of the body?

Adult Clinical Rotations: Student Presentation Guidelines

Adult Clinical Rotations

Student Presentation Guidelines

Description: Students will be required to present a clinical topic to the adult speech pathologists. Oral and written components are required.

Topics: Teach us something new! Maybe a disorder you had an experience with during your rotation (something we could learn more about); patient and/or family information packets; or a treatment strategy. If you decide to present a treatment strategy, please include the following information: treatment efficacy, cost efficiency, availability, reliability, etc. If you have difficulty choosing a topic, ask your supervisor for suggestions.

Written requirement: Please prepare a summarized handout for clinicians (1-2 pages) or a packet for patients/families. Include references. Do not print something directly from a website. You should organize this information on your own. If creating a Pt/family packet, provide helpful web sites, phone numbers, support groups, etc.

Oral requirement: You will be given approximately 5-7 minutes including a question-answer period. This is not a great deal of time, so plan accordingly.

Date: TBA

Location: 11th floor of Rutledge Towers (ENT conference room). Please bring your lunch.

Martin-Harris et al., 2007 JSLHR Study

The (Martin-Harris et al., 2007 study showed progressively deeper progression of the 5mL liquid bolus with progressively older subjects. At the onset of maximal hyoid motion (the onset of the pharyngeal response and the starting point for measuring stage transition or pharyngeal delay time), the mean age at which the head of the bolus tended to be at the level of the intersection of the mandibular ramus with the tongue base was about 48 years (looking at their figures-not the raw data), at the vallecular pit it was age about 60, hypopharynx = ~70, and pyriform sinuses was about 72 or 3. However (and a huge however), the ranges for each age group were very wide (meaning that the range of age at which bolus head was at the various sites at swallow onset included individuals between about 40 and 70 years). Interestingly in the second swallow, all of the "pyriform sinus" swallows occurred in patients 80 and older, if I am reading this correctly.

This study also plotted pharyngeal delay time and the plot shows confirmation of a definite lengthening in pharyngeal response onset with progressive aging.

This study is published in JSLHR (50 (3): 585) which is available to all ASHA members online (Martin-Harris et al., 2007)

James L. Coyle
University of Pittsburgh

and response from Bonnie Martin-Harris, PhD:

Dear Jim,
Thank you for citing our work and for your complete summary. I do want to point out the following that we believe was one of the most interesting
findings:

"There was, however, one 91-year-old who demonstrated this "timely and safe" position relative to the onset of the swallow. More than 25% of our sample exhibited a bolus head location in the vallecular pits at the onset of hyoid motion. The youngest of these was 26 years old, and the oldest was 89 years old. Thirteen of our participants demonstrated a bolus head location in the hypopharynx superior to the pyriform sinuses at the onset of the pharyngeal swallow. This position was represented by the young (the youngest individual in our sample was
26 years of age) and the old (the oldest individual in our sample was 97 years of age)."

There is some normal variation across ages. Clinicians must understand this variation and can only recognize the threat of related swallowing difficulties via careful evaluation of all functional components of the oropharyngeal swallowing mechanism.

Great to see this dynamic discussion.
Bonnie


Bonnie Martin-Harris, Ph.D., CCC-SLP, BRS-S Director, MUSC Evelyn Trammell Institute for Voice and Swallowing Associate Professor, Otolaryngology-Head and Neck Surgery Medical University of South Carolina
135 Rutledge Avenue
PO Box 250550
Charleston, SC 29425
Phone: (843) 792-7162
Fax: (843) 792-0546

Normal Variation in Pharyngeal Swallow Times in Elderly

Dr. Robbins' work has shown that the duration of stage transition is longer in the elderly. Translated, the bolus head (with liquids) is past the ramus of the mandible for a second or two in some cases, in healthy elderly subjects (Robbins, Hamilton, Lof, & Kempster, 1992). As you know the "top" of the valleculae lie at the plane of the mandibular ramus.

That would be Hiiemae and Palmer (1999), and Saitoh, et al., 2006. These investigators found that with solids and soft solids as well as chewed foods, the bolus head tended to lie anywhere from the valleculae to the pyriform sinuses for up to many seconds, even in non-old subjects. For this reason the measure traditionally used to indicate "pharyngeal delay" (i.e. the duration of stage transition) is no longer valid for solids (Hiiemae & Palmer, 1999; Saitoh et al., 2007).


James L. Coyle

University of Pittsburgh
References

Hiiemae, K. M. & Palmer, J. B. (1999). Food transport and bolus formation during complete feeding sequences on foods of different initial consistency. Dysphagia, 14, 31-42.
Robbins, J., Hamilton, J. W., Lof, G. L., & Kempster, G. B. (1992). Oropharyngeal swallowing in normal adults of different ages. Gastroenterology, 103, 823-829.
Saitoh, E., Shibata, S., Matsuo, K., Baba, M., Fujii, W., & Palmer, J. B. (2007). Chewing and food consistency: effects on bolus transport and swallow initiation. Dysphagia, 22, 100-107.