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Airway management

2021-05-27T01:33:14Z

Shaik Aisha sultana: /* Management of the Airway in Patients with Trauma */

__NOTOC__
{{SI}}
{{CMG}}{{AE}}{{Nnasiri}}

==Overview==
''Airway management'' is the process of ensuring that there is an open pathway between a patient’s [[lung]]s and the outside world, and the [[lungs]] are safe from [[Pulmonary aspiration|aspiration]]. [[Airway]] loss is a major cause of preventable prehospital death in [[trauma]] patients. Airway management complications are common, especially in [[trauma]] patients because of associated [[pathology]], lack of complete evaluation before [[intubation]], unanticipated difficulty during ventilation and [[intubation]]. Additionally, [[trauma]] [[patients]] are at increased risk of [[airway obstruction]], aspiration, [[hypoxia]] and [[hypotension]], and [[vital sign|other unstable vital]] The providers must have skillset related to working with a variety of tools and techniques used in airway management and knowledge of the important [[anatomical]], [[physiological]], and [[pathological]] features related to the airway. They also should know the differences between the adult versus [[pediatric]] and [[neonatal]] airways as these [[anatomical]] and physiological differences are critical, impactful on patients lives and knowing these leads to effective control and management of the [[airway]]. Some of the indications for managing the [[airway]] in patients include [[respiratory failure]], altered sensorium([[Glasgow Coma Scale]] less than or equal to 8), rapid deterioration of [[mental status]], [[airway]] injury or compromise, injuries causing a high risk for [[aspiration]]-which includes all penetrating injuries to the [[abdomen]] or [[chest wall]]. Inadequate [[airway]] management may lead to [[cardiovascular]] arrest and compromise life-saving interventions in a [[trauma]] patient. Several [[airway]] control devices and techniques are available to assist [[healthcare]] providers in order to maintain the airway by [[ventilation]] and [[oxygenation]]. These include [[bag valve mask]] ([[Bag valve mask|BVM]]) [[ventilation]], direct [[laryngoscopy]] with [[endotracheal intubation]] (ETI) and adjunct [[Supraglottitis|supraglottic]] [[airway]] devices such as the [[laryngeal]] mask airway.

==Functional anatomy of the upper airway==
For a successful approach to [[airway]] management, [[health care providers]] must have knowledge of important [[anatomical]], [[physiological]], and [[pathological]] features related to the airway as well as knowledge of the various equipment and methods that can be utilized for this purpose. Also, the difference between airway management in adults, [[pediatrics]], and [[neonates]] is very critical.<ref name="pmid3056703">{{cite journal |vauthors=Morris IR |title=Functional anatomy of the upper airway |journal=Emerg. Med. Clin. North Am. |volume=6 |issue=4 |pages=639–69 |date=November 1988 |pmid=3056703 |doi= |url=}}</ref>

*The [[upper airway]] is consists of the [[pharynx]] and [[nasal]] cavities, the [[larynx]] and [[trachea]] may be included, and the [[oral cavity]] provides an alternate air entry into the [[respiratory system]].
*The nose is a bony and [[cartilage|cartilaginous]] structure attached to the facial [[skeleton]] and is divided into the two [[nasal]] cavities. The nose functions as a heater and humidifier of inspired air, it is also helps in [[phonation]] and [[vocal resonation]] and houses the [[olfactory]] receptors. The [[paranasal sinuses]] drain into the nasal cavities.
*An [[endotracheal tube]] passes through the [[nose]] or mouth into the [[trachea]] to protect the [[airway]] and achieve positive-pressure [[ventilation]]. The mouth opens posteriorly into the [[oropharynx]] and becomes part of the [[gastrointestinal system]], helps the [[digestion]] and also plays a role as an alternate pathway for [[respiration]]. It is also involved in [[phonation]].
*[[Orotracheal intubation]] can be used as an alternative to [[nasal]] [[intubation]] to achieve [[airway]] protection and maintain [[ventilation]]; but depending upon the condition of the [[patient]] and difficulty due to [[anatomical]] shape of [[upper airway]], this route may not be doable, for instance in supine unconscious persons, the backward movement of the [[tongue]] and lower [[jaw]] may cause [[airway obstruction]] and performing [[orotracheal intubation]] may not be the optimal way of managing airway.
*The [[pharynx]] is a membrane-lined cavity behind the [[mouth]] and [[nose]], extends from the base of the [[skull]] to the [[cricoid cartilage]] at the level of sixth [[cervical vertebrae]] which is an entrance to the [[esophagus]]. [[Anterior]]<nowiki/>ly it opens into the [[nasal cavity]], the [[mouth]], and the [[larynx]], which divide it into the naso-, oro-, and [[laryngopharynx]], respectively. The [[pharynx]] is involved with the act of [[swallowing]].
*The [[larynx]] consists of [[Cartilages of the larynx|cartilages]] and fibro-elastic membranes covered by a sheet of [[muscles]] and [[mucous membrane]]. It functions as an open valve in [[respiration]], helps in [[phonation]], and [[swallowing]]. The [[larynx]] extends from its entrance which is formed by the [[Aryepiglottic fold|aryepiglottic folds]], to the lower border of the [[cricoid cartilage]] till the tip of the [[epiglottis]], and bulges [[posterior]]<nowiki/>ly into the [[laryngopharynx]].
*The trachea is formed by U-shaped [[cartilaginous]] rings in anterior and [[trachealis muscle]] in [[posterior]], it extends from the lower edge of the [[cricoid cartilage]] to the [[carina]] where it divides into the [[mainstem bronchus]]. In order to place [[endotracheal tube]] in proper way, tip of the tube should be at mid [[Tracheal bronchus|tracheal]] level.

[[File:UpperRespiratorySystem.png|400px|thumb|left|upper airway system[https://commons.wikimedia.org/wiki/File:Blausen_0872_UpperRespiratorySystem.pngBlausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436.]]] 

==Recommendations for evaluation of airway==
The basic approach in airway management in the [[emergency]] setting includes:<ref name="RosenbergPhero2014">{{cite journal|last1=Rosenberg|first1=M. B|last2=Phero|first2=J. C|last3=Becker|first3=D. E|title=Essentials of Airway Management, Oxygenation, and Ventilation: Part 2: Advanced Airway Devices: Supraglottic Airways|journal=Anesthesia Progress|volume=61|issue=3|year=2014|pages=113–118|issn=0003-3006|doi=10.2344/0003-3006-61.3.113}}</ref>

:*Protection from [[aspiration]] and [[pneumonia]] related to that.
:*Providing adequate [[ventilation]] and [[oxygenation]].

Following are steps that must be considered prior to conducting airway management, these include:

:*'''History:''' An [[airway]] [[history]] should be conducted whenever it is possible before airway management in all [[patients]] to detect medical, [[surgical]], and [[anesthetic]] factors that may indicate the presence of a difficult [[airway]]. A detailed review of previous [[anesthetic]] records, if available, may provide useful information about airway management.

:*'''Physical Examination:''' An airway [[physical examination]] should be conducted before the initiation of airway management. The goal of [[physical examination]] is to detect physical characteristics that may indicate the presence of a difficult airway because an unsuccessful [[upper airway|airway]] management is associated with increase in [[mortality]] and [[morbidity]].

:*'''Additional Evaluation:''' Additional evaluation may be indicated in some [[patients]] to characterize the likelihood or nature of the anticipated difficult airway. Certain diagnostic tests (e.g., [[radiography]], [[computed tomography]] scans, [[fluoroscopy]]) can identify a variety of acquired or congenital features in patients with difficult airways

==Techniques for airway management==
The decision about whether an airway intervention is required or not is crucial for patient's [[Survival rate|survival]] and depends on first responders skills and quick assessment and decision. These crucial steps requires techniques which are used universally in order to manage [[patient]]'s airway. Following are initial evaluation methods which had been developed to assist patient's [[ventilation]] and keep the [[airway]] patent, these techniques include:<ref name="RoychoudhuryJose2016">{{cite journal|last1=Roychoudhury|first1=Ajoy|last2=Jose|first2=Anson|last3=Nagori|first3=ShakilAhmed|last4=Agarwal|first4=Bhaskar|last5=Bhutia|first5=Ongkila|title=Management of maxillofacial trauma in emergency: An update of challenges and controversies|journal=Journal of Emergencies, Trauma, and Shock|volume=9|issue=2|year=2016|pages=73|issn=0974-2700|doi=10.4103/0974-2700.179456}}</ref><ref name="pmid18946431">{{cite journal |vauthors=Agrò FE, Cataldo R, Mattei A |title=New devices and techniques for airway management |journal=Minerva Anestesiol |volume=75 |issue=3 |pages=141–9 |date=March 2009 |pmid=18946431 |doi= |url=}}</ref><ref name="pmid29560073">{{cite journal |vauthors=Gleason JM, Christian BR, Barton ED |title=Nasal Cannula Apneic Oxygenation Prevents Desaturation During Endotracheal Intubation: An Integrative Literature Review |journal=West J Emerg Med |volume=19 |issue=2 |pages=403–411 |date=March 2018 |pmid=29560073 |pmc=5851518 |doi=10.5811/westjem.2017.12.34699 |url=}}</ref><ref name="LawBroemling2013">{{cite journal|last1=Law|first1=J. Adam|last2=Broemling|first2=Natasha|last3=Cooper|first3=Richard M.|last4=Drolet|first4=Pierre|last5=Duggan|first5=Laura V.|last6=Griesdale|first6=Donald E.|last7=Hung|first7=Orlando R.|last8=Jones|first8=Philip M.|last9=Kovacs|first9=George|last10=Massey|first10=Simon|last11=Morris|first11=Ian R.|last12=Mullen|first12=Timothy|last13=Murphy|first13=Michael F.|last14=Preston|first14=Roanne|last15=Naik|first15=Viren N.|last16=Scott|first16=Jeanette|last17=Stacey|first17=Shean|last18=Turkstra|first18=Timothy P.|last19=Wong|first19=David T.|title=The difficult airway with recommendations for management – Part 1 – Difficult tracheal intubation encountered in an unconscious/induced patient|journal=Canadian Journal of Anesthesia/Journal canadien d'anesthésie|volume=60|issue=11|year=2013|pages=1089–1118|issn=0832-610X|doi=10.1007/s12630-013-0019-3}}</ref><ref name="OkuboGibo2017">{{cite journal|last1=Okubo|first1=Masashi|last2=Gibo|first2=Koichiro|last3=Hagiwara|first3=Yusuke|last4=Nakayama|first4=Yukiko|last5=Hasegawa|first5=Kohei|title=The effectiveness of rapid sequence intubation (RSI) versus non-RSI in emergency department: an analysis of multicenter prospective observational study|journal=International Journal of Emergency Medicine|volume=10|issue=1|year=2017|issn=1865-1372|doi=10.1186/s12245-017-0129-8}}</ref>

*'''Spontaneous breathing:''' When a provider is confronted with an awake [[patient]] having a patent airway. Spontaneous ventilation can be assisted through the placement of a nasal or oral airway. [[Oxygenation]] can be improved by giving [[oxygen]] via nasal [[cannula]], simple [[face mask]], or nonrebreather face mask. Unfortunately, the maximally achieved [[FiO2]] is often overestimated by care providers and [[hypoventilation]] resulting in [[hypercapnia]] cannot be normalized with increase in [[oxygen]] supply.
*'''Mouth-to-Mouth ventilation:''' Mouth-to-mouth or mouth-to-nose ventilation is a useful management technique, however, because of the risk of [[infection]] transmission it is recommended by American heart association that health care providers do "Hands-only" [[CPR]]. Proper face masks should be utilized if they are available.
*'''Bag-mask ventilation:''' It is a standard initial approach to airway management in the prehospital and [[hospital]] settings.

:*Proper preoxygenation prior to [[intubation]] and [[anesthetic]] induction provides patients with improved [[oxygenation]] and increases the time to [[hypoxemia]].
:*Bag-mask [[ventilation]] is a basic essential technique when [[endotracheal tube]] [[intubation]] is difficult, it assists for rapid [[ventilation]] and [[oxygenation]] in patients.
:*Bag-mask [[ventilation]] can be achieved by a single practitioner alone or side by side with a second care provider in an [[Operating room|emergency room or an operating room]]
:*Bag mask [[ventilation]] can also be utilized as a pressure support during spontaneous [[respiration]] in patients with decre<nowiki/>ased [[tidal volume]]<nowiki/>s and insufficient [[ventilation]], very similar to the use of [[CPAP]] or [[BiPAP]] to assist [[patients]] who are spontaneously [[breathing]] but are not adequately ventilating or oxygenating.

*'''Oropharyngeal and nasopharyngeal airways:'''

:*This is used as an adjunct device for spontaneous or [[assisted ventilation]].
:*[[Oropharyngeal]] and [[nasopharyngeal airway]]<nowiki/>s are frequently utilized by prehospital care providers to improve [[oxygenation]] and [[ventilation]].
:*These devices are frequently used until a more definitive [[airway]] is obtained, and there are several circumstances that prohibit their placement (severe head or [[facial]] injuries).

*'''Supraglottic airway devices:''' [[Supraglottic laryngeal cancer|Supraglottic]] airway (SGA) device placement is very useful to keep the [[airway]]<nowiki/>s open, it has advantages in comparison with [[endotracheal tube]] intubation, or other methods, these advantages include:<ref name="pmid27537593">{{cite journal |vauthors=Park SK, Ko G, Choi GJ, Ahn EJ, Kang H |title=Comparison between supraglottic airway devices and endotracheal tubes in patients undergoing laparoscopic surgery: A systematic review and meta-analysis |journal=Medicine (Baltimore) |volume=95 |issue=33 |pages=e4598 |date=August 2016 |pmid=27537593 |doi=10.1097/MD.0000000000004598 |url=}}</ref>

:*They act as a niche between [[bag and mask ventilation]] and endotracheal [[intubation]].
:*Requires less training than [[ETI]].
:*It is less invasive than [[ETI]].
:*It can offer better [[ventilation]] during transport than bag-mask [[ventilation]] alone.
:**[[Supraglottitis|Supraglottic]] airway devices can be used as an alternative tool in cases of failed [[intubation]].

*'''[[Endotracheal intubation]]:''' It is the gold standard for definitive airway management in the prehospital setting, and also hospital setting. It allows for positive pressure [[ventilation]], [[positive end-expiratory pressure]] (PEEP), positive pressure recruitment maneuvers, and protection from [[aspiration]].

:*'''Mallampati classification for assessment of upper airway anatomical Balance:''' It is named after the Indian-born American [[anesthesiologist]] Seshagiri Mallampati, is used to predict the ease of [[endotracheal intubation]].The test assess the distance from the [[tongue]] base to the roof of the [[mouth]] visually. It is an indirect way of assessing how the airway and predicting the difficult intubation.
:*'''Modified Mallampati Scoring:'''
:**Class I: [[Soft palate]], [[uvula]], [[fauces]], [[Pillars of the fauces|pillars]] visible.
:**Class II: [[Soft palate]], a major part of the [[uvula]], [[fauces]] visible.
:**Class III: [[Soft palate]], the base of [[uvula]] visible.
:**Class IV: Only [[hard palate]] visible.

:*'''[[Cormack-Lehane grading ]]on [[Direct laryngoscopy]]:''' This grading is used to predict the difficulty in [[intubation]] based on the structures visualised on [[laryngoscopy]]. The grade 2 was subdivided into 2a and 2b in the modified [[Cormack-Lehane classification]].
:*'''Modified [[Cormack-Lehane classification]]:'''
:**Class 1:Full view of [[glottis ]]is visible.
:**Class 2a:Partial view of [[glottis]] is visible.
:**Class 2b:Only posterior extremity of [[glottis]] or only [[arytenoid cartilages]] are seen.
:**Class 3:Only [[epiglottis]] ,but not [[glottis]] is seen.
:**Class 4:Neither of the [[glottis]] or [[epiglottis]] are seen.
 

*'''Rapid sequence intubation''':

:*[[Rapid sequence intubation]] ([[RSI|RSI)]] is a technique used for endotracheal [[intubation]] when the patient is at high risk of [[aspiration]]. For RSI to be performed, it requires two persons, first patient's lungs are preoxygenated with bag and mask . One person applies constant pressure on the [[cricoid cartilage]], occluding the [[esophagus]]. Sedative-hypnotic or an [[induction agent]] and a [[muscle relaxant]] is administered and patient's [[trachea]] is intubated, and [[cricoid pressure ]]is released after the cuff is inflated. Traditionally, [[thiopentone sodium]] and [[succinylcholine]] were used for [[RSI]], and it had an advantage that patient's airway will be relaxed and paralysed, facilitating the [[intubation] and if any unanticipated difficulty occurs, these drugs were short acting and the effect weans off quickly. There is a debate that optimal intubating conditions should be achieved first before trying to attempt [[intubation]] in the prehospital setting. Time is an important factor and critical in prehospital [[airway]] management of [[patients]], due to [[trauma]], [[cardiac arrest]], [[hypoxemia]], or [[aspiration]] risk. Administration of the [[Neuromuscular blocking agents|neuromuscular blocking agent]] is associated with a reduction in time from rapid sequence [[intubation]] administration to the end of [[intubation]] attempt.

[[File:Glidescope 02.jpg|400px|thumb|left|Photograph of an anesthesiologist using the Glidescope video laryngoscope to intubate the trachea of a morbidly obese elderly person with challenging airway anatomy[https://en.wikipedia.org/wiki/Airway_managementI (DiverDave (talk)) created this work entirely by myself. (Original uploaded on en.wikipedia)]]] 

==Management of the Airway in Patients with Trauma==
*[[Airway management]] includes maintaining a patent [[airway ]]by [[bag and mask ventilation]], using [[oroapharyngeal]] or[[ nasopharyngeal]]airways, endotracheal [[intubation]] and also management of the airway during [[extubation]] and after [[extubation]].
===[[Difficult airway]]===
*[[Difficult airway]] includes problems encountered during [[bag and mask ventilation]], like holding of [[face mask]] applying [[positive pressure ventilation]], problems with [[laryngoscopy]] and [[intubation]].
===Suspected Spinal Cord Injury===

*In [[patients]] with suspected [[trauma]], extreme caution must be taken in aligning the [[head]] and [[neck]]. The [[cervical spine]] must be maintained in a neutral mid-line position, the exception to this is physical resistance.<ref name="ThiboutotNicole2009">{{cite journal|last1=Thiboutot|first1=François|last2=Nicole|first2=Pierre C.|last3=Trépanier|first3=Claude A.|last4=Turgeon|first4=Alexis F.|last5=Lessard|first5=Martin R.|title=Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial|journal=Canadian Journal of Anesthesia/Journal Canadien d'anesthésie|volume=56|issue=6|year=2009|pages=412–418|issn=0832-610X|doi=10.1007/s12630-009-9089-7}}</ref><ref>{{cite journal|doi=10.1016/j.jclinane.2005.04.003 [Indexed for MEDLINE]}}</ref><ref name="KrishnamoorthyDagal2014">{{cite journal|last1=Krishnamoorthy|first1=Vijay|last2=Dagal|first2=Arman|last3=Austin|first3=Naola|title=Airway management in cervical spine injury|journal=International Journal of Critical Illness and Injury Science|volume=4|issue=1|year=2014|pages=50|issn=2229-5151|doi=10.4103/2229-5151.128013}}</ref><ref name="GhafoorMartin2005">{{cite journal|last1=Ghafoor|first1=Abid U.|last2=Martin|first2=Timothy W.|last3=Gopalakrishnan|first3=Senthil|last4=Viswamitra|first4=Sanjaya|title=Caring for the patients with cervical spine injuries: what have we learned?|journal=Journal of Clinical Anesthesia|volume=17|issue=8|year=2005|pages=640–649|issn=09528180|doi=10.1016/j.jclinane.2005.04.003}}</ref><ref name="SriganeshBusse2018">{{cite journal|last1=Sriganesh|first1=Kamath|last2=Busse|first2=JasonW|last3=Shanthanna|first3=Harsha|last4=Ramesh|first4=VenkatapuraJ|title=Airway management in the presence of cervical spine instability: A cross-sectional survey of the members of the Indian Society of Neuroanaesthesiology and Critical Care|journal=Indian Journal of Anaesthesia|volume=62|issue=2|year=2018|pages=115|issn=0019-5049|doi=10.4103/ija.IJA_671_17}}</ref>

*'''Neck Maneuvers During Airway Management:'''
**Immobilizing patient's [[neck]] by using sandbag-collar-tape on hardboard in a pre-hospital care setting.
**Applying pressure on cricoid with [[anterior]] half of hard [[cervical collar]] removed and another hand behind the [[posterior]] [[cervical collar]].
**Manual in-line stabilization is the technique of choice in any suspected [[cervical spine]] injury, during endotracheal intubation. In this technique, head grasped firmly at the [[mastoid process]] and the occiput.

*Traction should be avoided as it may distract the [[cervical spine]] and cause more [[neurological]] damage, even after manual in-line stabilization.

*Jaw thrust is the only basic [[airway]] opening maneuver appropriate for any [[patient]] with a suspected [[cervical spine injury]]. This method is used when head-tilt/chin-lift can be potentially dangerous to use on a patient who may have a [[cervical spine injury]]. In jaw-thrust maneuver, first care provider lifts the [[hyoid bone]] and [[tongue]] away from the [[posterior]] [[pharyngeal]] wall by pulling the [[mandible]] forward, displacing the [[tongue]] anteriorly.
*[[Suction]] and use of [[forceps]] under direct vision using a [[laryngoscope]] with the [[head]] and [[neck]] maintained in the neutral position.
*In order to minimize the risk of [[hypoxic]] damage from [[airway obstruction]] in an [[unconscious]] patient, proper positioning is done by placing patients in the [[lateral]] side with log rolling technique.

===Approach to airway management of a patient with Maxillo-Facial Injury===
[[Airway]] management of patients with [[maxillofacial]] trauma is challenging and vital because it's directly affecting the patient's survival. [[Endotracheal intubation]] is the [[Gold standard (test)|gold standard]] procedure to secure the [[airway]] in [[trauma]] [[patients]], however, in these [[patients]] passage of [[endotracheal tube]] may not be possible because the oral cavity, [[pharynx]], and [[larynx]] may be filled with [[blood]], secretions, [[soft tissue]], and [[bone]] fragments. Another reason for this is that the risk of [[aspiration]] and [[regurgitation]] is high in these patients.<ref name="BarakBahouth2015">{{cite journal|last1=Barak|first1=Michal|last2=Bahouth|first2=Hany|last3=Leiser|first3=Yoav|last4=Abu El-Naaj|first4=Imad|title=Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach|journal=BioMed Research International|volume=2015|year=2015|pages=1–9|issn=2314-6133|doi=10.1155/2015/724032}}</ref><ref name="pmid21655009">{{cite journal |vauthors=Raval CB, Rashiduddin M |title=Airway management in patients with maxillofacial trauma - A retrospective study of 177 cases |journal=Saudi J Anaesth |volume=5 |issue=1 |pages=9–14 |date=January 2011 |pmid=21655009 |pmc=3101764 |doi=10.4103/1658-354X.76476 |url=}}</ref><ref name="pmid7588664">{{cite journal |vauthors=Brimacombe J, Tucker P, Simons S |title=The laryngeal mask airway for awake diagnostic bronchoscopy. A retrospective study of 200 consecutive patients |journal=Eur J Anaesthesiol |volume=12 |issue=4 |pages=357–61 |date=July 1995 |pmid=7588664 |doi= |url=}}</ref><ref name="HsiaoPacheco-Fowler2008">{{cite journal|last1=Hsiao|first1=James|last2=Pacheco-Fowler|first2=Victor|title=Cricothyroidotomy|journal=New England Journal of Medicine|volume=358|issue=22|year=2008|pages=e25|issn=0028-4793|doi=10.1056/NEJMvcm0706755}}</ref>

*In such circumstances, there are numerous [[airway]] devices are available to rescue patients with [[maxillofacial]] injuries, some of these devices include:<ref name="BarakBahouth2015">{{cite journal|last1=Barak|first1=Michal|last2=Bahouth|first2=Hany|last3=Leiser|first3=Yoav|last4=Abu El-Naaj|first4=Imad|title=Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach|journal=BioMed Research International|volume=2015|year=2015|pages=1–9|issn=2314-6133|doi=10.1155/2015/724032}}</ref><ref name="MeyerPatel2014">{{cite journal|last1=Meyer|first1=TanyaK|last2=Patel|first2=SapnaA|title=Surgical Airway|journal=International Journal of Critical Illness and Injury Science|volume=4|issue=1|year=2014|pages=71|issn=2229-5151|doi=10.4103/2229-5151.128016}}</ref>
**Flexible [[fiberoptic]] [[bronchoscopy]] (FOB), enable an indirect view of [[vocal cords]].
**[[Laryngeal mask airway]] (LMA) may be inserted blindly since it does not require a view of the [[vocal cords]]. Another option for securing the [[airway]] in these patients is to pass the endotracheal tube after placing an LMA for them.
*Final option for establishing the airway in [[patients]] with [[maxillofacial]] injury is [[surgery]] by [[cricothyroidotomy]].
**[[Cricothyroidotomy]] also known as [[cricothyrotomy]] is a procedure done by trained [[health care providers]], they make a small [[incision]] through the skin and [[cricoid]] membrane which lies between the [[thyroid]] and [[cricoid]] [[cartilage]]<nowiki/>s, followed by inserting a [[tracheostomy tube]] to open alternative way of [[ventilation]] and [[oxygenation]] in the [[emergency]] situation which uses of [[endotracheal intubation]] is almost impossible or difficult and time-consuming.
**'''Indication for cricothyroidotomy include:'''
***Inability to secure [[airway]] through an [[endotracheal tube]]
***Major [[trauma]] to [[facial]] [[muscles]], [[pharynx]], [[larynx]].
***[[Congenital deformities]] and [[upper airway]] [[stenosis]].

*'''Contraindications for cricothyroidotomy:'''
**[[Age]], in [[pediatrics]] younger than 12 years old needle [[cricothyrotomy]] is indicated because of less potential damage to the [[larynx]] and surrounding structures.
**Massive [[trauma]] to the [[larynx]] or [[cricoid cartilage]]
**Inability to identify surface landmarks due to [[obesity]], [[cervical]] trauma.
**When [[Orotracheal intubation|orotracheal]] and [[Nasotracheal intubation|nasotracheal]] [[intubation]] are viable options
**[[Airway obstruction]] distal to [[subglottic airway]], e.g. [[tracheal stenosis]]
**[[Laryngeal cancer]]: Other than for an extreme airway [[emergency]], [[cricothyroidotomy]] must be avoided to not to seed the [[soft tissue]] of the [[neck]] with [[cancer]] cells
**[[Coagulopathy]] (other than [[emergency]] situation)

*'''Complications of cricothyroidotomy:'''
**[[Esophageal]] perforation if the blade penetrates too deeply.
**[[Subcutaneous emphysema]]
**Rupture of vital [[vessels]] such as a [[carotid artery]], excessive [[bleeding]], and [[hemorrhage]].

*'''Indications of definitive airway management in patients with maxillofacial injury:'''
**Absent spontaneous [[breathing]]
**[[Comatose]] [[patients]]([[Glasgow coma score]] < 9)
**[[Airway]] injury or [[obstruction]]
**Persistent [[oxygen saturation]] below 90%
**High risk for [[aspiration]]
**[[Systemic shock]]([[Systolic Blood Pressure Intervention|Systolic Blood Pressure]]<80mmHg)
**"Cannot intubate, cannot ventilate" situations

==Complications of airway management==

Airway management complications are common, these complications usually occur in [[intensive care units]] and [[emergency department]]<nowiki/>s, summary of airway management related complactions include:<ref name="CookMacDougall-Davis2012">{{cite journal|last1=Cook|first1=T.M.|last2=MacDougall-Davis|first2=S.R.|title=Complications and failure of airway management|journal=British Journal of Anaesthesia|volume=109|year=2012|pages=i68–i85|issn=00070912|doi=10.1093/bja/aes393}}</ref>

*[[Patient]] harm/death associated with suboptimal care
*[[Hypoxia]] is the most common cause of [[airway]]-related deaths
*[[Obesity]]
*[[Pulmonary]] [[aspiration]] remains the leading cause of airway-related [[anesthetic]] deaths
*Failure in airway management techniques

{{#ev:youtube|ycQs27YVE60}}

==Related Chapters==

*[[intubation|Intubation]]
*[[endotracheal tube|Endotracheal Tube]]
*[[laryngeal mask airway|Laryngeal Mask Airway]]
*[[oropharyngeal airway|Oropharyngeal Airway]]
*[[nasopharyngeal airway|Nasopharyngeal Airway]]
*[[Ventilation (physiology)|Ventilation]]
*[[Cricothyrotomy]]
*[[Tracheotomy]]

==References==
{{reflist|2}}
[[Category:Emergency medicine]]
[[Category:First aid]]
[[Category:anesthesia]]
[[Category:Intensive care medicine]]

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Airway management

2021-05-27T00:51:23Z

Shaik Aisha sultana: /* Techniques for airway management */

__NOTOC__
{{SI}}
{{CMG}}{{AE}}{{Nnasiri}}

==Overview==
''Airway management'' is the process of ensuring that there is an open pathway between a patient’s [[lung]]s and the outside world, and the [[lungs]] are safe from [[Pulmonary aspiration|aspiration]]. [[Airway]] loss is a major cause of preventable prehospital death in [[trauma]] patients. Airway management complications are common, especially in [[trauma]] patients because of associated [[pathology]], lack of complete evaluation before [[intubation]], unanticipated difficulty during ventilation and [[intubation]]. Additionally, [[trauma]] [[patients]] are at increased risk of [[airway obstruction]], aspiration, [[hypoxia]] and [[hypotension]], and [[vital sign|other unstable vital]] The providers must have skillset related to working with a variety of tools and techniques used in airway management and knowledge of the important [[anatomical]], [[physiological]], and [[pathological]] features related to the airway. They also should know the differences between the adult versus [[pediatric]] and [[neonatal]] airways as these [[anatomical]] and physiological differences are critical, impactful on patients lives and knowing these leads to effective control and management of the [[airway]]. Some of the indications for managing the [[airway]] in patients include [[respiratory failure]], altered sensorium([[Glasgow Coma Scale]] less than or equal to 8), rapid deterioration of [[mental status]], [[airway]] injury or compromise, injuries causing a high risk for [[aspiration]]-which includes all penetrating injuries to the [[abdomen]] or [[chest wall]]. Inadequate [[airway]] management may lead to [[cardiovascular]] arrest and compromise life-saving interventions in a [[trauma]] patient. Several [[airway]] control devices and techniques are available to assist [[healthcare]] providers in order to maintain the airway by [[ventilation]] and [[oxygenation]]. These include [[bag valve mask]] ([[Bag valve mask|BVM]]) [[ventilation]], direct [[laryngoscopy]] with [[endotracheal intubation]] (ETI) and adjunct [[Supraglottitis|supraglottic]] [[airway]] devices such as the [[laryngeal]] mask airway.

==Functional anatomy of the upper airway==
For a successful approach to [[airway]] management, [[health care providers]] must have knowledge of important [[anatomical]], [[physiological]], and [[pathological]] features related to the airway as well as knowledge of the various equipment and methods that can be utilized for this purpose. Also, the difference between airway management in adults, [[pediatrics]], and [[neonates]] is very critical.<ref name="pmid3056703">{{cite journal |vauthors=Morris IR |title=Functional anatomy of the upper airway |journal=Emerg. Med. Clin. North Am. |volume=6 |issue=4 |pages=639–69 |date=November 1988 |pmid=3056703 |doi= |url=}}</ref>

*The [[upper airway]] is consists of the [[pharynx]] and [[nasal]] cavities, the [[larynx]] and [[trachea]] may be included, and the [[oral cavity]] provides an alternate air entry into the [[respiratory system]].
*The nose is a bony and [[cartilage|cartilaginous]] structure attached to the facial [[skeleton]] and is divided into the two [[nasal]] cavities. The nose functions as a heater and humidifier of inspired air, it is also helps in [[phonation]] and [[vocal resonation]] and houses the [[olfactory]] receptors. The [[paranasal sinuses]] drain into the nasal cavities.
*An [[endotracheal tube]] passes through the [[nose]] or mouth into the [[trachea]] to protect the [[airway]] and achieve positive-pressure [[ventilation]]. The mouth opens posteriorly into the [[oropharynx]] and becomes part of the [[gastrointestinal system]], helps the [[digestion]] and also plays a role as an alternate pathway for [[respiration]]. It is also involved in [[phonation]].
*[[Orotracheal intubation]] can be used as an alternative to [[nasal]] [[intubation]] to achieve [[airway]] protection and maintain [[ventilation]]; but depending upon the condition of the [[patient]] and difficulty due to [[anatomical]] shape of [[upper airway]], this route may not be doable, for instance in supine unconscious persons, the backward movement of the [[tongue]] and lower [[jaw]] may cause [[airway obstruction]] and performing [[orotracheal intubation]] may not be the optimal way of managing airway.
*The [[pharynx]] is a membrane-lined cavity behind the [[mouth]] and [[nose]], extends from the base of the [[skull]] to the [[cricoid cartilage]] at the level of sixth [[cervical vertebrae]] which is an entrance to the [[esophagus]]. [[Anterior]]<nowiki/>ly it opens into the [[nasal cavity]], the [[mouth]], and the [[larynx]], which divide it into the naso-, oro-, and [[laryngopharynx]], respectively. The [[pharynx]] is involved with the act of [[swallowing]].
*The [[larynx]] consists of [[Cartilages of the larynx|cartilages]] and fibro-elastic membranes covered by a sheet of [[muscles]] and [[mucous membrane]]. It functions as an open valve in [[respiration]], helps in [[phonation]], and [[swallowing]]. The [[larynx]] extends from its entrance which is formed by the [[Aryepiglottic fold|aryepiglottic folds]], to the lower border of the [[cricoid cartilage]] till the tip of the [[epiglottis]], and bulges [[posterior]]<nowiki/>ly into the [[laryngopharynx]].
*The trachea is formed by U-shaped [[cartilaginous]] rings in anterior and [[trachealis muscle]] in [[posterior]], it extends from the lower edge of the [[cricoid cartilage]] to the [[carina]] where it divides into the [[mainstem bronchus]]. In order to place [[endotracheal tube]] in proper way, tip of the tube should be at mid [[Tracheal bronchus|tracheal]] level.

[[File:UpperRespiratorySystem.png|400px|thumb|left|upper airway system[https://commons.wikimedia.org/wiki/File:Blausen_0872_UpperRespiratorySystem.pngBlausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436.]]] 

==Recommendations for evaluation of airway==
The basic approach in airway management in the [[emergency]] setting includes:<ref name="RosenbergPhero2014">{{cite journal|last1=Rosenberg|first1=M. B|last2=Phero|first2=J. C|last3=Becker|first3=D. E|title=Essentials of Airway Management, Oxygenation, and Ventilation: Part 2: Advanced Airway Devices: Supraglottic Airways|journal=Anesthesia Progress|volume=61|issue=3|year=2014|pages=113–118|issn=0003-3006|doi=10.2344/0003-3006-61.3.113}}</ref>

:*Protection from [[aspiration]] and [[pneumonia]] related to that.
:*Providing adequate [[ventilation]] and [[oxygenation]].

Following are steps that must be considered prior to conducting airway management, these include:

:*'''History:''' An [[airway]] [[history]] should be conducted whenever it is possible before airway management in all [[patients]] to detect medical, [[surgical]], and [[anesthetic]] factors that may indicate the presence of a difficult [[airway]]. A detailed review of previous [[anesthetic]] records, if available, may provide useful information about airway management.

:*'''Physical Examination:''' An airway [[physical examination]] should be conducted before the initiation of airway management. The goal of [[physical examination]] is to detect physical characteristics that may indicate the presence of a difficult airway because an unsuccessful [[upper airway|airway]] management is associated with increase in [[mortality]] and [[morbidity]].

:*'''Additional Evaluation:''' Additional evaluation may be indicated in some [[patients]] to characterize the likelihood or nature of the anticipated difficult airway. Certain diagnostic tests (e.g., [[radiography]], [[computed tomography]] scans, [[fluoroscopy]]) can identify a variety of acquired or congenital features in patients with difficult airways

==Techniques for airway management==
The decision about whether an airway intervention is required or not is crucial for patient's [[Survival rate|survival]] and depends on first responders skills and quick assessment and decision. These crucial steps requires techniques which are used universally in order to manage [[patient]]'s airway. Following are initial evaluation methods which had been developed to assist patient's [[ventilation]] and keep the [[airway]] patent, these techniques include:<ref name="RoychoudhuryJose2016">{{cite journal|last1=Roychoudhury|first1=Ajoy|last2=Jose|first2=Anson|last3=Nagori|first3=ShakilAhmed|last4=Agarwal|first4=Bhaskar|last5=Bhutia|first5=Ongkila|title=Management of maxillofacial trauma in emergency: An update of challenges and controversies|journal=Journal of Emergencies, Trauma, and Shock|volume=9|issue=2|year=2016|pages=73|issn=0974-2700|doi=10.4103/0974-2700.179456}}</ref><ref name="pmid18946431">{{cite journal |vauthors=Agrò FE, Cataldo R, Mattei A |title=New devices and techniques for airway management |journal=Minerva Anestesiol |volume=75 |issue=3 |pages=141–9 |date=March 2009 |pmid=18946431 |doi= |url=}}</ref><ref name="pmid29560073">{{cite journal |vauthors=Gleason JM, Christian BR, Barton ED |title=Nasal Cannula Apneic Oxygenation Prevents Desaturation During Endotracheal Intubation: An Integrative Literature Review |journal=West J Emerg Med |volume=19 |issue=2 |pages=403–411 |date=March 2018 |pmid=29560073 |pmc=5851518 |doi=10.5811/westjem.2017.12.34699 |url=}}</ref><ref name="LawBroemling2013">{{cite journal|last1=Law|first1=J. Adam|last2=Broemling|first2=Natasha|last3=Cooper|first3=Richard M.|last4=Drolet|first4=Pierre|last5=Duggan|first5=Laura V.|last6=Griesdale|first6=Donald E.|last7=Hung|first7=Orlando R.|last8=Jones|first8=Philip M.|last9=Kovacs|first9=George|last10=Massey|first10=Simon|last11=Morris|first11=Ian R.|last12=Mullen|first12=Timothy|last13=Murphy|first13=Michael F.|last14=Preston|first14=Roanne|last15=Naik|first15=Viren N.|last16=Scott|first16=Jeanette|last17=Stacey|first17=Shean|last18=Turkstra|first18=Timothy P.|last19=Wong|first19=David T.|title=The difficult airway with recommendations for management – Part 1 – Difficult tracheal intubation encountered in an unconscious/induced patient|journal=Canadian Journal of Anesthesia/Journal canadien d'anesthésie|volume=60|issue=11|year=2013|pages=1089–1118|issn=0832-610X|doi=10.1007/s12630-013-0019-3}}</ref><ref name="OkuboGibo2017">{{cite journal|last1=Okubo|first1=Masashi|last2=Gibo|first2=Koichiro|last3=Hagiwara|first3=Yusuke|last4=Nakayama|first4=Yukiko|last5=Hasegawa|first5=Kohei|title=The effectiveness of rapid sequence intubation (RSI) versus non-RSI in emergency department: an analysis of multicenter prospective observational study|journal=International Journal of Emergency Medicine|volume=10|issue=1|year=2017|issn=1865-1372|doi=10.1186/s12245-017-0129-8}}</ref>

*'''Spontaneous breathing:''' When a provider is confronted with an awake [[patient]] having a patent airway. Spontaneous ventilation can be assisted through the placement of a nasal or oral airway. [[Oxygenation]] can be improved by giving [[oxygen]] via nasal [[cannula]], simple [[face mask]], or nonrebreather face mask. Unfortunately, the maximally achieved [[FiO2]] is often overestimated by care providers and [[hypoventilation]] resulting in [[hypercapnia]] cannot be normalized with increase in [[oxygen]] supply.
*'''Mouth-to-Mouth ventilation:''' Mouth-to-mouth or mouth-to-nose ventilation is a useful management technique, however, because of the risk of [[infection]] transmission it is recommended by American heart association that health care providers do "Hands-only" [[CPR]]. Proper face masks should be utilized if they are available.
*'''Bag-mask ventilation:''' It is a standard initial approach to airway management in the prehospital and [[hospital]] settings.

:*Proper preoxygenation prior to [[intubation]] and [[anesthetic]] induction provides patients with improved [[oxygenation]] and increases the time to [[hypoxemia]].
:*Bag-mask [[ventilation]] is a basic essential technique when [[endotracheal tube]] [[intubation]] is difficult, it assists for rapid [[ventilation]] and [[oxygenation]] in patients.
:*Bag-mask [[ventilation]] can be achieved by a single practitioner alone or side by side with a second care provider in an [[Operating room|emergency room or an operating room]]
:*Bag mask [[ventilation]] can also be utilized as a pressure support during spontaneous [[respiration]] in patients with decre<nowiki/>ased [[tidal volume]]<nowiki/>s and insufficient [[ventilation]], very similar to the use of [[CPAP]] or [[BiPAP]] to assist [[patients]] who are spontaneously [[breathing]] but are not adequately ventilating or oxygenating.

*'''Oropharyngeal and nasopharyngeal airways:'''

:*This is used as an adjunct device for spontaneous or [[assisted ventilation]].
:*[[Oropharyngeal]] and [[nasopharyngeal airway]]<nowiki/>s are frequently utilized by prehospital care providers to improve [[oxygenation]] and [[ventilation]].
:*These devices are frequently used until a more definitive [[airway]] is obtained, and there are several circumstances that prohibit their placement (severe head or [[facial]] injuries).

*'''Supraglottic airway devices:''' [[Supraglottic laryngeal cancer|Supraglottic]] airway (SGA) device placement is very useful to keep the [[airway]]<nowiki/>s open, it has advantages in comparison with [[endotracheal tube]] intubation, or other methods, these advantages include:<ref name="pmid27537593">{{cite journal |vauthors=Park SK, Ko G, Choi GJ, Ahn EJ, Kang H |title=Comparison between supraglottic airway devices and endotracheal tubes in patients undergoing laparoscopic surgery: A systematic review and meta-analysis |journal=Medicine (Baltimore) |volume=95 |issue=33 |pages=e4598 |date=August 2016 |pmid=27537593 |doi=10.1097/MD.0000000000004598 |url=}}</ref>

:*They act as a niche between [[bag and mask ventilation]] and endotracheal [[intubation]].
:*Requires less training than [[ETI]].
:*It is less invasive than [[ETI]].
:*It can offer better [[ventilation]] during transport than bag-mask [[ventilation]] alone.
:**[[Supraglottitis|Supraglottic]] airway devices can be used as an alternative tool in cases of failed [[intubation]].

*'''[[Endotracheal intubation]]:''' It is the gold standard for definitive airway management in the prehospital setting, and also hospital setting. It allows for positive pressure [[ventilation]], [[positive end-expiratory pressure]] (PEEP), positive pressure recruitment maneuvers, and protection from [[aspiration]].

:*'''Mallampati classification for assessment of upper airway anatomical Balance:''' It is named after the Indian-born American [[anesthesiologist]] Seshagiri Mallampati, is used to predict the ease of [[endotracheal intubation]].The test assess the distance from the [[tongue]] base to the roof of the [[mouth]] visually. It is an indirect way of assessing how the airway and predicting the difficult intubation.
:*'''Modified Mallampati Scoring:'''
:**Class I: [[Soft palate]], [[uvula]], [[fauces]], [[Pillars of the fauces|pillars]] visible.
:**Class II: [[Soft palate]], a major part of the [[uvula]], [[fauces]] visible.
:**Class III: [[Soft palate]], the base of [[uvula]] visible.
:**Class IV: Only [[hard palate]] visible.

:*'''[[Cormack-Lehane grading ]]on [[Direct laryngoscopy]]:''' This grading is used to predict the difficulty in [[intubation]] based on the structures visualised on [[laryngoscopy]]. The grade 2 was subdivided into 2a and 2b in the modified [[Cormack-Lehane classification]].
:*'''Modified [[Cormack-Lehane classification]]:'''
:**Class 1:Full view of [[glottis ]]is visible.
:**Class 2a:Partial view of [[glottis]] is visible.
:**Class 2b:Only posterior extremity of [[glottis]] or only [[arytenoid cartilages]] are seen.
:**Class 3:Only [[epiglottis]] ,but not [[glottis]] is seen.
:**Class 4:Neither of the [[glottis]] or [[epiglottis]] are seen.
 

*'''Rapid sequence intubation''':

:*[[Rapid sequence intubation]] ([[RSI|RSI)]] is a technique used for endotracheal [[intubation]] when the patient is at high risk of [[aspiration]]. For RSI to be performed, it requires two persons, first patient's lungs are preoxygenated with bag and mask . One person applies constant pressure on the [[cricoid cartilage]], occluding the [[esophagus]]. Sedative-hypnotic or an [[induction agent]] and a [[muscle relaxant]] is administered and patient's [[trachea]] is intubated, and [[cricoid pressure ]]is released after the cuff is inflated. Traditionally, [[thiopentone sodium]] and [[succinylcholine]] were used for [[RSI]], and it had an advantage that patient's airway will be relaxed and paralysed, facilitating the [[intubation] and if any unanticipated difficulty occurs, these drugs were short acting and the effect weans off quickly. There is a debate that optimal intubating conditions should be achieved first before trying to attempt [[intubation]] in the prehospital setting. Time is an important factor and critical in prehospital [[airway]] management of [[patients]], due to [[trauma]], [[cardiac arrest]], [[hypoxemia]], or [[aspiration]] risk. Administration of the [[Neuromuscular blocking agents|neuromuscular blocking agent]] is associated with a reduction in time from rapid sequence [[intubation]] administration to the end of [[intubation]] attempt.

[[File:Glidescope 02.jpg|400px|thumb|left|Photograph of an anesthesiologist using the Glidescope video laryngoscope to intubate the trachea of a morbidly obese elderly person with challenging airway anatomy[https://en.wikipedia.org/wiki/Airway_managementI (DiverDave (talk)) created this work entirely by myself. (Original uploaded on en.wikipedia)]]] 

==Management of the Airway in Patients with Trauma==
===Suspected Spinal Cord Injury===

*In [[patients]] with suspected [[trauma]], extreme caution must be taken in aligning the [[head]] and [[neck]]. The [[cervical spine]] must be maintained in a neutral mid-line position, the exception to this is physical resistance.<ref name="ThiboutotNicole2009">{{cite journal|last1=Thiboutot|first1=François|last2=Nicole|first2=Pierre C.|last3=Trépanier|first3=Claude A.|last4=Turgeon|first4=Alexis F.|last5=Lessard|first5=Martin R.|title=Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial|journal=Canadian Journal of Anesthesia/Journal Canadien d'anesthésie|volume=56|issue=6|year=2009|pages=412–418|issn=0832-610X|doi=10.1007/s12630-009-9089-7}}</ref><ref>{{cite journal|doi=10.1016/j.jclinane.2005.04.003 [Indexed for MEDLINE]}}</ref><ref name="KrishnamoorthyDagal2014">{{cite journal|last1=Krishnamoorthy|first1=Vijay|last2=Dagal|first2=Arman|last3=Austin|first3=Naola|title=Airway management in cervical spine injury|journal=International Journal of Critical Illness and Injury Science|volume=4|issue=1|year=2014|pages=50|issn=2229-5151|doi=10.4103/2229-5151.128013}}</ref><ref name="GhafoorMartin2005">{{cite journal|last1=Ghafoor|first1=Abid U.|last2=Martin|first2=Timothy W.|last3=Gopalakrishnan|first3=Senthil|last4=Viswamitra|first4=Sanjaya|title=Caring for the patients with cervical spine injuries: what have we learned?|journal=Journal of Clinical Anesthesia|volume=17|issue=8|year=2005|pages=640–649|issn=09528180|doi=10.1016/j.jclinane.2005.04.003}}</ref><ref name="SriganeshBusse2018">{{cite journal|last1=Sriganesh|first1=Kamath|last2=Busse|first2=JasonW|last3=Shanthanna|first3=Harsha|last4=Ramesh|first4=VenkatapuraJ|title=Airway management in the presence of cervical spine instability: A cross-sectional survey of the members of the Indian Society of Neuroanaesthesiology and Critical Care|journal=Indian Journal of Anaesthesia|volume=62|issue=2|year=2018|pages=115|issn=0019-5049|doi=10.4103/ija.IJA_671_17}}</ref>

*'''Neck Maneuvers During Airway Management:'''
**Immobilizing patient's [[neck]] by using sandbag-collar-tape on hardboard in a pre-hospital care setting.
**Applying pressure on cricoid with [[anterior]] half of hard [[cervical collar]] removed and another hand behind the [[posterior]] [[cervical collar]].
**Manual in-line stabilization is the technique of choice in any suspected [[cervical spine]] injury, during endotracheal intubation. In this technique, head grasped firmly at the [[mastoid process]] and the occiput.

*Traction should be avoided as it may distract the [[cervical spine]] and cause more [[neurological]] damage, even after manual in-line stabilization.

*Jaw thrust is the only basic [[airway]] opening maneuver appropriate for any [[patient]] with a suspected [[cervical spine injury]]. This method is used when head-tilt/chin-lift can be potentially dangerous to use on a patient who may have a [[cervical spine injury]]. In jaw-thrust maneuver, first care provider lifts the [[hyoid bone]] and [[tongue]] away from the [[posterior]] [[pharyngeal]] wall by pulling the [[mandible]] forward, displacing the [[tongue]] anteriorly.
*[[Suction]] and use of [[forceps]] under direct vision using a [[laryngoscope]] with the [[head]] and [[neck]] maintained in the neutral position.
*In order to minimize the risk of [[hypoxic]] damage from [[airway obstruction]] in an [[unconscious]] patient, proper positioning is done by placing patients in the [[lateral]] side with log rolling technique.

===Approach to airway management of a patient with Maxillo-Facial Injury===
[[Airway]] management of patients with [[maxillofacial]] trauma is challenging and vital because it's directly affecting the patient's survival. [[Endotracheal intubation]] is the [[Gold standard (test)|gold standard]] procedure to secure the [[airway]] in [[trauma]] [[patients]], however, in these [[patients]] passage of [[endotracheal tube]] may not be possible because the oral cavity, [[pharynx]], and [[larynx]] may be filled with [[blood]], secretions, [[soft tissue]], and [[bone]] fragments. Another reason for this is that the risk of [[aspiration]] and [[regurgitation]] is high in these patients.<ref name="BarakBahouth2015">{{cite journal|last1=Barak|first1=Michal|last2=Bahouth|first2=Hany|last3=Leiser|first3=Yoav|last4=Abu El-Naaj|first4=Imad|title=Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach|journal=BioMed Research International|volume=2015|year=2015|pages=1–9|issn=2314-6133|doi=10.1155/2015/724032}}</ref><ref name="pmid21655009">{{cite journal |vauthors=Raval CB, Rashiduddin M |title=Airway management in patients with maxillofacial trauma - A retrospective study of 177 cases |journal=Saudi J Anaesth |volume=5 |issue=1 |pages=9–14 |date=January 2011 |pmid=21655009 |pmc=3101764 |doi=10.4103/1658-354X.76476 |url=}}</ref><ref name="pmid7588664">{{cite journal |vauthors=Brimacombe J, Tucker P, Simons S |title=The laryngeal mask airway for awake diagnostic bronchoscopy. A retrospective study of 200 consecutive patients |journal=Eur J Anaesthesiol |volume=12 |issue=4 |pages=357–61 |date=July 1995 |pmid=7588664 |doi= |url=}}</ref><ref name="HsiaoPacheco-Fowler2008">{{cite journal|last1=Hsiao|first1=James|last2=Pacheco-Fowler|first2=Victor|title=Cricothyroidotomy|journal=New England Journal of Medicine|volume=358|issue=22|year=2008|pages=e25|issn=0028-4793|doi=10.1056/NEJMvcm0706755}}</ref>

*In such circumstances, there are numerous [[airway]] devices are available to rescue patients with [[maxillofacial]] injuries, some of these devices include:<ref name="BarakBahouth2015">{{cite journal|last1=Barak|first1=Michal|last2=Bahouth|first2=Hany|last3=Leiser|first3=Yoav|last4=Abu El-Naaj|first4=Imad|title=Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach|journal=BioMed Research International|volume=2015|year=2015|pages=1–9|issn=2314-6133|doi=10.1155/2015/724032}}</ref><ref name="MeyerPatel2014">{{cite journal|last1=Meyer|first1=TanyaK|last2=Patel|first2=SapnaA|title=Surgical Airway|journal=International Journal of Critical Illness and Injury Science|volume=4|issue=1|year=2014|pages=71|issn=2229-5151|doi=10.4103/2229-5151.128016}}</ref>
**Flexible [[fiberoptic]] [[bronchoscopy]] (FOB), enable an indirect view of [[vocal cords]].
**[[Laryngeal mask airway]] (LMA) may be inserted blindly since it does not require a view of the [[vocal cords]]. Another option for securing the [[airway]] in these patients is to pass the endotracheal tube after placing an LMA for them.
*Final option for establishing the airway in [[patients]] with [[maxillofacial]] injury is [[surgery]] by [[cricothyroidotomy]].
**[[Cricothyroidotomy]] also known as [[cricothyrotomy]] is a procedure done by trained [[health care providers]], they make a small [[incision]] through the skin and [[cricoid]] membrane which lies between the [[thyroid]] and [[cricoid]] [[cartilage]]<nowiki/>s, followed by inserting a [[tracheostomy tube]] to open alternative way of [[ventilation]] and [[oxygenation]] in the [[emergency]] situation which uses of [[endotracheal intubation]] is almost impossible or difficult and time-consuming.
**'''Indication for cricothyroidotomy include:'''
***Inability to secure [[airway]] through an [[endotracheal tube]]
***Major [[trauma]] to [[facial]] [[muscles]], [[pharynx]], [[larynx]].
***[[Congenital deformities]] and [[upper airway]] [[stenosis]].

*'''Contraindications for cricothyroidotomy:'''
**[[Age]], in [[pediatrics]] younger than 12 years old needle [[cricothyrotomy]] is indicated because of less potential damage to the [[larynx]] and surrounding structures.
**Massive [[trauma]] to the [[larynx]] or [[cricoid cartilage]]
**Inability to identify surface landmarks due to [[obesity]], [[cervical]] trauma.
**When [[Orotracheal intubation|orotracheal]] and [[Nasotracheal intubation|nasotracheal]] [[intubation]] are viable options
**[[Airway obstruction]] distal to [[subglottic airway]], e.g. [[tracheal stenosis]]
**[[Laryngeal cancer]]: Other than for an extreme airway [[emergency]], [[cricothyroidotomy]] must be avoided to not to seed the [[soft tissue]] of the [[neck]] with [[cancer]] cells
**[[Coagulopathy]] (other than [[emergency]] situation)

*'''Complications of cricothyroidotomy:'''
**[[Esophageal]] perforation if the blade penetrates too deeply.
**[[Subcutaneous emphysema]]
**Rupture of vital [[vessels]] such as a [[carotid artery]], excessive [[bleeding]], and [[hemorrhage]].

*'''Indications of definitive airway management in patients with maxillofacial injury:'''
**Absent spontaneous [[breathing]]
**[[Comatose]] [[patients]]([[Glasgow coma score]] < 9)
**[[Airway]] injury or [[obstruction]]
**Persistent [[oxygen saturation]] below 90%
**High risk for [[aspiration]]
**[[Systemic shock]]([[Systolic Blood Pressure Intervention|Systolic Blood Pressure]]<80mmHg)
**"Cannot intubate, cannot ventilate" situations

==Complications of airway management==

Airway management complications are common, these complications usually occur in [[intensive care units]] and [[emergency department]]<nowiki/>s, summary of airway management related complactions include:<ref name="CookMacDougall-Davis2012">{{cite journal|last1=Cook|first1=T.M.|last2=MacDougall-Davis|first2=S.R.|title=Complications and failure of airway management|journal=British Journal of Anaesthesia|volume=109|year=2012|pages=i68–i85|issn=00070912|doi=10.1093/bja/aes393}}</ref>

*[[Patient]] harm/death associated with suboptimal care
*[[Hypoxia]] is the most common cause of [[airway]]-related deaths
*[[Obesity]]
*[[Pulmonary]] [[aspiration]] remains the leading cause of airway-related [[anesthetic]] deaths
*Failure in airway management techniques

{{#ev:youtube|ycQs27YVE60}}

==Related Chapters==

*[[intubation|Intubation]]
*[[endotracheal tube|Endotracheal Tube]]
*[[laryngeal mask airway|Laryngeal Mask Airway]]
*[[oropharyngeal airway|Oropharyngeal Airway]]
*[[nasopharyngeal airway|Nasopharyngeal Airway]]
*[[Ventilation (physiology)|Ventilation]]
*[[Cricothyrotomy]]
*[[Tracheotomy]]

==References==
{{reflist|2}}
[[Category:Emergency medicine]]
[[Category:First aid]]
[[Category:anesthesia]]
[[Category:Intensive care medicine]]

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Airway management

2021-05-27T00:45:26Z

Shaik Aisha sultana: /* Techniques for airway management */ cormack lehane classification

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{{SI}}
{{CMG}}{{AE}}{{Nnasiri}}

==Overview==
''Airway management'' is the process of ensuring that there is an open pathway between a patient’s [[lung]]s and the outside world, and the [[lungs]] are safe from [[Pulmonary aspiration|aspiration]]. [[Airway]] loss is a major cause of preventable prehospital death in [[trauma]] patients. Airway management complications are common, especially in [[trauma]] patients because of associated [[pathology]], lack of complete evaluation before [[intubation]], unanticipated difficulty during ventilation and [[intubation]]. Additionally, [[trauma]] [[patients]] are at increased risk of [[airway obstruction]], aspiration, [[hypoxia]] and [[hypotension]], and [[vital sign|other unstable vital]] The providers must have skillset related to working with a variety of tools and techniques used in airway management and knowledge of the important [[anatomical]], [[physiological]], and [[pathological]] features related to the airway. They also should know the differences between the adult versus [[pediatric]] and [[neonatal]] airways as these [[anatomical]] and physiological differences are critical, impactful on patients lives and knowing these leads to effective control and management of the [[airway]]. Some of the indications for managing the [[airway]] in patients include [[respiratory failure]], altered sensorium([[Glasgow Coma Scale]] less than or equal to 8), rapid deterioration of [[mental status]], [[airway]] injury or compromise, injuries causing a high risk for [[aspiration]]-which includes all penetrating injuries to the [[abdomen]] or [[chest wall]]. Inadequate [[airway]] management may lead to [[cardiovascular]] arrest and compromise life-saving interventions in a [[trauma]] patient. Several [[airway]] control devices and techniques are available to assist [[healthcare]] providers in order to maintain the airway by [[ventilation]] and [[oxygenation]]. These include [[bag valve mask]] ([[Bag valve mask|BVM]]) [[ventilation]], direct [[laryngoscopy]] with [[endotracheal intubation]] (ETI) and adjunct [[Supraglottitis|supraglottic]] [[airway]] devices such as the [[laryngeal]] mask airway.

==Functional anatomy of the upper airway==
For a successful approach to [[airway]] management, [[health care providers]] must have knowledge of important [[anatomical]], [[physiological]], and [[pathological]] features related to the airway as well as knowledge of the various equipment and methods that can be utilized for this purpose. Also, the difference between airway management in adults, [[pediatrics]], and [[neonates]] is very critical.<ref name="pmid3056703">{{cite journal |vauthors=Morris IR |title=Functional anatomy of the upper airway |journal=Emerg. Med. Clin. North Am. |volume=6 |issue=4 |pages=639–69 |date=November 1988 |pmid=3056703 |doi= |url=}}</ref>

*The [[upper airway]] is consists of the [[pharynx]] and [[nasal]] cavities, the [[larynx]] and [[trachea]] may be included, and the [[oral cavity]] provides an alternate air entry into the [[respiratory system]].
*The nose is a bony and [[cartilage|cartilaginous]] structure attached to the facial [[skeleton]] and is divided into the two [[nasal]] cavities. The nose functions as a heater and humidifier of inspired air, it is also helps in [[phonation]] and [[vocal resonation]] and houses the [[olfactory]] receptors. The [[paranasal sinuses]] drain into the nasal cavities.
*An [[endotracheal tube]] passes through the [[nose]] or mouth into the [[trachea]] to protect the [[airway]] and achieve positive-pressure [[ventilation]]. The mouth opens posteriorly into the [[oropharynx]] and becomes part of the [[gastrointestinal system]], helps the [[digestion]] and also plays a role as an alternate pathway for [[respiration]]. It is also involved in [[phonation]].
*[[Orotracheal intubation]] can be used as an alternative to [[nasal]] [[intubation]] to achieve [[airway]] protection and maintain [[ventilation]]; but depending upon the condition of the [[patient]] and difficulty due to [[anatomical]] shape of [[upper airway]], this route may not be doable, for instance in supine unconscious persons, the backward movement of the [[tongue]] and lower [[jaw]] may cause [[airway obstruction]] and performing [[orotracheal intubation]] may not be the optimal way of managing airway.
*The [[pharynx]] is a membrane-lined cavity behind the [[mouth]] and [[nose]], extends from the base of the [[skull]] to the [[cricoid cartilage]] at the level of sixth [[cervical vertebrae]] which is an entrance to the [[esophagus]]. [[Anterior]]<nowiki/>ly it opens into the [[nasal cavity]], the [[mouth]], and the [[larynx]], which divide it into the naso-, oro-, and [[laryngopharynx]], respectively. The [[pharynx]] is involved with the act of [[swallowing]].
*The [[larynx]] consists of [[Cartilages of the larynx|cartilages]] and fibro-elastic membranes covered by a sheet of [[muscles]] and [[mucous membrane]]. It functions as an open valve in [[respiration]], helps in [[phonation]], and [[swallowing]]. The [[larynx]] extends from its entrance which is formed by the [[Aryepiglottic fold|aryepiglottic folds]], to the lower border of the [[cricoid cartilage]] till the tip of the [[epiglottis]], and bulges [[posterior]]<nowiki/>ly into the [[laryngopharynx]].
*The trachea is formed by U-shaped [[cartilaginous]] rings in anterior and [[trachealis muscle]] in [[posterior]], it extends from the lower edge of the [[cricoid cartilage]] to the [[carina]] where it divides into the [[mainstem bronchus]]. In order to place [[endotracheal tube]] in proper way, tip of the tube should be at mid [[Tracheal bronchus|tracheal]] level.

[[File:UpperRespiratorySystem.png|400px|thumb|left|upper airway system[https://commons.wikimedia.org/wiki/File:Blausen_0872_UpperRespiratorySystem.pngBlausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436.]]] 

==Recommendations for evaluation of airway==
The basic approach in airway management in the [[emergency]] setting includes:<ref name="RosenbergPhero2014">{{cite journal|last1=Rosenberg|first1=M. B|last2=Phero|first2=J. C|last3=Becker|first3=D. E|title=Essentials of Airway Management, Oxygenation, and Ventilation: Part 2: Advanced Airway Devices: Supraglottic Airways|journal=Anesthesia Progress|volume=61|issue=3|year=2014|pages=113–118|issn=0003-3006|doi=10.2344/0003-3006-61.3.113}}</ref>

:*Protection from [[aspiration]] and [[pneumonia]] related to that.
:*Providing adequate [[ventilation]] and [[oxygenation]].

Following are steps that must be considered prior to conducting airway management, these include:

:*'''History:''' An [[airway]] [[history]] should be conducted whenever it is possible before airway management in all [[patients]] to detect medical, [[surgical]], and [[anesthetic]] factors that may indicate the presence of a difficult [[airway]]. A detailed review of previous [[anesthetic]] records, if available, may provide useful information about airway management.

:*'''Physical Examination:''' An airway [[physical examination]] should be conducted before the initiation of airway management. The goal of [[physical examination]] is to detect physical characteristics that may indicate the presence of a difficult airway because an unsuccessful [[upper airway|airway]] management is associated with increase in [[mortality]] and [[morbidity]].

:*'''Additional Evaluation:''' Additional evaluation may be indicated in some [[patients]] to characterize the likelihood or nature of the anticipated difficult airway. Certain diagnostic tests (e.g., [[radiography]], [[computed tomography]] scans, [[fluoroscopy]]) can identify a variety of acquired or congenital features in patients with difficult airways

==Techniques for airway management==
The decision about whether an airway intervention is required or not is crucial for patient's [[Survival rate|survival]] and depends on first responders skills and quick assessment and decision. These crucial steps requires techniques which are used universally in order to manage [[patient]]'s airway. Following are initial evaluation methods which had been developed to assist patient's [[ventilation]] and keep the [[airway]] patent, these techniques include:<ref name="RoychoudhuryJose2016">{{cite journal|last1=Roychoudhury|first1=Ajoy|last2=Jose|first2=Anson|last3=Nagori|first3=ShakilAhmed|last4=Agarwal|first4=Bhaskar|last5=Bhutia|first5=Ongkila|title=Management of maxillofacial trauma in emergency: An update of challenges and controversies|journal=Journal of Emergencies, Trauma, and Shock|volume=9|issue=2|year=2016|pages=73|issn=0974-2700|doi=10.4103/0974-2700.179456}}</ref><ref name="pmid18946431">{{cite journal |vauthors=Agrò FE, Cataldo R, Mattei A |title=New devices and techniques for airway management |journal=Minerva Anestesiol |volume=75 |issue=3 |pages=141–9 |date=March 2009 |pmid=18946431 |doi= |url=}}</ref><ref name="pmid29560073">{{cite journal |vauthors=Gleason JM, Christian BR, Barton ED |title=Nasal Cannula Apneic Oxygenation Prevents Desaturation During Endotracheal Intubation: An Integrative Literature Review |journal=West J Emerg Med |volume=19 |issue=2 |pages=403–411 |date=March 2018 |pmid=29560073 |pmc=5851518 |doi=10.5811/westjem.2017.12.34699 |url=}}</ref><ref name="LawBroemling2013">{{cite journal|last1=Law|first1=J. Adam|last2=Broemling|first2=Natasha|last3=Cooper|first3=Richard M.|last4=Drolet|first4=Pierre|last5=Duggan|first5=Laura V.|last6=Griesdale|first6=Donald E.|last7=Hung|first7=Orlando R.|last8=Jones|first8=Philip M.|last9=Kovacs|first9=George|last10=Massey|first10=Simon|last11=Morris|first11=Ian R.|last12=Mullen|first12=Timothy|last13=Murphy|first13=Michael F.|last14=Preston|first14=Roanne|last15=Naik|first15=Viren N.|last16=Scott|first16=Jeanette|last17=Stacey|first17=Shean|last18=Turkstra|first18=Timothy P.|last19=Wong|first19=David T.|title=The difficult airway with recommendations for management – Part 1 – Difficult tracheal intubation encountered in an unconscious/induced patient|journal=Canadian Journal of Anesthesia/Journal canadien d'anesthésie|volume=60|issue=11|year=2013|pages=1089–1118|issn=0832-610X|doi=10.1007/s12630-013-0019-3}}</ref><ref name="OkuboGibo2017">{{cite journal|last1=Okubo|first1=Masashi|last2=Gibo|first2=Koichiro|last3=Hagiwara|first3=Yusuke|last4=Nakayama|first4=Yukiko|last5=Hasegawa|first5=Kohei|title=The effectiveness of rapid sequence intubation (RSI) versus non-RSI in emergency department: an analysis of multicenter prospective observational study|journal=International Journal of Emergency Medicine|volume=10|issue=1|year=2017|issn=1865-1372|doi=10.1186/s12245-017-0129-8}}</ref>

*'''Spontaneous breathing:''' When a provider is confronted with an awake [[patient]] having a patent airway. Spontaneous ventilation can be assisted through the placement of a nasal or oral airway. [[Oxygenation]] can be improved by giving [[oxygen]] via nasal [[cannula]], simple [[face mask]], or nonrebreather face mask. Unfortunately, the maximally achieved [[FiO2]] is often overestimated by care providers and [[hypoventilation]] resulting in [[hypercapnia]] cannot be normalized with increase in [[oxygen]] supply.
*'''Mouth-to-Mouth ventilation:''' Mouth-to-mouth or mouth-to-nose ventilation is a useful management technique, however, because of the risk of [[infection]] transmission it is recommended by American heart association that health care providers do "Hands-only" [[CPR]]. Proper face masks should be utilized if they are available.
*'''Bag-mask ventilation:''' It is a standard initial approach to airway management in the prehospital and [[hospital]] settings.

:*Proper preoxygenation prior to [[intubation]] and [[anesthetic]] induction provides patients with improved [[oxygenation]] and increases the time to [[hypoxemia]].
:*Bag-mask [[ventilation]] is a basic essential technique when [[endotracheal tube]] [[intubation]] is difficult, it assists for rapid [[ventilation]] and [[oxygenation]] in patients.
:*Bag-mask [[ventilation]] can be achieved by a single practitioner alone or side by side with a second care provider in an [[Operating room|emergency room or an operating room]]
:*Bag mask [[ventilation]] can also be utilized as a pressure support during spontaneous [[respiration]] in patients with decre<nowiki/>ased [[tidal volume]]<nowiki/>s and insufficient [[ventilation]], very similar to the use of [[CPAP]] or [[BiPAP]] to assist [[patients]] who are spontaneously [[breathing]] but are not adequately ventilating or oxygenating.

*'''Oropharyngeal and nasopharyngeal airways:'''

:*This is used as an adjunct device for spontaneous or [[assisted ventilation]].
:*[[Oropharyngeal]] and [[nasopharyngeal airway]]<nowiki/>s are frequently utilized by prehospital care providers to improve [[oxygenation]] and [[ventilation]].
:*These devices are frequently used until a more definitive [[airway]] is obtained, and there are several circumstances that prohibit their placement (severe head or [[facial]] injuries).

*'''Supraglottic airway devices:''' [[Supraglottic laryngeal cancer|Supraglottic]] airway (SGA) device placement is very useful to keep the [[airway]]<nowiki/>s open, it has advantages in comparison with [[endotracheal tube]] intubation, or other methods, these advantages include:<ref name="pmid27537593">{{cite journal |vauthors=Park SK, Ko G, Choi GJ, Ahn EJ, Kang H |title=Comparison between supraglottic airway devices and endotracheal tubes in patients undergoing laparoscopic surgery: A systematic review and meta-analysis |journal=Medicine (Baltimore) |volume=95 |issue=33 |pages=e4598 |date=August 2016 |pmid=27537593 |doi=10.1097/MD.0000000000004598 |url=}}</ref>

:*They act as a niche between bag and mask ventilation and endo tracheal intubation.
:*Requires less training than ETI
:*It is less invasive than ETI.
:*It can offer better [[ventilation]] during transport than bag-mask [[ventilation]] alone.
:**[[Supraglottitis|Supraglottic]] airway devices can be used as an alternative tool in cases of failed [[intubation]].

*'''[[Endotracheal intubation]]:''' It is the gold standard for definitive airway management in the prehospital setting, and also hospital setting. It allows for positive pressure [[ventilation]], [[positive end-expiratory pressure]] (PEEP), positive pressure recruitment maneuvers, and protection from [[aspiration]].

:*'''Mallampati classification for assessment of upper airway anatomical Balance:''' It is named after the Indian-born American [[anesthesiologist]] Seshagiri Mallampati, is used to predict the ease of [[endotracheal intubation]].The test assess the distance from the [[tongue]] base to the roof of the [[mouth]] visually. It is an indirect way of assessing how the airway and predicting the difficult intubation.
:*'''Modified Mallampati Scoring:'''
:**Class I: [[Soft palate]], [[uvula]], [[fauces]], [[Pillars of the fauces|pillars]] visible.
:**Class II: [[Soft palate]], a major part of the [[uvula]], [[fauces]] visible.
:**Class III: [[Soft palate]], the base of [[uvula]] visible.
:**Class IV: Only [[hard palate]] visible.

:*'''Cormack-Lehane grading on Direct laryngoscopy:''' This grading is used to predict the difficulty in intubation based on the structures visualised on laryngoscopy. The grade 2 was subdivided into 2a and 2b in the modified Cormack-Lehane classification.
:*'''Modified Cormack-Lehane classification:'''
:**Class 1:Full view of glottis is visible.
:**Class 2a:Partial view of glottis is visible.
:**Class 2b:Only posterior extremity of glottis oronly arytenoid cartilages are seen.
:**Class 3:Only epiglottis , but not glottis is seen.
:**Class 4:Neither of the glottis or epiglottis are seen.
 

*'''Rapid sequence intubation''':

:*[[Rapid sequence intubation]] ([[RSI|RSI)]] is a technique used for endotracheal intubation when the patient is at high risk of aspiration. For RSI to be performed, it requires two persons, first patient's lungs are preoxygenated with bag and mask . One person applies constant pressure on the cricoid cartilage, occluding the esophagus. Sedative-hypnotic or an inducing agent and a muscle relaxant is administered and patient's trachea is intubated, and cricoid pressure is released after the cuff is inflated. Traditionally, thiopentone sodium and succinylcholine were used for RSI, and it had an advantage that patient's airway will be relaxed and paralysed, facilitating the intubation and if any unanticipated difficulty occurs, these drugs were short acting and the effect weans off quickly. There is a debate that optimal intubating conditions should be achieved first before trying to attempt [[intubation]] in the prehospital setting. Time is an important factor and critical in prehospital [[airway]] management of [[patients]], due to [[trauma]], [[cardiac arrest]], [[hypoxemia]], or aspiration risk. Administration of the [[Neuromuscular blocking agents|neuromuscular blocking agent]] is associated with a reduction in time from rapid sequence [[intubation]] administration to the end of [[intubation]] attempt.

[[File:Glidescope 02.jpg|400px|thumb|left|Photograph of an anesthesiologist using the Glidescope video laryngoscope to intubate the trachea of a morbidly obese elderly person with challenging airway anatomy[https://en.wikipedia.org/wiki/Airway_managementI (DiverDave (talk)) created this work entirely by myself. (Original uploaded on en.wikipedia)]]] 

==Management of the Airway in Patients with Trauma==
===Suspected Spinal Cord Injury===

*In [[patients]] with suspected [[trauma]], extreme caution must be taken in aligning the [[head]] and [[neck]]. The [[cervical spine]] must be maintained in a neutral mid-line position, the exception to this is physical resistance.<ref name="ThiboutotNicole2009">{{cite journal|last1=Thiboutot|first1=François|last2=Nicole|first2=Pierre C.|last3=Trépanier|first3=Claude A.|last4=Turgeon|first4=Alexis F.|last5=Lessard|first5=Martin R.|title=Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial|journal=Canadian Journal of Anesthesia/Journal Canadien d'anesthésie|volume=56|issue=6|year=2009|pages=412–418|issn=0832-610X|doi=10.1007/s12630-009-9089-7}}</ref><ref>{{cite journal|doi=10.1016/j.jclinane.2005.04.003 [Indexed for MEDLINE]}}</ref><ref name="KrishnamoorthyDagal2014">{{cite journal|last1=Krishnamoorthy|first1=Vijay|last2=Dagal|first2=Arman|last3=Austin|first3=Naola|title=Airway management in cervical spine injury|journal=International Journal of Critical Illness and Injury Science|volume=4|issue=1|year=2014|pages=50|issn=2229-5151|doi=10.4103/2229-5151.128013}}</ref><ref name="GhafoorMartin2005">{{cite journal|last1=Ghafoor|first1=Abid U.|last2=Martin|first2=Timothy W.|last3=Gopalakrishnan|first3=Senthil|last4=Viswamitra|first4=Sanjaya|title=Caring for the patients with cervical spine injuries: what have we learned?|journal=Journal of Clinical Anesthesia|volume=17|issue=8|year=2005|pages=640–649|issn=09528180|doi=10.1016/j.jclinane.2005.04.003}}</ref><ref name="SriganeshBusse2018">{{cite journal|last1=Sriganesh|first1=Kamath|last2=Busse|first2=JasonW|last3=Shanthanna|first3=Harsha|last4=Ramesh|first4=VenkatapuraJ|title=Airway management in the presence of cervical spine instability: A cross-sectional survey of the members of the Indian Society of Neuroanaesthesiology and Critical Care|journal=Indian Journal of Anaesthesia|volume=62|issue=2|year=2018|pages=115|issn=0019-5049|doi=10.4103/ija.IJA_671_17}}</ref>

*'''Neck Maneuvers During Airway Management:'''
**Immobilizing patient's [[neck]] by using sandbag-collar-tape on hardboard in a pre-hospital care setting.
**Applying pressure on cricoid with [[anterior]] half of hard [[cervical collar]] removed and another hand behind the [[posterior]] [[cervical collar]].
**Manual in-line stabilization is the technique of choice in any suspected [[cervical spine]] injury, during endotracheal intubation. In this technique, head grasped firmly at the [[mastoid process]] and the occiput.

*Traction should be avoided as it may distract the [[cervical spine]] and cause more [[neurological]] damage, even after manual in-line stabilization.

*Jaw thrust is the only basic [[airway]] opening maneuver appropriate for any [[patient]] with a suspected [[cervical spine injury]]. This method is used when head-tilt/chin-lift can be potentially dangerous to use on a patient who may have a [[cervical spine injury]]. In jaw-thrust maneuver, first care provider lifts the [[hyoid bone]] and [[tongue]] away from the [[posterior]] [[pharyngeal]] wall by pulling the [[mandible]] forward, displacing the [[tongue]] anteriorly.
*[[Suction]] and use of [[forceps]] under direct vision using a [[laryngoscope]] with the [[head]] and [[neck]] maintained in the neutral position.
*In order to minimize the risk of [[hypoxic]] damage from [[airway obstruction]] in an [[unconscious]] patient, proper positioning is done by placing patients in the [[lateral]] side with log rolling technique.

===Approach to airway management of a patient with Maxillo-Facial Injury===
[[Airway]] management of patients with [[maxillofacial]] trauma is challenging and vital because it's directly affecting the patient's survival. [[Endotracheal intubation]] is the [[Gold standard (test)|gold standard]] procedure to secure the [[airway]] in [[trauma]] [[patients]], however, in these [[patients]] passage of [[endotracheal tube]] may not be possible because the oral cavity, [[pharynx]], and [[larynx]] may be filled with [[blood]], secretions, [[soft tissue]], and [[bone]] fragments. Another reason for this is that the risk of [[aspiration]] and [[regurgitation]] is high in these patients.<ref name="BarakBahouth2015">{{cite journal|last1=Barak|first1=Michal|last2=Bahouth|first2=Hany|last3=Leiser|first3=Yoav|last4=Abu El-Naaj|first4=Imad|title=Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach|journal=BioMed Research International|volume=2015|year=2015|pages=1–9|issn=2314-6133|doi=10.1155/2015/724032}}</ref><ref name="pmid21655009">{{cite journal |vauthors=Raval CB, Rashiduddin M |title=Airway management in patients with maxillofacial trauma - A retrospective study of 177 cases |journal=Saudi J Anaesth |volume=5 |issue=1 |pages=9–14 |date=January 2011 |pmid=21655009 |pmc=3101764 |doi=10.4103/1658-354X.76476 |url=}}</ref><ref name="pmid7588664">{{cite journal |vauthors=Brimacombe J, Tucker P, Simons S |title=The laryngeal mask airway for awake diagnostic bronchoscopy. A retrospective study of 200 consecutive patients |journal=Eur J Anaesthesiol |volume=12 |issue=4 |pages=357–61 |date=July 1995 |pmid=7588664 |doi= |url=}}</ref><ref name="HsiaoPacheco-Fowler2008">{{cite journal|last1=Hsiao|first1=James|last2=Pacheco-Fowler|first2=Victor|title=Cricothyroidotomy|journal=New England Journal of Medicine|volume=358|issue=22|year=2008|pages=e25|issn=0028-4793|doi=10.1056/NEJMvcm0706755}}</ref>

*In such circumstances, there are numerous [[airway]] devices are available to rescue patients with [[maxillofacial]] injuries, some of these devices include:<ref name="BarakBahouth2015">{{cite journal|last1=Barak|first1=Michal|last2=Bahouth|first2=Hany|last3=Leiser|first3=Yoav|last4=Abu El-Naaj|first4=Imad|title=Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach|journal=BioMed Research International|volume=2015|year=2015|pages=1–9|issn=2314-6133|doi=10.1155/2015/724032}}</ref><ref name="MeyerPatel2014">{{cite journal|last1=Meyer|first1=TanyaK|last2=Patel|first2=SapnaA|title=Surgical Airway|journal=International Journal of Critical Illness and Injury Science|volume=4|issue=1|year=2014|pages=71|issn=2229-5151|doi=10.4103/2229-5151.128016}}</ref>
**Flexible [[fiberoptic]] [[bronchoscopy]] (FOB), enable an indirect view of [[vocal cords]].
**[[Laryngeal mask airway]] (LMA) may be inserted blindly since it does not require a view of the [[vocal cords]]. Another option for securing the [[airway]] in these patients is to pass the endotracheal tube after placing an LMA for them.
*Final option for establishing the airway in [[patients]] with [[maxillofacial]] injury is [[surgery]] by [[cricothyroidotomy]].
**[[Cricothyroidotomy]] also known as [[cricothyrotomy]] is a procedure done by trained [[health care providers]], they make a small [[incision]] through the skin and [[cricoid]] membrane which lies between the [[thyroid]] and [[cricoid]] [[cartilage]]<nowiki/>s, followed by inserting a [[tracheostomy tube]] to open alternative way of [[ventilation]] and [[oxygenation]] in the [[emergency]] situation which uses of [[endotracheal intubation]] is almost impossible or difficult and time-consuming.
**'''Indication for cricothyroidotomy include:'''
***Inability to secure [[airway]] through an [[endotracheal tube]]
***Major [[trauma]] to [[facial]] [[muscles]], [[pharynx]], [[larynx]].
***[[Congenital deformities]] and [[upper airway]] [[stenosis]].

*'''Contraindications for cricothyroidotomy:'''
**[[Age]], in [[pediatrics]] younger than 12 years old needle [[cricothyrotomy]] is indicated because of less potential damage to the [[larynx]] and surrounding structures.
**Massive [[trauma]] to the [[larynx]] or [[cricoid cartilage]]
**Inability to identify surface landmarks due to [[obesity]], [[cervical]] trauma.
**When [[Orotracheal intubation|orotracheal]] and [[Nasotracheal intubation|nasotracheal]] [[intubation]] are viable options
**[[Airway obstruction]] distal to [[subglottic airway]], e.g. [[tracheal stenosis]]
**[[Laryngeal cancer]]: Other than for an extreme airway [[emergency]], [[cricothyroidotomy]] must be avoided to not to seed the [[soft tissue]] of the [[neck]] with [[cancer]] cells
**[[Coagulopathy]] (other than [[emergency]] situation)

*'''Complications of cricothyroidotomy:'''
**[[Esophageal]] perforation if the blade penetrates too deeply.
**[[Subcutaneous emphysema]]
**Rupture of vital [[vessels]] such as a [[carotid artery]], excessive [[bleeding]], and [[hemorrhage]].

*'''Indications of definitive airway management in patients with maxillofacial injury:'''
**Absent spontaneous [[breathing]]
**[[Comatose]] [[patients]]([[Glasgow coma score]] < 9)
**[[Airway]] injury or [[obstruction]]
**Persistent [[oxygen saturation]] below 90%
**High risk for [[aspiration]]
**[[Systemic shock]]([[Systolic Blood Pressure Intervention|Systolic Blood Pressure]]<80mmHg)
**"Cannot intubate, cannot ventilate" situations

==Complications of airway management==

Airway management complications are common, these complications usually occur in [[intensive care units]] and [[emergency department]]<nowiki/>s, summary of airway management related complactions include:<ref name="CookMacDougall-Davis2012">{{cite journal|last1=Cook|first1=T.M.|last2=MacDougall-Davis|first2=S.R.|title=Complications and failure of airway management|journal=British Journal of Anaesthesia|volume=109|year=2012|pages=i68–i85|issn=00070912|doi=10.1093/bja/aes393}}</ref>

*[[Patient]] harm/death associated with suboptimal care
*[[Hypoxia]] is the most common cause of [[airway]]-related deaths
*[[Obesity]]
*[[Pulmonary]] [[aspiration]] remains the leading cause of airway-related [[anesthetic]] deaths
*Failure in airway management techniques

{{#ev:youtube|ycQs27YVE60}}

==Related Chapters==

*[[intubation|Intubation]]
*[[endotracheal tube|Endotracheal Tube]]
*[[laryngeal mask airway|Laryngeal Mask Airway]]
*[[oropharyngeal airway|Oropharyngeal Airway]]
*[[nasopharyngeal airway|Nasopharyngeal Airway]]
*[[Ventilation (physiology)|Ventilation]]
*[[Cricothyrotomy]]
*[[Tracheotomy]]

==References==
{{reflist|2}}
[[Category:Emergency medicine]]
[[Category:First aid]]
[[Category:anesthesia]]
[[Category:Intensive care medicine]]

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Airway management

2021-05-27T00:38:36Z

Shaik Aisha sultana: /* Techniques for airway management */ cormack lehane classification

__NOTOC__
{{SI}}
{{CMG}}{{AE}}{{Nnasiri}}

==Overview==
''Airway management'' is the process of ensuring that there is an open pathway between a patient’s [[lung]]s and the outside world, and the [[lungs]] are safe from [[Pulmonary aspiration|aspiration]]. [[Airway]] loss is a major cause of preventable prehospital death in [[trauma]] patients. Airway management complications are common, especially in [[trauma]] patients because of associated [[pathology]], lack of complete evaluation before [[intubation]], unanticipated difficulty during ventilation and [[intubation]]. Additionally, [[trauma]] [[patients]] are at increased risk of [[airway obstruction]], aspiration, [[hypoxia]] and [[hypotension]], and [[vital sign|other unstable vital]] The providers must have skillset related to working with a variety of tools and techniques used in airway management and knowledge of the important [[anatomical]], [[physiological]], and [[pathological]] features related to the airway. They also should know the differences between the adult versus [[pediatric]] and [[neonatal]] airways as these [[anatomical]] and physiological differences are critical, impactful on patients lives and knowing these leads to effective control and management of the [[airway]]. Some of the indications for managing the [[airway]] in patients include [[respiratory failure]], altered sensorium([[Glasgow Coma Scale]] less than or equal to 8), rapid deterioration of [[mental status]], [[airway]] injury or compromise, injuries causing a high risk for [[aspiration]]-which includes all penetrating injuries to the [[abdomen]] or [[chest wall]]. Inadequate [[airway]] management may lead to [[cardiovascular]] arrest and compromise life-saving interventions in a [[trauma]] patient. Several [[airway]] control devices and techniques are available to assist [[healthcare]] providers in order to maintain the airway by [[ventilation]] and [[oxygenation]]. These include [[bag valve mask]] ([[Bag valve mask|BVM]]) [[ventilation]], direct [[laryngoscopy]] with [[endotracheal intubation]] (ETI) and adjunct [[Supraglottitis|supraglottic]] [[airway]] devices such as the [[laryngeal]] mask airway.

==Functional anatomy of the upper airway==
For a successful approach to [[airway]] management, [[health care providers]] must have knowledge of important [[anatomical]], [[physiological]], and [[pathological]] features related to the airway as well as knowledge of the various equipment and methods that can be utilized for this purpose. Also, the difference between airway management in adults, [[pediatrics]], and [[neonates]] is very critical.<ref name="pmid3056703">{{cite journal |vauthors=Morris IR |title=Functional anatomy of the upper airway |journal=Emerg. Med. Clin. North Am. |volume=6 |issue=4 |pages=639–69 |date=November 1988 |pmid=3056703 |doi= |url=}}</ref>

*The [[upper airway]] is consists of the [[pharynx]] and [[nasal]] cavities, the [[larynx]] and [[trachea]] may be included, and the [[oral cavity]] provides an alternate air entry into the [[respiratory system]].
*The nose is a bony and [[cartilage|cartilaginous]] structure attached to the facial [[skeleton]] and is divided into the two [[nasal]] cavities. The nose functions as a heater and humidifier of inspired air, it is also helps in [[phonation]] and [[vocal resonation]] and houses the [[olfactory]] receptors. The [[paranasal sinuses]] drain into the nasal cavities.
*An [[endotracheal tube]] passes through the [[nose]] or mouth into the [[trachea]] to protect the [[airway]] and achieve positive-pressure [[ventilation]]. The mouth opens posteriorly into the [[oropharynx]] and becomes part of the [[gastrointestinal system]], helps the [[digestion]] and also plays a role as an alternate pathway for [[respiration]]. It is also involved in [[phonation]].
*[[Orotracheal intubation]] can be used as an alternative to [[nasal]] [[intubation]] to achieve [[airway]] protection and maintain [[ventilation]]; but depending upon the condition of the [[patient]] and difficulty due to [[anatomical]] shape of [[upper airway]], this route may not be doable, for instance in supine unconscious persons, the backward movement of the [[tongue]] and lower [[jaw]] may cause [[airway obstruction]] and performing [[orotracheal intubation]] may not be the optimal way of managing airway.
*The [[pharynx]] is a membrane-lined cavity behind the [[mouth]] and [[nose]], extends from the base of the [[skull]] to the [[cricoid cartilage]] at the level of sixth [[cervical vertebrae]] which is an entrance to the [[esophagus]]. [[Anterior]]<nowiki/>ly it opens into the [[nasal cavity]], the [[mouth]], and the [[larynx]], which divide it into the naso-, oro-, and [[laryngopharynx]], respectively. The [[pharynx]] is involved with the act of [[swallowing]].
*The [[larynx]] consists of [[Cartilages of the larynx|cartilages]] and fibro-elastic membranes covered by a sheet of [[muscles]] and [[mucous membrane]]. It functions as an open valve in [[respiration]], helps in [[phonation]], and [[swallowing]]. The [[larynx]] extends from its entrance which is formed by the [[Aryepiglottic fold|aryepiglottic folds]], to the lower border of the [[cricoid cartilage]] till the tip of the [[epiglottis]], and bulges [[posterior]]<nowiki/>ly into the [[laryngopharynx]].
*The trachea is formed by U-shaped [[cartilaginous]] rings in anterior and [[trachealis muscle]] in [[posterior]], it extends from the lower edge of the [[cricoid cartilage]] to the [[carina]] where it divides into the [[mainstem bronchus]]. In order to place [[endotracheal tube]] in proper way, tip of the tube should be at mid [[Tracheal bronchus|tracheal]] level.

[[File:UpperRespiratorySystem.png|400px|thumb|left|upper airway system[https://commons.wikimedia.org/wiki/File:Blausen_0872_UpperRespiratorySystem.pngBlausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436.]]] 

==Recommendations for evaluation of airway==
The basic approach in airway management in the [[emergency]] setting includes:<ref name="RosenbergPhero2014">{{cite journal|last1=Rosenberg|first1=M. B|last2=Phero|first2=J. C|last3=Becker|first3=D. E|title=Essentials of Airway Management, Oxygenation, and Ventilation: Part 2: Advanced Airway Devices: Supraglottic Airways|journal=Anesthesia Progress|volume=61|issue=3|year=2014|pages=113–118|issn=0003-3006|doi=10.2344/0003-3006-61.3.113}}</ref>

:*Protection from [[aspiration]] and [[pneumonia]] related to that.
:*Providing adequate [[ventilation]] and [[oxygenation]].

Following are steps that must be considered prior to conducting airway management, these include:

:*'''History:''' An [[airway]] [[history]] should be conducted whenever it is possible before airway management in all [[patients]] to detect medical, [[surgical]], and [[anesthetic]] factors that may indicate the presence of a difficult [[airway]]. A detailed review of previous [[anesthetic]] records, if available, may provide useful information about airway management.

:*'''Physical Examination:''' An airway [[physical examination]] should be conducted before the initiation of airway management. The goal of [[physical examination]] is to detect physical characteristics that may indicate the presence of a difficult airway because an unsuccessful [[upper airway|airway]] management is associated with increase in [[mortality]] and [[morbidity]].

:*'''Additional Evaluation:''' Additional evaluation may be indicated in some [[patients]] to characterize the likelihood or nature of the anticipated difficult airway. Certain diagnostic tests (e.g., [[radiography]], [[computed tomography]] scans, [[fluoroscopy]]) can identify a variety of acquired or congenital features in patients with difficult airways

==Techniques for airway management==
The decision about whether an airway intervention is required or not is crucial for patient's [[Survival rate|survival]] and depends on first responders skills and quick assessment and decision. These crucial steps requires techniques which are used universally in order to manage [[patient]]'s airway. Following are initial evaluation methods which had been developed to assist patient's [[ventilation]] and keep the [[airway]] patent, these techniques include:<ref name="RoychoudhuryJose2016">{{cite journal|last1=Roychoudhury|first1=Ajoy|last2=Jose|first2=Anson|last3=Nagori|first3=ShakilAhmed|last4=Agarwal|first4=Bhaskar|last5=Bhutia|first5=Ongkila|title=Management of maxillofacial trauma in emergency: An update of challenges and controversies|journal=Journal of Emergencies, Trauma, and Shock|volume=9|issue=2|year=2016|pages=73|issn=0974-2700|doi=10.4103/0974-2700.179456}}</ref><ref name="pmid18946431">{{cite journal |vauthors=Agrò FE, Cataldo R, Mattei A |title=New devices and techniques for airway management |journal=Minerva Anestesiol |volume=75 |issue=3 |pages=141–9 |date=March 2009 |pmid=18946431 |doi= |url=}}</ref><ref name="pmid29560073">{{cite journal |vauthors=Gleason JM, Christian BR, Barton ED |title=Nasal Cannula Apneic Oxygenation Prevents Desaturation During Endotracheal Intubation: An Integrative Literature Review |journal=West J Emerg Med |volume=19 |issue=2 |pages=403–411 |date=March 2018 |pmid=29560073 |pmc=5851518 |doi=10.5811/westjem.2017.12.34699 |url=}}</ref><ref name="LawBroemling2013">{{cite journal|last1=Law|first1=J. Adam|last2=Broemling|first2=Natasha|last3=Cooper|first3=Richard M.|last4=Drolet|first4=Pierre|last5=Duggan|first5=Laura V.|last6=Griesdale|first6=Donald E.|last7=Hung|first7=Orlando R.|last8=Jones|first8=Philip M.|last9=Kovacs|first9=George|last10=Massey|first10=Simon|last11=Morris|first11=Ian R.|last12=Mullen|first12=Timothy|last13=Murphy|first13=Michael F.|last14=Preston|first14=Roanne|last15=Naik|first15=Viren N.|last16=Scott|first16=Jeanette|last17=Stacey|first17=Shean|last18=Turkstra|first18=Timothy P.|last19=Wong|first19=David T.|title=The difficult airway with recommendations for management – Part 1 – Difficult tracheal intubation encountered in an unconscious/induced patient|journal=Canadian Journal of Anesthesia/Journal canadien d'anesthésie|volume=60|issue=11|year=2013|pages=1089–1118|issn=0832-610X|doi=10.1007/s12630-013-0019-3}}</ref><ref name="OkuboGibo2017">{{cite journal|last1=Okubo|first1=Masashi|last2=Gibo|first2=Koichiro|last3=Hagiwara|first3=Yusuke|last4=Nakayama|first4=Yukiko|last5=Hasegawa|first5=Kohei|title=The effectiveness of rapid sequence intubation (RSI) versus non-RSI in emergency department: an analysis of multicenter prospective observational study|journal=International Journal of Emergency Medicine|volume=10|issue=1|year=2017|issn=1865-1372|doi=10.1186/s12245-017-0129-8}}</ref>

*'''Spontaneous breathing:''' When a provider is confronted with an awake [[patient]] having a patent airway. Spontaneous ventilation can be assisted through the placement of a nasal or oral airway. [[Oxygenation]] can be improved by giving [[oxygen]] via nasal [[cannula]], simple [[face mask]], or nonrebreather face mask. Unfortunately, the maximally achieved [[FiO2]] is often overestimated by care providers and [[hypoventilation]] resulting in [[hypercapnia]] cannot be normalized with increase in [[oxygen]] supply.
*'''Mouth-to-Mouth ventilation:''' Mouth-to-mouth or mouth-to-nose ventilation is a useful management technique, however, because of the risk of [[infection]] transmission it is recommended by American heart association that health care providers do "Hands-only" [[CPR]]. Proper face masks should be utilized if they are available.
*'''Bag-mask ventilation:''' It is a standard initial approach to airway management in the prehospital and [[hospital]] settings.

:*Proper preoxygenation prior to [[intubation]] and [[anesthetic]] induction provides patients with improved [[oxygenation]] and increases the time to [[hypoxemia]].
:*Bag-mask [[ventilation]] is a basic essential technique when [[endotracheal tube]] [[intubation]] is difficult, it assists for rapid [[ventilation]] and [[oxygenation]] in patients.
:*Bag-mask [[ventilation]] can be achieved by a single practitioner alone or side by side with a second care provider in an [[Operating room|emergency room or an operating room]]
:*Bag mask [[ventilation]] can also be utilized as a pressure support during spontaneous [[respiration]] in patients with decre<nowiki/>ased [[tidal volume]]<nowiki/>s and insufficient [[ventilation]], very similar to the use of [[CPAP]] or [[BiPAP]] to assist [[patients]] who are spontaneously [[breathing]] but are not adequately ventilating or oxygenating.

*'''Oropharyngeal and nasopharyngeal airways:'''

:*This is used as an adjunct device for spontaneous or [[assisted ventilation]].
:*[[Oropharyngeal]] and [[nasopharyngeal airway]]<nowiki/>s are frequently utilized by prehospital care providers to improve [[oxygenation]] and [[ventilation]].
:*These devices are frequently used until a more definitive [[airway]] is obtained, and there are several circumstances that prohibit their placement (severe head or [[facial]] injuries).

*'''Supraglottic airway devices:''' [[Supraglottic laryngeal cancer|Supraglottic]] airway (SGA) device placement is very useful to keep the [[airway]]<nowiki/>s open, it has advantages in comparison with [[endotracheal tube]] intubation, or other methods, these advantages include:<ref name="pmid27537593">{{cite journal |vauthors=Park SK, Ko G, Choi GJ, Ahn EJ, Kang H |title=Comparison between supraglottic airway devices and endotracheal tubes in patients undergoing laparoscopic surgery: A systematic review and meta-analysis |journal=Medicine (Baltimore) |volume=95 |issue=33 |pages=e4598 |date=August 2016 |pmid=27537593 |doi=10.1097/MD.0000000000004598 |url=}}</ref>

:*They act as a niche between bag and mask ventilation and endo tracheal intubation.
:*Requires less training than ETI
:*It is less invasive than ETI.
:*It can offer better [[ventilation]] during transport than bag-mask [[ventilation]] alone.
:**[[Supraglottitis|Supraglottic]] airway devices can be used as an alternative tool in cases of failed [[intubation]].

*'''[[Endotracheal intubation]]:''' It is the gold standard for definitive airway management in the prehospital setting, and also hospital setting. It allows for positive pressure [[ventilation]], [[positive end-expiratory pressure]] (PEEP), positive pressure recruitment maneuvers, and protection from [[aspiration]].

:*'''Mallampati classification for assessment of upper airway anatomical Balance:''' It is named after the Indian-born American [[anesthesiologist]] Seshagiri Mallampati, is used to predict the ease of [[endotracheal intubation]].The test assess the distance from the [[tongue]] base to the roof of the [[mouth]] visually. It is an indirect way of assessing how the airway and predicting the difficult intubation.
:*'''Modified Mallampati Scoring:'''
:**Class I: [[Soft palate]], [[uvula]], [[fauces]], [[Pillars of the fauces|pillars]] visible.
:**Class II: [[Soft palate]], a major part of the [[uvula]], [[fauces]] visible.
:**Class III: [[Soft palate]], the base of [[uvula]] visible.
:**Class IV: Only [[hard palate]] visible.

'''Cormack-Lehane grading on Direct laryngoscopy''': This grading is used to predict the difficulty in intubation based on the structures visualised on laryngoscopy. The grade 2 was subdivided into 2a and 2b in the modified Cormack-Lehane classification.

 

*'''Rapid sequence intubation''':

:*[[Rapid sequence intubation]] ([[RSI|RSI)]] is a technique used for endotracheal intubation when the patient is at high risk of aspiration. For RSI to be performed, it requires two persons, first patient's lungs are preoxygenated with bag and mask . One person applies constant pressure on the cricoid cartilage, occluding the esophagus. Sedative-hypnotic or an inducing agent and a muscle relaxant is administered and patient's trachea is intubated, and cricoid pressure is released after the cuff is inflated. Traditionally, thiopentone sodium and succinylcholine were used for RSI, and it had an advantage that patient's airway will be relaxed and paralysed, facilitating the intubation and if any unanticipated difficulty occurs, these drugs were short acting and the effect weans off quickly. There is a debate that optimal intubating conditions should be achieved first before trying to attempt [[intubation]] in the prehospital setting. Time is an important factor and critical in prehospital [[airway]] management of [[patients]], due to [[trauma]], [[cardiac arrest]], [[hypoxemia]], or aspiration risk. Administration of the [[Neuromuscular blocking agents|neuromuscular blocking agent]] is associated with a reduction in time from rapid sequence [[intubation]] administration to the end of [[intubation]] attempt.

[[File:Glidescope 02.jpg|400px|thumb|left|Photograph of an anesthesiologist using the Glidescope video laryngoscope to intubate the trachea of a morbidly obese elderly person with challenging airway anatomy[https://en.wikipedia.org/wiki/Airway_managementI (DiverDave (talk)) created this work entirely by myself. (Original uploaded on en.wikipedia)]]] 

==Management of the Airway in Patients with Trauma==
===Suspected Spinal Cord Injury===

*In [[patients]] with suspected [[trauma]], extreme caution must be taken in aligning the [[head]] and [[neck]]. The [[cervical spine]] must be maintained in a neutral mid-line position, the exception to this is physical resistance.<ref name="ThiboutotNicole2009">{{cite journal|last1=Thiboutot|first1=François|last2=Nicole|first2=Pierre C.|last3=Trépanier|first3=Claude A.|last4=Turgeon|first4=Alexis F.|last5=Lessard|first5=Martin R.|title=Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial|journal=Canadian Journal of Anesthesia/Journal Canadien d'anesthésie|volume=56|issue=6|year=2009|pages=412–418|issn=0832-610X|doi=10.1007/s12630-009-9089-7}}</ref><ref>{{cite journal|doi=10.1016/j.jclinane.2005.04.003 [Indexed for MEDLINE]}}</ref><ref name="KrishnamoorthyDagal2014">{{cite journal|last1=Krishnamoorthy|first1=Vijay|last2=Dagal|first2=Arman|last3=Austin|first3=Naola|title=Airway management in cervical spine injury|journal=International Journal of Critical Illness and Injury Science|volume=4|issue=1|year=2014|pages=50|issn=2229-5151|doi=10.4103/2229-5151.128013}}</ref><ref name="GhafoorMartin2005">{{cite journal|last1=Ghafoor|first1=Abid U.|last2=Martin|first2=Timothy W.|last3=Gopalakrishnan|first3=Senthil|last4=Viswamitra|first4=Sanjaya|title=Caring for the patients with cervical spine injuries: what have we learned?|journal=Journal of Clinical Anesthesia|volume=17|issue=8|year=2005|pages=640–649|issn=09528180|doi=10.1016/j.jclinane.2005.04.003}}</ref><ref name="SriganeshBusse2018">{{cite journal|last1=Sriganesh|first1=Kamath|last2=Busse|first2=JasonW|last3=Shanthanna|first3=Harsha|last4=Ramesh|first4=VenkatapuraJ|title=Airway management in the presence of cervical spine instability: A cross-sectional survey of the members of the Indian Society of Neuroanaesthesiology and Critical Care|journal=Indian Journal of Anaesthesia|volume=62|issue=2|year=2018|pages=115|issn=0019-5049|doi=10.4103/ija.IJA_671_17}}</ref>

*'''Neck Maneuvers During Airway Management:'''
**Immobilizing patient's [[neck]] by using sandbag-collar-tape on hardboard in a pre-hospital care setting.
**Applying pressure on cricoid with [[anterior]] half of hard [[cervical collar]] removed and another hand behind the [[posterior]] [[cervical collar]].
**Manual in-line stabilization is the technique of choice in any suspected [[cervical spine]] injury, during endotracheal intubation. In this technique, head grasped firmly at the [[mastoid process]] and the occiput.

*Traction should be avoided as it may distract the [[cervical spine]] and cause more [[neurological]] damage, even after manual in-line stabilization.

*Jaw thrust is the only basic [[airway]] opening maneuver appropriate for any [[patient]] with a suspected [[cervical spine injury]]. This method is used when head-tilt/chin-lift can be potentially dangerous to use on a patient who may have a [[cervical spine injury]]. In jaw-thrust maneuver, first care provider lifts the [[hyoid bone]] and [[tongue]] away from the [[posterior]] [[pharyngeal]] wall by pulling the [[mandible]] forward, displacing the [[tongue]] anteriorly.
*[[Suction]] and use of [[forceps]] under direct vision using a [[laryngoscope]] with the [[head]] and [[neck]] maintained in the neutral position.
*In order to minimize the risk of [[hypoxic]] damage from [[airway obstruction]] in an [[unconscious]] patient, proper positioning is done by placing patients in the [[lateral]] side with log rolling technique.

===Approach to airway management of a patient with Maxillo-Facial Injury===
[[Airway]] management of patients with [[maxillofacial]] trauma is challenging and vital because it's directly affecting the patient's survival. [[Endotracheal intubation]] is the [[Gold standard (test)|gold standard]] procedure to secure the [[airway]] in [[trauma]] [[patients]], however, in these [[patients]] passage of [[endotracheal tube]] may not be possible because the oral cavity, [[pharynx]], and [[larynx]] may be filled with [[blood]], secretions, [[soft tissue]], and [[bone]] fragments. Another reason for this is that the risk of [[aspiration]] and [[regurgitation]] is high in these patients.<ref name="BarakBahouth2015">{{cite journal|last1=Barak|first1=Michal|last2=Bahouth|first2=Hany|last3=Leiser|first3=Yoav|last4=Abu El-Naaj|first4=Imad|title=Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach|journal=BioMed Research International|volume=2015|year=2015|pages=1–9|issn=2314-6133|doi=10.1155/2015/724032}}</ref><ref name="pmid21655009">{{cite journal |vauthors=Raval CB, Rashiduddin M |title=Airway management in patients with maxillofacial trauma - A retrospective study of 177 cases |journal=Saudi J Anaesth |volume=5 |issue=1 |pages=9–14 |date=January 2011 |pmid=21655009 |pmc=3101764 |doi=10.4103/1658-354X.76476 |url=}}</ref><ref name="pmid7588664">{{cite journal |vauthors=Brimacombe J, Tucker P, Simons S |title=The laryngeal mask airway for awake diagnostic bronchoscopy. A retrospective study of 200 consecutive patients |journal=Eur J Anaesthesiol |volume=12 |issue=4 |pages=357–61 |date=July 1995 |pmid=7588664 |doi= |url=}}</ref><ref name="HsiaoPacheco-Fowler2008">{{cite journal|last1=Hsiao|first1=James|last2=Pacheco-Fowler|first2=Victor|title=Cricothyroidotomy|journal=New England Journal of Medicine|volume=358|issue=22|year=2008|pages=e25|issn=0028-4793|doi=10.1056/NEJMvcm0706755}}</ref>

*In such circumstances, there are numerous [[airway]] devices are available to rescue patients with [[maxillofacial]] injuries, some of these devices include:<ref name="BarakBahouth2015">{{cite journal|last1=Barak|first1=Michal|last2=Bahouth|first2=Hany|last3=Leiser|first3=Yoav|last4=Abu El-Naaj|first4=Imad|title=Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach|journal=BioMed Research International|volume=2015|year=2015|pages=1–9|issn=2314-6133|doi=10.1155/2015/724032}}</ref><ref name="MeyerPatel2014">{{cite journal|last1=Meyer|first1=TanyaK|last2=Patel|first2=SapnaA|title=Surgical Airway|journal=International Journal of Critical Illness and Injury Science|volume=4|issue=1|year=2014|pages=71|issn=2229-5151|doi=10.4103/2229-5151.128016}}</ref>
**Flexible [[fiberoptic]] [[bronchoscopy]] (FOB), enable an indirect view of [[vocal cords]].
**[[Laryngeal mask airway]] (LMA) may be inserted blindly since it does not require a view of the [[vocal cords]]. Another option for securing the [[airway]] in these patients is to pass the endotracheal tube after placing an LMA for them.
*Final option for establishing the airway in [[patients]] with [[maxillofacial]] injury is [[surgery]] by [[cricothyroidotomy]].
**[[Cricothyroidotomy]] also known as [[cricothyrotomy]] is a procedure done by trained [[health care providers]], they make a small [[incision]] through the skin and [[cricoid]] membrane which lies between the [[thyroid]] and [[cricoid]] [[cartilage]]<nowiki/>s, followed by inserting a [[tracheostomy tube]] to open alternative way of [[ventilation]] and [[oxygenation]] in the [[emergency]] situation which uses of [[endotracheal intubation]] is almost impossible or difficult and time-consuming.
**'''Indication for cricothyroidotomy include:'''
***Inability to secure [[airway]] through an [[endotracheal tube]]
***Major [[trauma]] to [[facial]] [[muscles]], [[pharynx]], [[larynx]].
***[[Congenital deformities]] and [[upper airway]] [[stenosis]].

*'''Contraindications for cricothyroidotomy:'''
**[[Age]], in [[pediatrics]] younger than 12 years old needle [[cricothyrotomy]] is indicated because of less potential damage to the [[larynx]] and surrounding structures.
**Massive [[trauma]] to the [[larynx]] or [[cricoid cartilage]]
**Inability to identify surface landmarks due to [[obesity]], [[cervical]] trauma.
**When [[Orotracheal intubation|orotracheal]] and [[Nasotracheal intubation|nasotracheal]] [[intubation]] are viable options
**[[Airway obstruction]] distal to [[subglottic airway]], e.g. [[tracheal stenosis]]
**[[Laryngeal cancer]]: Other than for an extreme airway [[emergency]], [[cricothyroidotomy]] must be avoided to not to seed the [[soft tissue]] of the [[neck]] with [[cancer]] cells
**[[Coagulopathy]] (other than [[emergency]] situation)

*'''Complications of cricothyroidotomy:'''
**[[Esophageal]] perforation if the blade penetrates too deeply.
**[[Subcutaneous emphysema]]
**Rupture of vital [[vessels]] such as a [[carotid artery]], excessive [[bleeding]], and [[hemorrhage]].

*'''Indications of definitive airway management in patients with maxillofacial injury:'''
**Absent spontaneous [[breathing]]
**[[Comatose]] [[patients]]([[Glasgow coma score]] < 9)
**[[Airway]] injury or [[obstruction]]
**Persistent [[oxygen saturation]] below 90%
**High risk for [[aspiration]]
**[[Systemic shock]]([[Systolic Blood Pressure Intervention|Systolic Blood Pressure]]<80mmHg)
**"Cannot intubate, cannot ventilate" situations

==Complications of airway management==

Airway management complications are common, these complications usually occur in [[intensive care units]] and [[emergency department]]<nowiki/>s, summary of airway management related complactions include:<ref name="CookMacDougall-Davis2012">{{cite journal|last1=Cook|first1=T.M.|last2=MacDougall-Davis|first2=S.R.|title=Complications and failure of airway management|journal=British Journal of Anaesthesia|volume=109|year=2012|pages=i68–i85|issn=00070912|doi=10.1093/bja/aes393}}</ref>

*[[Patient]] harm/death associated with suboptimal care
*[[Hypoxia]] is the most common cause of [[airway]]-related deaths
*[[Obesity]]
*[[Pulmonary]] [[aspiration]] remains the leading cause of airway-related [[anesthetic]] deaths
*Failure in airway management techniques

{{#ev:youtube|ycQs27YVE60}}

==Related Chapters==

*[[intubation|Intubation]]
*[[endotracheal tube|Endotracheal Tube]]
*[[laryngeal mask airway|Laryngeal Mask Airway]]
*[[oropharyngeal airway|Oropharyngeal Airway]]
*[[nasopharyngeal airway|Nasopharyngeal Airway]]
*[[Ventilation (physiology)|Ventilation]]
*[[Cricothyrotomy]]
*[[Tracheotomy]]

==References==
{{reflist|2}}
[[Category:Emergency medicine]]
[[Category:First aid]]
[[Category:anesthesia]]
[[Category:Intensive care medicine]]

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Airway management

2021-05-27T00:00:29Z

Shaik Aisha sultana: /* Techniques for airway management */ RSI

__NOTOC__
{{SI}}
{{CMG}}{{AE}}{{Nnasiri}}

==Overview==
''Airway management'' is the process of ensuring that there is an open pathway between a patient’s [[lung]]s and the outside world, and the [[lungs]] are safe from [[Pulmonary aspiration|aspiration]]. [[Airway]] loss is a major cause of preventable prehospital death in [[trauma]] patients. Airway management complications are common, especially in [[trauma]] patients because of associated [[pathology]], lack of complete evaluation before [[intubation]], unanticipated difficulty during ventilation and [[intubation]]. Additionally, [[trauma]] [[patients]] are at increased risk of [[airway obstruction]], aspiration, [[hypoxia]] and [[hypotension]], and [[vital sign|other unstable vital]] The providers must have skillset related to working with a variety of tools and techniques used in airway management and knowledge of the important [[anatomical]], [[physiological]], and [[pathological]] features related to the airway. They also should know the differences between the adult versus [[pediatric]] and [[neonatal]] airways as these [[anatomical]] and physiological differences are critical, impactful on patients lives and knowing these leads to effective control and management of the [[airway]]. Some of the indications for managing the [[airway]] in patients include [[respiratory failure]], altered sensorium([[Glasgow Coma Scale]] less than or equal to 8), rapid deterioration of [[mental status]], [[airway]] injury or compromise, injuries causing a high risk for [[aspiration]]-which includes all penetrating injuries to the [[abdomen]] or [[chest wall]]. Inadequate [[airway]] management may lead to [[cardiovascular]] arrest and compromise life-saving interventions in a [[trauma]] patient. Several [[airway]] control devices and techniques are available to assist [[healthcare]] providers in order to maintain the airway by [[ventilation]] and [[oxygenation]]. These include [[bag valve mask]] ([[Bag valve mask|BVM]]) [[ventilation]], direct [[laryngoscopy]] with [[endotracheal intubation]] (ETI) and adjunct [[Supraglottitis|supraglottic]] [[airway]] devices such as the [[laryngeal]] mask airway.

==Functional anatomy of the upper airway==
For a successful approach to [[airway]] management, [[health care providers]] must have knowledge of important [[anatomical]], [[physiological]], and [[pathological]] features related to the airway as well as knowledge of the various equipment and methods that can be utilized for this purpose. Also, the difference between airway management in adults, [[pediatrics]], and [[neonates]] is very critical.<ref name="pmid3056703">{{cite journal |vauthors=Morris IR |title=Functional anatomy of the upper airway |journal=Emerg. Med. Clin. North Am. |volume=6 |issue=4 |pages=639–69 |date=November 1988 |pmid=3056703 |doi= |url=}}</ref>

*The [[upper airway]] is consists of the [[pharynx]] and [[nasal]] cavities, the [[larynx]] and [[trachea]] may be included, and the [[oral cavity]] provides an alternate air entry into the [[respiratory system]].
*The nose is a bony and [[cartilage|cartilaginous]] structure attached to the facial [[skeleton]] and is divided into the two [[nasal]] cavities. The nose functions as a heater and humidifier of inspired air, it is also helps in [[phonation]] and [[vocal resonation]] and houses the [[olfactory]] receptors. The [[paranasal sinuses]] drain into the nasal cavities.
*An [[endotracheal tube]] passes through the [[nose]] or mouth into the [[trachea]] to protect the [[airway]] and achieve positive-pressure [[ventilation]]. The mouth opens posteriorly into the [[oropharynx]] and becomes part of the [[gastrointestinal system]], helps the [[digestion]] and also plays a role as an alternate pathway for [[respiration]]. It is also involved in [[phonation]].
*[[Orotracheal intubation]] can be used as an alternative to [[nasal]] [[intubation]] to achieve [[airway]] protection and maintain [[ventilation]]; but depending upon the condition of the [[patient]] and difficulty due to [[anatomical]] shape of [[upper airway]], this route may not be doable, for instance in supine unconscious persons, the backward movement of the [[tongue]] and lower [[jaw]] may cause [[airway obstruction]] and performing [[orotracheal intubation]] may not be the optimal way of managing airway.
*The [[pharynx]] is a membrane-lined cavity behind the [[mouth]] and [[nose]], extends from the base of the [[skull]] to the [[cricoid cartilage]] at the level of sixth [[cervical vertebrae]] which is an entrance to the [[esophagus]]. [[Anterior]]<nowiki/>ly it opens into the [[nasal cavity]], the [[mouth]], and the [[larynx]], which divide it into the naso-, oro-, and [[laryngopharynx]], respectively. The [[pharynx]] is involved with the act of [[swallowing]].
*The [[larynx]] consists of [[Cartilages of the larynx|cartilages]] and fibro-elastic membranes covered by a sheet of [[muscles]] and [[mucous membrane]]. It functions as an open valve in [[respiration]], helps in [[phonation]], and [[swallowing]]. The [[larynx]] extends from its entrance which is formed by the [[Aryepiglottic fold|aryepiglottic folds]], to the lower border of the [[cricoid cartilage]] till the tip of the [[epiglottis]], and bulges [[posterior]]<nowiki/>ly into the [[laryngopharynx]].
*The trachea is formed by U-shaped [[cartilaginous]] rings in anterior and [[trachealis muscle]] in [[posterior]], it extends from the lower edge of the [[cricoid cartilage]] to the [[carina]] where it divides into the [[mainstem bronchus]]. In order to place [[endotracheal tube]] in proper way, tip of the tube should be at mid [[Tracheal bronchus|tracheal]] level.

[[File:UpperRespiratorySystem.png|400px|thumb|left|upper airway system[https://commons.wikimedia.org/wiki/File:Blausen_0872_UpperRespiratorySystem.pngBlausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436.]]] 

==Recommendations for evaluation of airway==
The basic approach in airway management in the [[emergency]] setting includes:<ref name="RosenbergPhero2014">{{cite journal|last1=Rosenberg|first1=M. B|last2=Phero|first2=J. C|last3=Becker|first3=D. E|title=Essentials of Airway Management, Oxygenation, and Ventilation: Part 2: Advanced Airway Devices: Supraglottic Airways|journal=Anesthesia Progress|volume=61|issue=3|year=2014|pages=113–118|issn=0003-3006|doi=10.2344/0003-3006-61.3.113}}</ref>

:*Protection from [[aspiration]] and [[pneumonia]] related to that.
:*Providing adequate [[ventilation]] and [[oxygenation]].

Following are steps that must be considered prior to conducting airway management, these include:

:*'''History:''' An [[airway]] [[history]] should be conducted whenever it is possible before airway management in all [[patients]] to detect medical, [[surgical]], and [[anesthetic]] factors that may indicate the presence of a difficult [[airway]]. A detailed review of previous [[anesthetic]] records, if available, may provide useful information about airway management.

:*'''Physical Examination:''' An airway [[physical examination]] should be conducted before the initiation of airway management. The goal of [[physical examination]] is to detect physical characteristics that may indicate the presence of a difficult airway because an unsuccessful [[upper airway|airway]] management is associated with increase in [[mortality]] and [[morbidity]].

:*'''Additional Evaluation:''' Additional evaluation may be indicated in some [[patients]] to characterize the likelihood or nature of the anticipated difficult airway. Certain diagnostic tests (e.g., [[radiography]], [[computed tomography]] scans, [[fluoroscopy]]) can identify a variety of acquired or congenital features in patients with difficult airways

==Techniques for airway management==
The decision about whether an airway intervention is required or not is crucial for patient's [[Survival rate|survival]] and depends on first responders skills and quick assessment and decision. These crucial steps requires techniques which are used universally in order to manage [[patient]]'s airway. Following are initial evaluation methods which had been developed to assist patient's [[ventilation]] and keep the [[airway]] patent, these techniques include:<ref name="RoychoudhuryJose2016">{{cite journal|last1=Roychoudhury|first1=Ajoy|last2=Jose|first2=Anson|last3=Nagori|first3=ShakilAhmed|last4=Agarwal|first4=Bhaskar|last5=Bhutia|first5=Ongkila|title=Management of maxillofacial trauma in emergency: An update of challenges and controversies|journal=Journal of Emergencies, Trauma, and Shock|volume=9|issue=2|year=2016|pages=73|issn=0974-2700|doi=10.4103/0974-2700.179456}}</ref><ref name="pmid18946431">{{cite journal |vauthors=Agrò FE, Cataldo R, Mattei A |title=New devices and techniques for airway management |journal=Minerva Anestesiol |volume=75 |issue=3 |pages=141–9 |date=March 2009 |pmid=18946431 |doi= |url=}}</ref><ref name="pmid29560073">{{cite journal |vauthors=Gleason JM, Christian BR, Barton ED |title=Nasal Cannula Apneic Oxygenation Prevents Desaturation During Endotracheal Intubation: An Integrative Literature Review |journal=West J Emerg Med |volume=19 |issue=2 |pages=403–411 |date=March 2018 |pmid=29560073 |pmc=5851518 |doi=10.5811/westjem.2017.12.34699 |url=}}</ref><ref name="LawBroemling2013">{{cite journal|last1=Law|first1=J. Adam|last2=Broemling|first2=Natasha|last3=Cooper|first3=Richard M.|last4=Drolet|first4=Pierre|last5=Duggan|first5=Laura V.|last6=Griesdale|first6=Donald E.|last7=Hung|first7=Orlando R.|last8=Jones|first8=Philip M.|last9=Kovacs|first9=George|last10=Massey|first10=Simon|last11=Morris|first11=Ian R.|last12=Mullen|first12=Timothy|last13=Murphy|first13=Michael F.|last14=Preston|first14=Roanne|last15=Naik|first15=Viren N.|last16=Scott|first16=Jeanette|last17=Stacey|first17=Shean|last18=Turkstra|first18=Timothy P.|last19=Wong|first19=David T.|title=The difficult airway with recommendations for management – Part 1 – Difficult tracheal intubation encountered in an unconscious/induced patient|journal=Canadian Journal of Anesthesia/Journal canadien d'anesthésie|volume=60|issue=11|year=2013|pages=1089–1118|issn=0832-610X|doi=10.1007/s12630-013-0019-3}}</ref><ref name="OkuboGibo2017">{{cite journal|last1=Okubo|first1=Masashi|last2=Gibo|first2=Koichiro|last3=Hagiwara|first3=Yusuke|last4=Nakayama|first4=Yukiko|last5=Hasegawa|first5=Kohei|title=The effectiveness of rapid sequence intubation (RSI) versus non-RSI in emergency department: an analysis of multicenter prospective observational study|journal=International Journal of Emergency Medicine|volume=10|issue=1|year=2017|issn=1865-1372|doi=10.1186/s12245-017-0129-8}}</ref>

*'''Spontaneous breathing:''' When a provider is confronted with an awake [[patient]] having a patent airway. Spontaneous ventilation can be assisted through the placement of a nasal or oral airway. [[Oxygenation]] can be improved by giving [[oxygen]] via nasal [[cannula]], simple [[face mask]], or nonrebreather face mask. Unfortunately, the maximally achieved [[FiO2]] is often overestimated by care providers and [[hypoventilation]] resulting in [[hypercapnia]] cannot be normalized with increase in [[oxygen]] supply.
*'''Mouth-to-Mouth ventilation:''' Mouth-to-mouth or mouth-to-nose ventilation is a useful management technique, however, because of the risk of [[infection]] transmission it is recommended by American heart association that health care providers do "Hands-only" [[CPR]]. Proper face masks should be utilized if they are available.
*'''Bag-mask ventilation:''' It is a standard initial approach to airway management in the prehospital and [[hospital]] settings.

:*Proper preoxygenation prior to [[intubation]] and [[anesthetic]] induction provides patients with improved [[oxygenation]] and increases the time to [[hypoxemia]].
:*Bag-mask [[ventilation]] is a basic essential technique when [[endotracheal tube]] [[intubation]] is difficult, it assists for rapid [[ventilation]] and [[oxygenation]] in patients.
:*Bag-mask [[ventilation]] can be achieved by a single practitioner alone or side by side with a second care provider in an [[Operating room|emergency room or an operating room]]
:*Bag mask [[ventilation]] can also be utilized as a pressure support during spontaneous [[respiration]] in patients with decre<nowiki/>ased [[tidal volume]]<nowiki/>s and insufficient [[ventilation]], very similar to the use of [[CPAP]] or [[BiPAP]] to assist [[patients]] who are spontaneously [[breathing]] but are not adequately ventilating or oxygenating.

*'''Oropharyngeal and nasopharyngeal airways:'''

:*This is used as an adjunct device for spontaneous or [[assisted ventilation]].
:*[[Oropharyngeal]] and [[nasopharyngeal airway]]<nowiki/>s are frequently utilized by prehospital care providers to improve [[oxygenation]] and [[ventilation]].
:*These devices are frequently used until a more definitive [[airway]] is obtained, and there are several circumstances that prohibit their placement (severe head or [[facial]] injuries).

*'''Supraglottic airway devices:''' [[Supraglottic laryngeal cancer|Supraglottic]] airway (SGA) device placement is very useful to keep the [[airway]]<nowiki/>s open, it has advantages in comparison with [[endotracheal tube]] intubation, or other methods, these advantages include:<ref name="pmid27537593">{{cite journal |vauthors=Park SK, Ko G, Choi GJ, Ahn EJ, Kang H |title=Comparison between supraglottic airway devices and endotracheal tubes in patients undergoing laparoscopic surgery: A systematic review and meta-analysis |journal=Medicine (Baltimore) |volume=95 |issue=33 |pages=e4598 |date=August 2016 |pmid=27537593 |doi=10.1097/MD.0000000000004598 |url=}}</ref>

:*They act as a niche between bag and mask ventilation and endo tracheal intubation.
:*Requires less training than ETI
:*It is less invasive than ETI.
:*It can offer better [[ventilation]] during transport than bag-mask [[ventilation]] alone.
:**[[Supraglottitis|Supraglottic]] airway devices can be used as an alternative tool in cases of failed [[intubation]].

*'''[[Endotracheal intubation]]:''' It is the gold standard for definitive airway management in the prehospital setting, and also hospital setting. It allows for positive pressure [[ventilation]], [[positive end-expiratory pressure]] (PEEP), positive pressure recruitment maneuvers, and protection from [[aspiration]].

:*'''Mallampati classification for assessment of upper airway anatomical Balance:''' It is named after the Indian-born American [[anesthesiologist]] Seshagiri Mallampati, is used to predict the ease of [[endotracheal intubation]].The test assess the distance from the [[tongue]] base to the roof of the [[mouth]] visually. It is an indirect way of assessing how the airway and predicting the difficult intubation.
:*'''Modified Mallampati Scoring:'''
:**Class I: [[Soft palate]], [[uvula]], [[fauces]], [[Pillars of the fauces|pillars]] visible.
:**Class II: [[Soft palate]], a major part of the [[uvula]], [[fauces]] visible.
:**Class III: [[Soft palate]], the base of [[uvula]] visible.
:**Class IV: Only [[hard palate]] visible.

*'''Rapid sequence intubation''':

:*[[Rapid sequence intubation]] ([[RSI|RSI)]] is a technique used for endotracheal intubation when the patient is at high risk of aspiration. For RSI to be performed, it requires two persons, first patient's lungs are preoxygenated with bag and mask . One person applies constant pressure on the cricoid cartilage, occluding the esophagus. Sedative-hypnotic or an inducing agent and a muscle relaxant is administered and patient's trachea is intubated, and cricoid pressure is released after the cuff is inflated. Traditionally, thiopentone sodium and succinylcholine were used for RSI, and it had an advantage that patient's airway will be relaxed and paralysed, facilitating the intubation and if any unanticipated difficulty occurs, these drugs were short acting and the effect weans off quickly. There is a debate that optimal intubating conditions should be achieved first before trying to attempt [[intubation]] in the prehospital setting. Time is an important factor and critical in prehospital [[airway]] management of [[patients]], due to [[trauma]], [[cardiac arrest]], [[hypoxemia]], or aspiration risk. Administration of the [[Neuromuscular blocking agents|neuromuscular blocking agent]] is associated with a reduction in time from rapid sequence [[intubation]] administration to the end of [[intubation]] attempt.

[[File:Glidescope 02.jpg|400px|thumb|left|Photograph of an anesthesiologist using the Glidescope video laryngoscope to intubate the trachea of a morbidly obese elderly person with challenging airway anatomy[https://en.wikipedia.org/wiki/Airway_managementI (DiverDave (talk)) created this work entirely by myself. (Original uploaded on en.wikipedia)]]] 

==Management of the Airway in Patients with Trauma==
===Suspected Spinal Cord Injury===

*In [[patients]] with suspected [[trauma]], extreme caution must be taken in aligning the [[head]] and [[neck]]. The [[cervical spine]] must be maintained in a neutral mid-line position, the exception to this is physical resistance.<ref name="ThiboutotNicole2009">{{cite journal|last1=Thiboutot|first1=François|last2=Nicole|first2=Pierre C.|last3=Trépanier|first3=Claude A.|last4=Turgeon|first4=Alexis F.|last5=Lessard|first5=Martin R.|title=Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial|journal=Canadian Journal of Anesthesia/Journal Canadien d'anesthésie|volume=56|issue=6|year=2009|pages=412–418|issn=0832-610X|doi=10.1007/s12630-009-9089-7}}</ref><ref>{{cite journal|doi=10.1016/j.jclinane.2005.04.003 [Indexed for MEDLINE]}}</ref><ref name="KrishnamoorthyDagal2014">{{cite journal|last1=Krishnamoorthy|first1=Vijay|last2=Dagal|first2=Arman|last3=Austin|first3=Naola|title=Airway management in cervical spine injury|journal=International Journal of Critical Illness and Injury Science|volume=4|issue=1|year=2014|pages=50|issn=2229-5151|doi=10.4103/2229-5151.128013}}</ref><ref name="GhafoorMartin2005">{{cite journal|last1=Ghafoor|first1=Abid U.|last2=Martin|first2=Timothy W.|last3=Gopalakrishnan|first3=Senthil|last4=Viswamitra|first4=Sanjaya|title=Caring for the patients with cervical spine injuries: what have we learned?|journal=Journal of Clinical Anesthesia|volume=17|issue=8|year=2005|pages=640–649|issn=09528180|doi=10.1016/j.jclinane.2005.04.003}}</ref><ref name="SriganeshBusse2018">{{cite journal|last1=Sriganesh|first1=Kamath|last2=Busse|first2=JasonW|last3=Shanthanna|first3=Harsha|last4=Ramesh|first4=VenkatapuraJ|title=Airway management in the presence of cervical spine instability: A cross-sectional survey of the members of the Indian Society of Neuroanaesthesiology and Critical Care|journal=Indian Journal of Anaesthesia|volume=62|issue=2|year=2018|pages=115|issn=0019-5049|doi=10.4103/ija.IJA_671_17}}</ref>

*'''Neck Maneuvers During Airway Management:'''
**Immobilizing patient's [[neck]] by using sandbag-collar-tape on hardboard in a pre-hospital care setting.
**Applying pressure on cricoid with [[anterior]] half of hard [[cervical collar]] removed and another hand behind the [[posterior]] [[cervical collar]].
**Manual in-line stabilization is the technique of choice in any suspected [[cervical spine]] injury, during endotracheal intubation. In this technique, head grasped firmly at the [[mastoid process]] and the occiput.

*Traction should be avoided as it may distract the [[cervical spine]] and cause more [[neurological]] damage, even after manual in-line stabilization.

*Jaw thrust is the only basic [[airway]] opening maneuver appropriate for any [[patient]] with a suspected [[cervical spine injury]]. This method is used when head-tilt/chin-lift can be potentially dangerous to use on a patient who may have a [[cervical spine injury]]. In jaw-thrust maneuver, first care provider lifts the [[hyoid bone]] and [[tongue]] away from the [[posterior]] [[pharyngeal]] wall by pulling the [[mandible]] forward, displacing the [[tongue]] anteriorly.
*[[Suction]] and use of [[forceps]] under direct vision using a [[laryngoscope]] with the [[head]] and [[neck]] maintained in the neutral position.
*In order to minimize the risk of [[hypoxic]] damage from [[airway obstruction]] in an [[unconscious]] patient, proper positioning is done by placing patients in the [[lateral]] side with log rolling technique.

===Approach to airway management of a patient with Maxillo-Facial Injury===
[[Airway]] management of patients with [[maxillofacial]] trauma is challenging and vital because it's directly affecting the patient's survival. [[Endotracheal intubation]] is the [[Gold standard (test)|gold standard]] procedure to secure the [[airway]] in [[trauma]] [[patients]], however, in these [[patients]] passage of [[endotracheal tube]] may not be possible because the oral cavity, [[pharynx]], and [[larynx]] may be filled with [[blood]], secretions, [[soft tissue]], and [[bone]] fragments. Another reason for this is that the risk of [[aspiration]] and [[regurgitation]] is high in these patients.<ref name="BarakBahouth2015">{{cite journal|last1=Barak|first1=Michal|last2=Bahouth|first2=Hany|last3=Leiser|first3=Yoav|last4=Abu El-Naaj|first4=Imad|title=Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach|journal=BioMed Research International|volume=2015|year=2015|pages=1–9|issn=2314-6133|doi=10.1155/2015/724032}}</ref><ref name="pmid21655009">{{cite journal |vauthors=Raval CB, Rashiduddin M |title=Airway management in patients with maxillofacial trauma - A retrospective study of 177 cases |journal=Saudi J Anaesth |volume=5 |issue=1 |pages=9–14 |date=January 2011 |pmid=21655009 |pmc=3101764 |doi=10.4103/1658-354X.76476 |url=}}</ref><ref name="pmid7588664">{{cite journal |vauthors=Brimacombe J, Tucker P, Simons S |title=The laryngeal mask airway for awake diagnostic bronchoscopy. A retrospective study of 200 consecutive patients |journal=Eur J Anaesthesiol |volume=12 |issue=4 |pages=357–61 |date=July 1995 |pmid=7588664 |doi= |url=}}</ref><ref name="HsiaoPacheco-Fowler2008">{{cite journal|last1=Hsiao|first1=James|last2=Pacheco-Fowler|first2=Victor|title=Cricothyroidotomy|journal=New England Journal of Medicine|volume=358|issue=22|year=2008|pages=e25|issn=0028-4793|doi=10.1056/NEJMvcm0706755}}</ref>

*In such circumstances, there are numerous [[airway]] devices are available to rescue patients with [[maxillofacial]] injuries, some of these devices include:<ref name="BarakBahouth2015">{{cite journal|last1=Barak|first1=Michal|last2=Bahouth|first2=Hany|last3=Leiser|first3=Yoav|last4=Abu El-Naaj|first4=Imad|title=Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach|journal=BioMed Research International|volume=2015|year=2015|pages=1–9|issn=2314-6133|doi=10.1155/2015/724032}}</ref><ref name="MeyerPatel2014">{{cite journal|last1=Meyer|first1=TanyaK|last2=Patel|first2=SapnaA|title=Surgical Airway|journal=International Journal of Critical Illness and Injury Science|volume=4|issue=1|year=2014|pages=71|issn=2229-5151|doi=10.4103/2229-5151.128016}}</ref>
**Flexible [[fiberoptic]] [[bronchoscopy]] (FOB), enable an indirect view of [[vocal cords]].
**[[Laryngeal mask airway]] (LMA) may be inserted blindly since it does not require a view of the [[vocal cords]]. Another option for securing the [[airway]] in these patients is to pass the endotracheal tube after placing an LMA for them.
*Final option for establishing the airway in [[patients]] with [[maxillofacial]] injury is [[surgery]] by [[cricothyroidotomy]].
**[[Cricothyroidotomy]] also known as [[cricothyrotomy]] is a procedure done by trained [[health care providers]], they make a small [[incision]] through the skin and [[cricoid]] membrane which lies between the [[thyroid]] and [[cricoid]] [[cartilage]]<nowiki/>s, followed by inserting a [[tracheostomy tube]] to open alternative way of [[ventilation]] and [[oxygenation]] in the [[emergency]] situation which uses of [[endotracheal intubation]] is almost impossible or difficult and time-consuming.
**'''Indication for cricothyroidotomy include:'''
***Inability to secure [[airway]] through an [[endotracheal tube]]
***Major [[trauma]] to [[facial]] [[muscles]], [[pharynx]], [[larynx]].
***[[Congenital deformities]] and [[upper airway]] [[stenosis]].

*'''Contraindications for cricothyroidotomy:'''
**[[Age]], in [[pediatrics]] younger than 12 years old needle [[cricothyrotomy]] is indicated because of less potential damage to the [[larynx]] and surrounding structures.
**Massive [[trauma]] to the [[larynx]] or [[cricoid cartilage]]
**Inability to identify surface landmarks due to [[obesity]], [[cervical]] trauma.
**When [[Orotracheal intubation|orotracheal]] and [[Nasotracheal intubation|nasotracheal]] [[intubation]] are viable options
**[[Airway obstruction]] distal to [[subglottic airway]], e.g. [[tracheal stenosis]]
**[[Laryngeal cancer]]: Other than for an extreme airway [[emergency]], [[cricothyroidotomy]] must be avoided to not to seed the [[soft tissue]] of the [[neck]] with [[cancer]] cells
**[[Coagulopathy]] (other than [[emergency]] situation)

*'''Complications of cricothyroidotomy:'''
**[[Esophageal]] perforation if the blade penetrates too deeply.
**[[Subcutaneous emphysema]]
**Rupture of vital [[vessels]] such as a [[carotid artery]], excessive [[bleeding]], and [[hemorrhage]].

*'''Indications of definitive airway management in patients with maxillofacial injury:'''
**Absent spontaneous [[breathing]]
**[[Comatose]] [[patients]]([[Glasgow coma score]] < 9)
**[[Airway]] injury or [[obstruction]]
**Persistent [[oxygen saturation]] below 90%
**High risk for [[aspiration]]
**[[Systemic shock]]([[Systolic Blood Pressure Intervention|Systolic Blood Pressure]]<80mmHg)
**"Cannot intubate, cannot ventilate" situations

==Complications of airway management==

Airway management complications are common, these complications usually occur in [[intensive care units]] and [[emergency department]]<nowiki/>s, summary of airway management related complactions include:<ref name="CookMacDougall-Davis2012">{{cite journal|last1=Cook|first1=T.M.|last2=MacDougall-Davis|first2=S.R.|title=Complications and failure of airway management|journal=British Journal of Anaesthesia|volume=109|year=2012|pages=i68–i85|issn=00070912|doi=10.1093/bja/aes393}}</ref>

*[[Patient]] harm/death associated with suboptimal care
*[[Hypoxia]] is the most common cause of [[airway]]-related deaths
*[[Obesity]]
*[[Pulmonary]] [[aspiration]] remains the leading cause of airway-related [[anesthetic]] deaths
*Failure in airway management techniques

{{#ev:youtube|ycQs27YVE60}}

==Related Chapters==

*[[intubation|Intubation]]
*[[endotracheal tube|Endotracheal Tube]]
*[[laryngeal mask airway|Laryngeal Mask Airway]]
*[[oropharyngeal airway|Oropharyngeal Airway]]
*[[nasopharyngeal airway|Nasopharyngeal Airway]]
*[[Ventilation (physiology)|Ventilation]]
*[[Cricothyrotomy]]
*[[Tracheotomy]]

==References==
{{reflist|2}}
[[Category:Emergency medicine]]
[[Category:First aid]]
[[Category:anesthesia]]
[[Category:Intensive care medicine]]

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Airway management

2021-05-26T23:40:15Z

Shaik Aisha sultana: /* Recommendations for evaluation of airway */

__NOTOC__
{{SI}}
{{CMG}}{{AE}}{{Nnasiri}}

==Overview==
''Airway management'' is the process of ensuring that there is an open pathway between a patient’s [[lung]]s and the outside world, and the [[lungs]] are safe from [[Pulmonary aspiration|aspiration]]. [[Airway]] loss is a major cause of preventable prehospital death in [[trauma]] patients. Airway management complications are common, especially in [[trauma]] patients because of associated [[pathology]], lack of complete evaluation before [[intubation]], unanticipated difficulty during ventilation and [[intubation]]. Additionally, [[trauma]] [[patients]] are at increased risk of [[airway obstruction]], aspiration, [[hypoxia]] and [[hypotension]], and [[vital sign|other unstable vital]] The providers must have skillset related to working with a variety of tools and techniques used in airway management and knowledge of the important [[anatomical]], [[physiological]], and [[pathological]] features related to the airway. They also should know the differences between the adult versus [[pediatric]] and [[neonatal]] airways as these [[anatomical]] and physiological differences are critical, impactful on patients lives and knowing these leads to effective control and management of the [[airway]]. Some of the indications for managing the [[airway]] in patients include [[respiratory failure]], altered sensorium([[Glasgow Coma Scale]] less than or equal to 8), rapid deterioration of [[mental status]], [[airway]] injury or compromise, injuries causing a high risk for [[aspiration]]-which includes all penetrating injuries to the [[abdomen]] or [[chest wall]]. Inadequate [[airway]] management may lead to [[cardiovascular]] arrest and compromise life-saving interventions in a [[trauma]] patient. Several [[airway]] control devices and techniques are available to assist [[healthcare]] providers in order to maintain the airway by [[ventilation]] and [[oxygenation]]. These include [[bag valve mask]] ([[Bag valve mask|BVM]]) [[ventilation]], direct [[laryngoscopy]] with [[endotracheal intubation]] (ETI) and adjunct [[Supraglottitis|supraglottic]] [[airway]] devices such as the [[laryngeal]] mask airway.

==Functional anatomy of the upper airway==
For a successful approach to [[airway]] management, [[health care providers]] must have knowledge of important [[anatomical]], [[physiological]], and [[pathological]] features related to the airway as well as knowledge of the various equipment and methods that can be utilized for this purpose. Also, the difference between airway management in adults, [[pediatrics]], and [[neonates]] is very critical.<ref name="pmid3056703">{{cite journal |vauthors=Morris IR |title=Functional anatomy of the upper airway |journal=Emerg. Med. Clin. North Am. |volume=6 |issue=4 |pages=639–69 |date=November 1988 |pmid=3056703 |doi= |url=}}</ref>

*The [[upper airway]] is consists of the [[pharynx]] and [[nasal]] cavities, the [[larynx]] and [[trachea]] may be included, and the [[oral cavity]] provides an alternate air entry into the [[respiratory system]].
*The nose is a bony and [[cartilage|cartilaginous]] structure attached to the facial [[skeleton]] and is divided into the two [[nasal]] cavities. The nose functions as a heater and humidifier of inspired air, it is also helps in [[phonation]] and [[vocal resonation]] and houses the [[olfactory]] receptors. The [[paranasal sinuses]] drain into the nasal cavities.
*An [[endotracheal tube]] passes through the [[nose]] or mouth into the [[trachea]] to protect the [[airway]] and achieve positive-pressure [[ventilation]]. The mouth opens posteriorly into the [[oropharynx]] and becomes part of the [[gastrointestinal system]], helps the [[digestion]] and also plays a role as an alternate pathway for [[respiration]]. It is also involved in [[phonation]].
*[[Orotracheal intubation]] can be used as an alternative to [[nasal]] [[intubation]] to achieve [[airway]] protection and maintain [[ventilation]]; but depending upon the condition of the [[patient]] and difficulty due to [[anatomical]] shape of [[upper airway]], this route may not be doable, for instance in supine unconscious persons, the backward movement of the [[tongue]] and lower [[jaw]] may cause [[airway obstruction]] and performing [[orotracheal intubation]] may not be the optimal way of managing airway.
*The [[pharynx]] is a membrane-lined cavity behind the [[mouth]] and [[nose]], extends from the base of the [[skull]] to the [[cricoid cartilage]] at the level of sixth [[cervical vertebrae]] which is an entrance to the [[esophagus]]. [[Anterior]]<nowiki/>ly it opens into the [[nasal cavity]], the [[mouth]], and the [[larynx]], which divide it into the naso-, oro-, and [[laryngopharynx]], respectively. The [[pharynx]] is involved with the act of [[swallowing]].
*The [[larynx]] consists of [[Cartilages of the larynx|cartilages]] and fibro-elastic membranes covered by a sheet of [[muscles]] and [[mucous membrane]]. It functions as an open valve in [[respiration]], helps in [[phonation]], and [[swallowing]]. The [[larynx]] extends from its entrance which is formed by the [[Aryepiglottic fold|aryepiglottic folds]], to the lower border of the [[cricoid cartilage]] till the tip of the [[epiglottis]], and bulges [[posterior]]<nowiki/>ly into the [[laryngopharynx]].
*The trachea is formed by U-shaped [[cartilaginous]] rings in anterior and [[trachealis muscle]] in [[posterior]], it extends from the lower edge of the [[cricoid cartilage]] to the [[carina]] where it divides into the [[mainstem bronchus]]. In order to place [[endotracheal tube]] in proper way, tip of the tube should be at mid [[Tracheal bronchus|tracheal]] level.

[[File:UpperRespiratorySystem.png|400px|thumb|left|upper airway system[https://commons.wikimedia.org/wiki/File:Blausen_0872_UpperRespiratorySystem.pngBlausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436.]]] 

==Recommendations for evaluation of airway==
The basic approach in airway management in the [[emergency]] setting includes:<ref name="RosenbergPhero2014">{{cite journal|last1=Rosenberg|first1=M. B|last2=Phero|first2=J. C|last3=Becker|first3=D. E|title=Essentials of Airway Management, Oxygenation, and Ventilation: Part 2: Advanced Airway Devices: Supraglottic Airways|journal=Anesthesia Progress|volume=61|issue=3|year=2014|pages=113–118|issn=0003-3006|doi=10.2344/0003-3006-61.3.113}}</ref>

:*Protection from [[aspiration]] and [[pneumonia]] related to that.
:*Providing adequate [[ventilation]] and [[oxygenation]].

Following are steps that must be considered prior to conducting airway management, these include:

:*'''History:''' An [[airway]] [[history]] should be conducted whenever it is possible before airway management in all [[patients]] to detect medical, [[surgical]], and [[anesthetic]] factors that may indicate the presence of a difficult [[airway]]. A detailed review of previous [[anesthetic]] records, if available, may provide useful information about airway management.

:*'''Physical Examination:''' An airway [[physical examination]] should be conducted before the initiation of airway management. The goal of [[physical examination]] is to detect physical characteristics that may indicate the presence of a difficult airway because an unsuccessful [[upper airway|airway]] management is associated with increase in [[mortality]] and [[morbidity]].

:*'''Additional Evaluation:''' Additional evaluation may be indicated in some [[patients]] to characterize the likelihood or nature of the anticipated difficult airway. Certain diagnostic tests (e.g., [[radiography]], [[computed tomography]] scans, [[fluoroscopy]]) can identify a variety of acquired or congenital features in patients with difficult airways

==Techniques for airway management==
The decision about whether an airway intervention is required or not is crucial for patient's [[Survival rate|survival]] and depends on first responders skills and quick assessment and decision. These crucial steps requires techniques which are used universally in order to manage [[patient]]'s airway. Following are initial evaluation methods which had been developed to assist patient's [[ventilation]] and keep the [[airway]] patent, these techniques include:<ref name="RoychoudhuryJose2016">{{cite journal|last1=Roychoudhury|first1=Ajoy|last2=Jose|first2=Anson|last3=Nagori|first3=ShakilAhmed|last4=Agarwal|first4=Bhaskar|last5=Bhutia|first5=Ongkila|title=Management of maxillofacial trauma in emergency: An update of challenges and controversies|journal=Journal of Emergencies, Trauma, and Shock|volume=9|issue=2|year=2016|pages=73|issn=0974-2700|doi=10.4103/0974-2700.179456}}</ref><ref name="pmid18946431">{{cite journal |vauthors=Agrò FE, Cataldo R, Mattei A |title=New devices and techniques for airway management |journal=Minerva Anestesiol |volume=75 |issue=3 |pages=141–9 |date=March 2009 |pmid=18946431 |doi= |url=}}</ref><ref name="pmid29560073">{{cite journal |vauthors=Gleason JM, Christian BR, Barton ED |title=Nasal Cannula Apneic Oxygenation Prevents Desaturation During Endotracheal Intubation: An Integrative Literature Review |journal=West J Emerg Med |volume=19 |issue=2 |pages=403–411 |date=March 2018 |pmid=29560073 |pmc=5851518 |doi=10.5811/westjem.2017.12.34699 |url=}}</ref><ref name="LawBroemling2013">{{cite journal|last1=Law|first1=J. Adam|last2=Broemling|first2=Natasha|last3=Cooper|first3=Richard M.|last4=Drolet|first4=Pierre|last5=Duggan|first5=Laura V.|last6=Griesdale|first6=Donald E.|last7=Hung|first7=Orlando R.|last8=Jones|first8=Philip M.|last9=Kovacs|first9=George|last10=Massey|first10=Simon|last11=Morris|first11=Ian R.|last12=Mullen|first12=Timothy|last13=Murphy|first13=Michael F.|last14=Preston|first14=Roanne|last15=Naik|first15=Viren N.|last16=Scott|first16=Jeanette|last17=Stacey|first17=Shean|last18=Turkstra|first18=Timothy P.|last19=Wong|first19=David T.|title=The difficult airway with recommendations for management – Part 1 – Difficult tracheal intubation encountered in an unconscious/induced patient|journal=Canadian Journal of Anesthesia/Journal canadien d'anesthésie|volume=60|issue=11|year=2013|pages=1089–1118|issn=0832-610X|doi=10.1007/s12630-013-0019-3}}</ref><ref name="OkuboGibo2017">{{cite journal|last1=Okubo|first1=Masashi|last2=Gibo|first2=Koichiro|last3=Hagiwara|first3=Yusuke|last4=Nakayama|first4=Yukiko|last5=Hasegawa|first5=Kohei|title=The effectiveness of rapid sequence intubation (RSI) versus non-RSI in emergency department: an analysis of multicenter prospective observational study|journal=International Journal of Emergency Medicine|volume=10|issue=1|year=2017|issn=1865-1372|doi=10.1186/s12245-017-0129-8}}</ref>

*'''Spontaneous breathing:''' When a provider is confronted with an awake [[patient]] having a patent airway. Spontaneous ventilation can be assisted through the placement of a nasal or oral airway. [[Oxygenation]] can be improved by giving [[oxygen]] via nasal [[cannula]], simple [[face mask]], or nonrebreather face mask. Unfortunately, the maximally achieved [[FiO2]] is often overestimated by care providers and [[hypoventilation]] resulting in [[hypercapnia]] cannot be normalized with increase in [[oxygen]] supply.
*'''Mouth-to-Mouth ventilation:''' Mouth-to-mouth or mouth-to-nose ventilation is a useful management technique, however, because of the risk of [[infection]] transmission it is recommended by American heart association that health care providers do "Hands-only" [[CPR]]. Proper face masks should be utilized if they are available.
*'''Bag-mask ventilation:''' It is a standard initial approach to airway management in the prehospital and [[hospital]] settings.

:*Proper preoxygenation prior to [[intubation]] and [[anesthetic]] induction provides patients with improved [[oxygenation]] and increases the time to [[hypoxemia]].
:*Bag-mask [[ventilation]] is a basic essential technique when [[endotracheal tube]] [[intubation]] is difficult, it assists for rapid [[ventilation]] and [[oxygenation]] in patients.
:*Bag-mask [[ventilation]] can be achieved by a single practitioner alone or side by side with a second care provider in an [[Operating room|emergency room or an operating room]]
:*Bag mask [[ventilation]] can also be utilized as a pressure support during spontaneous [[respiration]] in patients with decre<nowiki/>ased [[tidal volume]]<nowiki/>s and insufficient [[ventilation]], very similar to the use of [[CPAP]] or [[BiPAP]] to assist [[patients]] who are spontaneously [[breathing]] but are not adequately ventilating or oxygenating.

*'''Oropharyngeal and nasopharyngeal airways:'''

:*This is used as an adjunct device for spontaneous or [[assisted ventilation]].
:*[[Oropharyngeal]] and [[nasopharyngeal airway]]<nowiki/>s are frequently utilized by prehospital care providers to improve [[oxygenation]] and [[ventilation]].
:*These devices are frequently used until a more definitive [[airway]] is obtained, and there are several circumstances that prohibit their placement (severe head or [[facial]] injuries).

*'''Supraglottic airway devices:''' [[Supraglottic laryngeal cancer|Supraglottic]] airway (SGA) device placement is very useful to keep the [[airway]]<nowiki/>s open, it has advantages in comparison with [[endotracheal tube]] intubation, or other methods, these advantages include:<ref name="pmid27537593">{{cite journal |vauthors=Park SK, Ko G, Choi GJ, Ahn EJ, Kang H |title=Comparison between supraglottic airway devices and endotracheal tubes in patients undergoing laparoscopic surgery: A systematic review and meta-analysis |journal=Medicine (Baltimore) |volume=95 |issue=33 |pages=e4598 |date=August 2016 |pmid=27537593 |doi=10.1097/MD.0000000000004598 |url=}}</ref>

:*They act as a niche between bag and mask ventilation and endo tracheal intubation.
:*Requires less training than ETI
:*It is less invasive than ETI.
:*It can offer better [[ventilation]] during transport than bag-mask [[ventilation]] alone.
:**[[Supraglottitis|Supraglottic]] airway devices can be used as an alternative tool in cases of failed [[intubation]].

*'''[[Endotracheal intubation]]:''' It is the gold standard for definitive airway management in the prehospital setting, and also hospital setting. It allows for positive pressure [[ventilation]], [[positive end-expiratory pressure]] (PEEP), positive pressure recruitment maneuvers, and protection from [[aspiration]].

:*'''Mallampati classification for assessment of upper airway anatomical Balance:''' It is named after the Indian-born American [[anesthesiologist]] Seshagiri Mallampati, is used to predict the ease of [[endotracheal intubation]].The test assess the distance from the [[tongue]] base to the roof of the [[mouth]] visually. It is an indirect way of assessing how the airway and predicting the difficult intubation.
:*'''Modified Mallampati Scoring:'''
:**Class I: [[Soft palate]], [[uvula]], [[fauces]], [[Pillars of the fauces|pillars]] visible.
:**Class II: [[Soft palate]], a major part of the [[uvula]], [[fauces]] visible.
:**Class III: [[Soft palate]], the base of [[uvula]] visible.
:**Class IV: Only [[hard palate]] visible.

*'''Rapid sequence intubation versus no-medication intubation''':

:*Use of [[pharmacological]] [[muscle relaxant]] eases the [[intubation]] process by relaxing muscles in the [[pharynx]]. [[Rapid sequence induction|Rapid sequence intubation]] ([[RSI]]) techniques incorporate [[pharmacologic]] [[muscle]] relaxation and are utilized by anesthesiologists and [[emergency medicine]] physicians. However, the disadvantage of these techniques is the elimination of a patient's ability to breathe spontaneously if the [[intubation]] fails. There is a debate that optimal intubating conditions should be achieved first before trying to attempt [[intubation]] in the prehospital setting. Time is an important factor and critical in prehospital [[airway]] management of [[patients]], due to [[trauma]], [[cardiac arrest]], [[hypoxemia]], or aspiration risk. Administration of the [[Neuromuscular blocking agents|neuromuscular blocking agent]] is associated with a reduction in time from rapid sequence [[intubation]] administration to the end of [[intubation]] attempt.

[[File:Glidescope 02.jpg|400px|thumb|left|Photograph of an anesthesiologist using the Glidescope video laryngoscope to intubate the trachea of a morbidly obese elderly person with challenging airway anatomy[https://en.wikipedia.org/wiki/Airway_managementI (DiverDave (talk)) created this work entirely by myself. (Original uploaded on en.wikipedia)]]] 

==Management of the Airway in Patients with Trauma==
===Suspected Spinal Cord Injury===

*In [[patients]] with suspected [[trauma]], extreme caution must be taken in aligning the [[head]] and [[neck]]. The [[cervical spine]] must be maintained in a neutral mid-line position, the exception to this is physical resistance.<ref name="ThiboutotNicole2009">{{cite journal|last1=Thiboutot|first1=François|last2=Nicole|first2=Pierre C.|last3=Trépanier|first3=Claude A.|last4=Turgeon|first4=Alexis F.|last5=Lessard|first5=Martin R.|title=Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial|journal=Canadian Journal of Anesthesia/Journal Canadien d'anesthésie|volume=56|issue=6|year=2009|pages=412–418|issn=0832-610X|doi=10.1007/s12630-009-9089-7}}</ref><ref>{{cite journal|doi=10.1016/j.jclinane.2005.04.003 [Indexed for MEDLINE]}}</ref><ref name="KrishnamoorthyDagal2014">{{cite journal|last1=Krishnamoorthy|first1=Vijay|last2=Dagal|first2=Arman|last3=Austin|first3=Naola|title=Airway management in cervical spine injury|journal=International Journal of Critical Illness and Injury Science|volume=4|issue=1|year=2014|pages=50|issn=2229-5151|doi=10.4103/2229-5151.128013}}</ref><ref name="GhafoorMartin2005">{{cite journal|last1=Ghafoor|first1=Abid U.|last2=Martin|first2=Timothy W.|last3=Gopalakrishnan|first3=Senthil|last4=Viswamitra|first4=Sanjaya|title=Caring for the patients with cervical spine injuries: what have we learned?|journal=Journal of Clinical Anesthesia|volume=17|issue=8|year=2005|pages=640–649|issn=09528180|doi=10.1016/j.jclinane.2005.04.003}}</ref><ref name="SriganeshBusse2018">{{cite journal|last1=Sriganesh|first1=Kamath|last2=Busse|first2=JasonW|last3=Shanthanna|first3=Harsha|last4=Ramesh|first4=VenkatapuraJ|title=Airway management in the presence of cervical spine instability: A cross-sectional survey of the members of the Indian Society of Neuroanaesthesiology and Critical Care|journal=Indian Journal of Anaesthesia|volume=62|issue=2|year=2018|pages=115|issn=0019-5049|doi=10.4103/ija.IJA_671_17}}</ref>

*'''Neck Maneuvers During Airway Management:'''
**Immobilizing patient's [[neck]] by using sandbag-collar-tape on hardboard in a pre-hospital care setting.
**Applying pressure on cricoid with [[anterior]] half of hard [[cervical collar]] removed and another hand behind the [[posterior]] [[cervical collar]].
**Manual in-line stabilization is the technique of choice in any suspected [[cervical spine]] injury, during endotracheal intubation. In this technique, head grasped firmly at the [[mastoid process]] and the occiput.

*Traction should be avoided as it may distract the [[cervical spine]] and cause more [[neurological]] damage, even after manual in-line stabilization.

*Jaw thrust is the only basic [[airway]] opening maneuver appropriate for any [[patient]] with a suspected [[cervical spine injury]]. This method is used when head-tilt/chin-lift can be potentially dangerous to use on a patient who may have a [[cervical spine injury]]. In jaw-thrust maneuver, first care provider lifts the [[hyoid bone]] and [[tongue]] away from the [[posterior]] [[pharyngeal]] wall by pulling the [[mandible]] forward, displacing the [[tongue]] anteriorly.
*[[Suction]] and use of [[forceps]] under direct vision using a [[laryngoscope]] with the [[head]] and [[neck]] maintained in the neutral position.
*In order to minimize the risk of [[hypoxic]] damage from [[airway obstruction]] in an [[unconscious]] patient, proper positioning is done by placing patients in the [[lateral]] side with log rolling technique.

===Approach to airway management of a patient with Maxillo-Facial Injury===
[[Airway]] management of patients with [[maxillofacial]] trauma is challenging and vital because it's directly affecting the patient's survival. [[Endotracheal intubation]] is the [[Gold standard (test)|gold standard]] procedure to secure the [[airway]] in [[trauma]] [[patients]], however, in these [[patients]] passage of [[endotracheal tube]] may not be possible because the oral cavity, [[pharynx]], and [[larynx]] may be filled with [[blood]], secretions, [[soft tissue]], and [[bone]] fragments. Another reason for this is that the risk of [[aspiration]] and [[regurgitation]] is high in these patients.<ref name="BarakBahouth2015">{{cite journal|last1=Barak|first1=Michal|last2=Bahouth|first2=Hany|last3=Leiser|first3=Yoav|last4=Abu El-Naaj|first4=Imad|title=Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach|journal=BioMed Research International|volume=2015|year=2015|pages=1–9|issn=2314-6133|doi=10.1155/2015/724032}}</ref><ref name="pmid21655009">{{cite journal |vauthors=Raval CB, Rashiduddin M |title=Airway management in patients with maxillofacial trauma - A retrospective study of 177 cases |journal=Saudi J Anaesth |volume=5 |issue=1 |pages=9–14 |date=January 2011 |pmid=21655009 |pmc=3101764 |doi=10.4103/1658-354X.76476 |url=}}</ref><ref name="pmid7588664">{{cite journal |vauthors=Brimacombe J, Tucker P, Simons S |title=The laryngeal mask airway for awake diagnostic bronchoscopy. A retrospective study of 200 consecutive patients |journal=Eur J Anaesthesiol |volume=12 |issue=4 |pages=357–61 |date=July 1995 |pmid=7588664 |doi= |url=}}</ref><ref name="HsiaoPacheco-Fowler2008">{{cite journal|last1=Hsiao|first1=James|last2=Pacheco-Fowler|first2=Victor|title=Cricothyroidotomy|journal=New England Journal of Medicine|volume=358|issue=22|year=2008|pages=e25|issn=0028-4793|doi=10.1056/NEJMvcm0706755}}</ref>

*In such circumstances, there are numerous [[airway]] devices are available to rescue patients with [[maxillofacial]] injuries, some of these devices include:<ref name="BarakBahouth2015">{{cite journal|last1=Barak|first1=Michal|last2=Bahouth|first2=Hany|last3=Leiser|first3=Yoav|last4=Abu El-Naaj|first4=Imad|title=Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach|journal=BioMed Research International|volume=2015|year=2015|pages=1–9|issn=2314-6133|doi=10.1155/2015/724032}}</ref><ref name="MeyerPatel2014">{{cite journal|last1=Meyer|first1=TanyaK|last2=Patel|first2=SapnaA|title=Surgical Airway|journal=International Journal of Critical Illness and Injury Science|volume=4|issue=1|year=2014|pages=71|issn=2229-5151|doi=10.4103/2229-5151.128016}}</ref>
**Flexible [[fiberoptic]] [[bronchoscopy]] (FOB), enable an indirect view of [[vocal cords]].
**[[Laryngeal mask airway]] (LMA) may be inserted blindly since it does not require a view of the [[vocal cords]]. Another option for securing the [[airway]] in these patients is to pass the endotracheal tube after placing an LMA for them.
*Final option for establishing the airway in [[patients]] with [[maxillofacial]] injury is [[surgery]] by [[cricothyroidotomy]].
**[[Cricothyroidotomy]] also known as [[cricothyrotomy]] is a procedure done by trained [[health care providers]], they make a small [[incision]] through the skin and [[cricoid]] membrane which lies between the [[thyroid]] and [[cricoid]] [[cartilage]]<nowiki/>s, followed by inserting a [[tracheostomy tube]] to open alternative way of [[ventilation]] and [[oxygenation]] in the [[emergency]] situation which uses of [[endotracheal intubation]] is almost impossible or difficult and time-consuming.
**'''Indication for cricothyroidotomy include:'''
***Inability to secure [[airway]] through an [[endotracheal tube]]
***Major [[trauma]] to [[facial]] [[muscles]], [[pharynx]], [[larynx]].
***[[Congenital deformities]] and [[upper airway]] [[stenosis]].

*'''Contraindications for cricothyroidotomy:'''
**[[Age]], in [[pediatrics]] younger than 12 years old needle [[cricothyrotomy]] is indicated because of less potential damage to the [[larynx]] and surrounding structures.
**Massive [[trauma]] to the [[larynx]] or [[cricoid cartilage]]
**Inability to identify surface landmarks due to [[obesity]], [[cervical]] trauma.
**When [[Orotracheal intubation|orotracheal]] and [[Nasotracheal intubation|nasotracheal]] [[intubation]] are viable options
**[[Airway obstruction]] distal to [[subglottic airway]], e.g. [[tracheal stenosis]]
**[[Laryngeal cancer]]: Other than for an extreme airway [[emergency]], [[cricothyroidotomy]] must be avoided to not to seed the [[soft tissue]] of the [[neck]] with [[cancer]] cells
**[[Coagulopathy]] (other than [[emergency]] situation)

*'''Complications of cricothyroidotomy:'''
**[[Esophageal]] perforation if the blade penetrates too deeply.
**[[Subcutaneous emphysema]]
**Rupture of vital [[vessels]] such as a [[carotid artery]], excessive [[bleeding]], and [[hemorrhage]].

*'''Indications of definitive airway management in patients with maxillofacial injury:'''
**Absent spontaneous [[breathing]]
**[[Comatose]] [[patients]]([[Glasgow coma score]] < 9)
**[[Airway]] injury or [[obstruction]]
**Persistent [[oxygen saturation]] below 90%
**High risk for [[aspiration]]
**[[Systemic shock]]([[Systolic Blood Pressure Intervention|Systolic Blood Pressure]]<80mmHg)
**"Cannot intubate, cannot ventilate" situations

==Complications of airway management==

Airway management complications are common, these complications usually occur in [[intensive care units]] and [[emergency department]]<nowiki/>s, summary of airway management related complactions include:<ref name="CookMacDougall-Davis2012">{{cite journal|last1=Cook|first1=T.M.|last2=MacDougall-Davis|first2=S.R.|title=Complications and failure of airway management|journal=British Journal of Anaesthesia|volume=109|year=2012|pages=i68–i85|issn=00070912|doi=10.1093/bja/aes393}}</ref>

*[[Patient]] harm/death associated with suboptimal care
*[[Hypoxia]] is the most common cause of [[airway]]-related deaths
*[[Obesity]]
*[[Pulmonary]] [[aspiration]] remains the leading cause of airway-related [[anesthetic]] deaths
*Failure in airway management techniques

{{#ev:youtube|ycQs27YVE60}}

==Related Chapters==

*[[intubation|Intubation]]
*[[endotracheal tube|Endotracheal Tube]]
*[[laryngeal mask airway|Laryngeal Mask Airway]]
*[[oropharyngeal airway|Oropharyngeal Airway]]
*[[nasopharyngeal airway|Nasopharyngeal Airway]]
*[[Ventilation (physiology)|Ventilation]]
*[[Cricothyrotomy]]
*[[Tracheotomy]]

==References==
{{reflist|2}}
[[Category:Emergency medicine]]
[[Category:First aid]]
[[Category:anesthesia]]
[[Category:Intensive care medicine]]

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Airway management

2021-05-26T03:49:07Z

Shaik Aisha sultana: /* Techniques for airway management */

__NOTOC__
{{SI}}
{{CMG}}{{AE}}{{Nnasiri}}

==Overview==
''Airway management'' is the process of ensuring that there is an open pathway between a patient’s [[lung]]s and the outside world, and the [[lungs]] are safe from [[Pulmonary aspiration|aspiration]]. [[Airway]] loss is a major cause of preventable prehospital death in [[trauma]] patients. Airway management complications are common, especially in [[trauma]] patients because of associated [[pathology]], lack of complete evaluation before [[intubation]], unanticipated difficulty during ventilation and [[intubation]]. Additionally, [[trauma]] [[patients]] are at increased risk of [[airway obstruction]], aspiration, [[hypoxia]] and [[hypotension]], and [[vital sign|other unstable vital]] The providers must have skillset related to working with a variety of tools and techniques used in airway management and knowledge of the important [[anatomical]], [[physiological]], and [[pathological]] features related to the airway. They also should know the differences between the adult versus [[pediatric]] and [[neonatal]] airways as these [[anatomical]] and physiological differences are critical, impactful on patients lives and knowing these leads to effective control and management of the [[airway]]. Some of the indications for managing the [[airway]] in patients include [[respiratory failure]], altered sensorium([[Glasgow Coma Scale]] less than or equal to 8), rapid deterioration of [[mental status]], [[airway]] injury or compromise, injuries causing a high risk for [[aspiration]]-which includes all penetrating injuries to the [[abdomen]] or [[chest wall]]. Inadequate [[airway]] management may lead to [[cardiovascular]] arrest and compromise life-saving interventions in a [[trauma]] patient. Several [[airway]] control devices and techniques are available to assist [[healthcare]] providers in order to maintain the airway by [[ventilation]] and [[oxygenation]]. These include [[bag valve mask]] ([[Bag valve mask|BVM]]) [[ventilation]], direct [[laryngoscopy]] with [[endotracheal intubation]] (ETI) and adjunct [[Supraglottitis|supraglottic]] [[airway]] devices such as the [[laryngeal]] mask airway.

==Functional anatomy of the upper airway==
For a successful approach to [[airway]] management, [[health care providers]] must have knowledge of important [[anatomical]], [[physiological]], and [[pathological]] features related to the airway as well as knowledge of the various equipment and methods that can be utilized for this purpose. Also, the difference between airway management in adults, [[pediatrics]], and [[neonates]] is very critical.<ref name="pmid3056703">{{cite journal |vauthors=Morris IR |title=Functional anatomy of the upper airway |journal=Emerg. Med. Clin. North Am. |volume=6 |issue=4 |pages=639–69 |date=November 1988 |pmid=3056703 |doi= |url=}}</ref>

*The [[upper airway]] is consists of the [[pharynx]] and [[nasal]] cavities, the [[larynx]] and [[trachea]] may be included, and the [[oral cavity]] provides an alternate air entry into the [[respiratory system]].
*The nose is a bony and [[cartilage|cartilaginous]] structure attached to the facial [[skeleton]] and is divided into the two [[nasal]] cavities. The nose functions as a heater and humidifier of inspired air, it is also helps in [[phonation]] and [[vocal resonation]] and houses the [[olfactory]] receptors. The [[paranasal sinuses]] drain into the nasal cavities.
*An [[endotracheal tube]] passes through the [[nose]] or mouth into the [[trachea]] to protect the [[airway]] and achieve positive-pressure [[ventilation]]. The mouth opens posteriorly into the [[oropharynx]] and becomes part of the [[gastrointestinal system]], helps the [[digestion]] and also plays a role as an alternate pathway for [[respiration]]. It is also involved in [[phonation]].
*[[Orotracheal intubation]] can be used as an alternative to [[nasal]] [[intubation]] to achieve [[airway]] protection and maintain [[ventilation]]; but depending upon the condition of the [[patient]] and difficulty due to [[anatomical]] shape of [[upper airway]], this route may not be doable, for instance in supine unconscious persons, the backward movement of the [[tongue]] and lower [[jaw]] may cause [[airway obstruction]] and performing [[orotracheal intubation]] may not be the optimal way of managing airway.
*The [[pharynx]] is a membrane-lined cavity behind the [[mouth]] and [[nose]], extends from the base of the [[skull]] to the [[cricoid cartilage]] at the level of sixth [[cervical vertebrae]] which is an entrance to the [[esophagus]]. [[Anterior]]<nowiki/>ly it opens into the [[nasal cavity]], the [[mouth]], and the [[larynx]], which divide it into the naso-, oro-, and [[laryngopharynx]], respectively. The [[pharynx]] is involved with the act of [[swallowing]].
*The [[larynx]] consists of [[Cartilages of the larynx|cartilages]] and fibro-elastic membranes covered by a sheet of [[muscles]] and [[mucous membrane]]. It functions as an open valve in [[respiration]], helps in [[phonation]], and [[swallowing]]. The [[larynx]] extends from its entrance which is formed by the [[Aryepiglottic fold|aryepiglottic folds]], to the lower border of the [[cricoid cartilage]] till the tip of the [[epiglottis]], and bulges [[posterior]]<nowiki/>ly into the [[laryngopharynx]].
*The trachea is formed by U-shaped [[cartilaginous]] rings in anterior and [[trachealis muscle]] in [[posterior]], it extends from the lower edge of the [[cricoid cartilage]] to the [[carina]] where it divides into the [[mainstem bronchus]]. In order to place [[endotracheal tube]] in proper way, tip of the tube should be at mid [[Tracheal bronchus|tracheal]] level.

[[File:UpperRespiratorySystem.png|400px|thumb|left|upper airway system[https://commons.wikimedia.org/wiki/File:Blausen_0872_UpperRespiratorySystem.pngBlausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436.]]] 

==Recommendations for evaluation of airway==
The basic approach in airway management in the [[emergency]] setting includes:<ref name="RosenbergPhero2014">{{cite journal|last1=Rosenberg|first1=M. B|last2=Phero|first2=J. C|last3=Becker|first3=D. E|title=Essentials of Airway Management, Oxygenation, and Ventilation: Part 2: Advanced Airway Devices: Supraglottic Airways|journal=Anesthesia Progress|volume=61|issue=3|year=2014|pages=113–118|issn=0003-3006|doi=10.2344/0003-3006-61.3.113}}</ref>

:*Protection from [[aspiration]] and [[pneumonia]] related to that.
:*Providing adequate [[oxygenation]] and [[ventilation]].

Following are steps that must be considered prior to conducting airway management, these include:

:*'''History:''' An [[airway]] [[history]] should be conducted whenever it is possible before airway management in all [[patients]] to detect medical, [[surgical]], and [[anesthetic]] factors that may indicate the presence of a difficult [[airway]]. A detailed review of previous [[anesthetic]] records, if available, may provide useful information about airway management.

:*'''Physical Examination:''' An airway [[physical examination]] should be conducted before the initiation of airway management. The goal of [[physical examination]] is to detect physical characteristics that may indicate the presence of a difficult airway because an unsuccessful [[upper airway]] management is associated with increase in [[mortality]] and [[morbidity]].

:*'''Additional Evaluation:''' Additional evaluation may be indicated in some [[patients]] to characterize the likelihood or nature of the anticipated difficult airway. Certain diagnostic tests (e.g., [[radiography]], [[computed tomography]] scans, [[fluoroscopy]]) can identify a variety of acquired or congenital features in patients with difficult airways

==Techniques for airway management==
The decision about whether an airway intervention is required or not is crucial for patient's [[Survival rate|survival]] and depends on first responders skills and quick assessment and decision. These crucial steps requires techniques which are used universally in order to manage [[patient]]'s airway. Following are initial evaluation methods which had been developed to assist patient's [[ventilation]] and keep the [[airway]] patent, these techniques include:<ref name="RoychoudhuryJose2016">{{cite journal|last1=Roychoudhury|first1=Ajoy|last2=Jose|first2=Anson|last3=Nagori|first3=ShakilAhmed|last4=Agarwal|first4=Bhaskar|last5=Bhutia|first5=Ongkila|title=Management of maxillofacial trauma in emergency: An update of challenges and controversies|journal=Journal of Emergencies, Trauma, and Shock|volume=9|issue=2|year=2016|pages=73|issn=0974-2700|doi=10.4103/0974-2700.179456}}</ref><ref name="pmid18946431">{{cite journal |vauthors=Agrò FE, Cataldo R, Mattei A |title=New devices and techniques for airway management |journal=Minerva Anestesiol |volume=75 |issue=3 |pages=141–9 |date=March 2009 |pmid=18946431 |doi= |url=}}</ref><ref name="pmid29560073">{{cite journal |vauthors=Gleason JM, Christian BR, Barton ED |title=Nasal Cannula Apneic Oxygenation Prevents Desaturation During Endotracheal Intubation: An Integrative Literature Review |journal=West J Emerg Med |volume=19 |issue=2 |pages=403–411 |date=March 2018 |pmid=29560073 |pmc=5851518 |doi=10.5811/westjem.2017.12.34699 |url=}}</ref><ref name="LawBroemling2013">{{cite journal|last1=Law|first1=J. Adam|last2=Broemling|first2=Natasha|last3=Cooper|first3=Richard M.|last4=Drolet|first4=Pierre|last5=Duggan|first5=Laura V.|last6=Griesdale|first6=Donald E.|last7=Hung|first7=Orlando R.|last8=Jones|first8=Philip M.|last9=Kovacs|first9=George|last10=Massey|first10=Simon|last11=Morris|first11=Ian R.|last12=Mullen|first12=Timothy|last13=Murphy|first13=Michael F.|last14=Preston|first14=Roanne|last15=Naik|first15=Viren N.|last16=Scott|first16=Jeanette|last17=Stacey|first17=Shean|last18=Turkstra|first18=Timothy P.|last19=Wong|first19=David T.|title=The difficult airway with recommendations for management – Part 1 – Difficult tracheal intubation encountered in an unconscious/induced patient|journal=Canadian Journal of Anesthesia/Journal canadien d'anesthésie|volume=60|issue=11|year=2013|pages=1089–1118|issn=0832-610X|doi=10.1007/s12630-013-0019-3}}</ref><ref name="OkuboGibo2017">{{cite journal|last1=Okubo|first1=Masashi|last2=Gibo|first2=Koichiro|last3=Hagiwara|first3=Yusuke|last4=Nakayama|first4=Yukiko|last5=Hasegawa|first5=Kohei|title=The effectiveness of rapid sequence intubation (RSI) versus non-RSI in emergency department: an analysis of multicenter prospective observational study|journal=International Journal of Emergency Medicine|volume=10|issue=1|year=2017|issn=1865-1372|doi=10.1186/s12245-017-0129-8}}</ref>

*'''Spontaneous breathing:''' When a provider is confronted with an awake [[patient]] having a patent airway. Spontaneous ventilation can be assisted through the placement of a nasal or oral airway. [[Oxygenation]] can be improved by giving [[oxygen]] via nasal [[cannula]], simple [[face mask]], or nonrebreather face mask. Unfortunately, the maximally achieved [[FiO2]] is often overestimated by care providers and [[hypoventilation]] resulting in [[hypercapnia]] cannot be normalized with increase in [[oxygen]] supply.
*'''Mouth-to-Mouth ventilation:''' Mouth-to-mouth or mouth-to-nose ventilation is a useful management technique, however, because of the risk of [[infection]] transmission it is recommended by American heart association that health care providers do "Hands-only" [[CPR]]. Proper face masks should be utilized if they are available.
*'''Bag-mask ventilation:''' It is a standard initial approach to airway management in the prehospital and [[hospital]] settings.

:*Proper preoxygenation prior to [[intubation]] and [[anesthetic]] induction provides patients with improved [[oxygenation]] and increases the time to [[hypoxemia]].
:*Bag-mask [[ventilation]] is a basic essential technique when [[endotracheal tube]] [[intubation]] is difficult, it assists for rapid [[ventilation]] and [[oxygenation]] in patients.
:*Bag-mask [[ventilation]] can be achieved by a single practitioner alone or side by side with a second care provider in an [[Operating room|emergency room or an operating room]]
:*Bag mask [[ventilation]] can also be utilized as a pressure support during spontaneous [[respiration]] in patients with decre<nowiki/>ased [[tidal volume]]<nowiki/>s and insufficient [[ventilation]], very similar to the use of [[CPAP]] or [[BiPAP]] to assist [[patients]] who are spontaneously [[breathing]] but are not adequately ventilating or oxygenating.

*'''Oropharyngeal and nasopharyngeal airways:'''

:*This is used as an adjunct device for spontaneous or [[assisted ventilation]].
:*[[Oropharyngeal]] and [[nasopharyngeal airway]]<nowiki/>s are frequently utilized by prehospital care providers to improve [[oxygenation]] and [[ventilation]].
:*These devices are frequently used until a more definitive [[airway]] is obtained, and there are several circumstances that prohibit their placement (severe head or [[facial]] injuries).

*'''Supraglottic airway devices:''' [[Supraglottic laryngeal cancer|Supraglottic]] airway (SGA) device placement is very useful to keep the [[airway]]<nowiki/>s open, it has advantages in comparison with [[endotracheal tube]] intubation, or other methods, these advantages include:<ref name="pmid27537593">{{cite journal |vauthors=Park SK, Ko G, Choi GJ, Ahn EJ, Kang H |title=Comparison between supraglottic airway devices and endotracheal tubes in patients undergoing laparoscopic surgery: A systematic review and meta-analysis |journal=Medicine (Baltimore) |volume=95 |issue=33 |pages=e4598 |date=August 2016 |pmid=27537593 |doi=10.1097/MD.0000000000004598 |url=}}</ref>

:*They act as a niche between bag and mask ventilation and endo tracheal intubation.
:*Requires less training than ETI
:*It is less invasive than ETI.
:*It can offer better [[ventilation]] during transport than bag-mask [[ventilation]] alone.
:**[[Supraglottitis|Supraglottic]] airway devices can be used as an alternative tool in cases of failed [[intubation]].

*'''[[Endotracheal intubation]]:''' It is the gold standard for definitive airway management in the prehospital setting, and also hospital setting. It allows for positive pressure [[ventilation]], [[positive end-expiratory pressure]] (PEEP), positive pressure recruitment maneuvers, and protection from [[aspiration]].

:*'''Mallampati classification for assessment of upper airway anatomical Balance:''' It is named after the Indian-born American [[anesthesiologist]] Seshagiri Mallampati, is used to predict the ease of [[endotracheal intubation]].The test assess the distance from the [[tongue]] base to the roof of the [[mouth]] visually. It is an indirect way of assessing how the airway and predicting the difficult intubation.
:*'''Modified Mallampati Scoring:'''
:**Class I: [[Soft palate]], [[uvula]], [[fauces]], [[Pillars of the fauces|pillars]] visible.
:**Class II: [[Soft palate]], a major part of the [[uvula]], [[fauces]] visible.
:**Class III: [[Soft palate]], the base of [[uvula]] visible.
:**Class IV: Only [[hard palate]] visible.

*'''Rapid sequence intubation versus no-medication intubation''':

:*Use of [[pharmacological]] [[muscle relaxant]] eases the [[intubation]] process by relaxing muscles in the [[pharynx]]. [[Rapid sequence induction|Rapid sequence intubation]] ([[RSI]]) techniques incorporate [[pharmacologic]] [[muscle]] relaxation and are utilized by anesthesiologists and [[emergency medicine]] physicians. However, the disadvantage of these techniques is the elimination of a patient's ability to breathe spontaneously if the [[intubation]] fails. There is a debate that optimal intubating conditions should be achieved first before trying to attempt [[intubation]] in the prehospital setting. Time is an important factor and critical in prehospital [[airway]] management of [[patients]], due to [[trauma]], [[cardiac arrest]], [[hypoxemia]], or aspiration risk. Administration of the [[Neuromuscular blocking agents|neuromuscular blocking agent]] is associated with a reduction in time from rapid sequence [[intubation]] administration to the end of [[intubation]] attempt.

[[File:Glidescope 02.jpg|400px|thumb|left|Photograph of an anesthesiologist using the Glidescope video laryngoscope to intubate the trachea of a morbidly obese elderly person with challenging airway anatomy[https://en.wikipedia.org/wiki/Airway_managementI (DiverDave (talk)) created this work entirely by myself. (Original uploaded on en.wikipedia)]]] 

==Management of the Airway in Patients with Trauma==
===Suspected Spinal Cord Injury===

*In [[patients]] with suspected [[trauma]], extreme caution must be taken in aligning the [[head]] and [[neck]]. The [[cervical spine]] must be maintained in a neutral mid-line position, the exception to this is physical resistance.<ref name="ThiboutotNicole2009">{{cite journal|last1=Thiboutot|first1=François|last2=Nicole|first2=Pierre C.|last3=Trépanier|first3=Claude A.|last4=Turgeon|first4=Alexis F.|last5=Lessard|first5=Martin R.|title=Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial|journal=Canadian Journal of Anesthesia/Journal Canadien d'anesthésie|volume=56|issue=6|year=2009|pages=412–418|issn=0832-610X|doi=10.1007/s12630-009-9089-7}}</ref><ref>{{cite journal|doi=10.1016/j.jclinane.2005.04.003 [Indexed for MEDLINE]}}</ref><ref name="KrishnamoorthyDagal2014">{{cite journal|last1=Krishnamoorthy|first1=Vijay|last2=Dagal|first2=Arman|last3=Austin|first3=Naola|title=Airway management in cervical spine injury|journal=International Journal of Critical Illness and Injury Science|volume=4|issue=1|year=2014|pages=50|issn=2229-5151|doi=10.4103/2229-5151.128013}}</ref><ref name="GhafoorMartin2005">{{cite journal|last1=Ghafoor|first1=Abid U.|last2=Martin|first2=Timothy W.|last3=Gopalakrishnan|first3=Senthil|last4=Viswamitra|first4=Sanjaya|title=Caring for the patients with cervical spine injuries: what have we learned?|journal=Journal of Clinical Anesthesia|volume=17|issue=8|year=2005|pages=640–649|issn=09528180|doi=10.1016/j.jclinane.2005.04.003}}</ref><ref name="SriganeshBusse2018">{{cite journal|last1=Sriganesh|first1=Kamath|last2=Busse|first2=JasonW|last3=Shanthanna|first3=Harsha|last4=Ramesh|first4=VenkatapuraJ|title=Airway management in the presence of cervical spine instability: A cross-sectional survey of the members of the Indian Society of Neuroanaesthesiology and Critical Care|journal=Indian Journal of Anaesthesia|volume=62|issue=2|year=2018|pages=115|issn=0019-5049|doi=10.4103/ija.IJA_671_17}}</ref>

*'''Neck Maneuvers During Airway Management:'''
**Immobilizing patient's [[neck]] by using sandbag-collar-tape on hardboard in a pre-hospital care setting.
**Applying pressure on cricoid with [[anterior]] half of hard [[cervical collar]] removed and another hand behind the [[posterior]] [[cervical collar]].
**Manual in-line stabilization is the technique of choice in any suspected [[cervical spine]] injury, during endotracheal intubation. In this technique, head grasped firmly at the [[mastoid process]] and the occiput.

*Traction should be avoided as it may distract the [[cervical spine]] and cause more [[neurological]] damage, even after manual in-line stabilization.

*Jaw thrust is the only basic [[airway]] opening maneuver appropriate for any [[patient]] with a suspected [[cervical spine injury]]. This method is used when head-tilt/chin-lift can be potentially dangerous to use on a patient who may have a [[cervical spine injury]]. In jaw-thrust maneuver, first care provider lifts the [[hyoid bone]] and [[tongue]] away from the [[posterior]] [[pharyngeal]] wall by pulling the [[mandible]] forward, displacing the [[tongue]] anteriorly.
*[[Suction]] and use of [[forceps]] under direct vision using a [[laryngoscope]] with the [[head]] and [[neck]] maintained in the neutral position.
*In order to minimize the risk of [[hypoxic]] damage from [[airway obstruction]] in an [[unconscious]] patient, proper positioning is done by placing patients in the [[lateral]] side with log rolling technique.

===Approach to airway management of a patient with Maxillo-Facial Injury===
[[Airway]] management of patients with [[maxillofacial]] trauma is challenging and vital because it's directly affecting the patient's survival. [[Endotracheal intubation]] is the [[Gold standard (test)|gold standard]] procedure to secure the [[airway]] in [[trauma]] [[patients]], however, in these [[patients]] passage of [[endotracheal tube]] may not be possible because the oral cavity, [[pharynx]], and [[larynx]] may be filled with [[blood]], secretions, [[soft tissue]], and [[bone]] fragments. Another reason for this is that the risk of [[aspiration]] and [[regurgitation]] is high in these patients.<ref name="BarakBahouth2015">{{cite journal|last1=Barak|first1=Michal|last2=Bahouth|first2=Hany|last3=Leiser|first3=Yoav|last4=Abu El-Naaj|first4=Imad|title=Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach|journal=BioMed Research International|volume=2015|year=2015|pages=1–9|issn=2314-6133|doi=10.1155/2015/724032}}</ref><ref name="pmid21655009">{{cite journal |vauthors=Raval CB, Rashiduddin M |title=Airway management in patients with maxillofacial trauma - A retrospective study of 177 cases |journal=Saudi J Anaesth |volume=5 |issue=1 |pages=9–14 |date=January 2011 |pmid=21655009 |pmc=3101764 |doi=10.4103/1658-354X.76476 |url=}}</ref><ref name="pmid7588664">{{cite journal |vauthors=Brimacombe J, Tucker P, Simons S |title=The laryngeal mask airway for awake diagnostic bronchoscopy. A retrospective study of 200 consecutive patients |journal=Eur J Anaesthesiol |volume=12 |issue=4 |pages=357–61 |date=July 1995 |pmid=7588664 |doi= |url=}}</ref><ref name="HsiaoPacheco-Fowler2008">{{cite journal|last1=Hsiao|first1=James|last2=Pacheco-Fowler|first2=Victor|title=Cricothyroidotomy|journal=New England Journal of Medicine|volume=358|issue=22|year=2008|pages=e25|issn=0028-4793|doi=10.1056/NEJMvcm0706755}}</ref>

*In such circumstances, there are numerous [[airway]] devices are available to rescue patients with [[maxillofacial]] injuries, some of these devices include:<ref name="BarakBahouth2015">{{cite journal|last1=Barak|first1=Michal|last2=Bahouth|first2=Hany|last3=Leiser|first3=Yoav|last4=Abu El-Naaj|first4=Imad|title=Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach|journal=BioMed Research International|volume=2015|year=2015|pages=1–9|issn=2314-6133|doi=10.1155/2015/724032}}</ref><ref name="MeyerPatel2014">{{cite journal|last1=Meyer|first1=TanyaK|last2=Patel|first2=SapnaA|title=Surgical Airway|journal=International Journal of Critical Illness and Injury Science|volume=4|issue=1|year=2014|pages=71|issn=2229-5151|doi=10.4103/2229-5151.128016}}</ref>
**Flexible [[fiberoptic]] [[bronchoscopy]] (FOB), enable an indirect view of [[vocal cords]].
**[[Laryngeal mask airway]] (LMA) may be inserted blindly since it does not require a view of the [[vocal cords]]. Another option for securing the [[airway]] in these patients is to pass the endotracheal tube after placing an LMA for them.
*Final option for establishing the airway in [[patients]] with [[maxillofacial]] injury is [[surgery]] by [[cricothyroidotomy]].
**[[Cricothyroidotomy]] also known as [[cricothyrotomy]] is a procedure done by trained [[health care providers]], they make a small [[incision]] through the skin and [[cricoid]] membrane which lies between the [[thyroid]] and [[cricoid]] [[cartilage]]<nowiki/>s, followed by inserting a [[tracheostomy tube]] to open alternative way of [[ventilation]] and [[oxygenation]] in the [[emergency]] situation which uses of [[endotracheal intubation]] is almost impossible or difficult and time-consuming.
**'''Indication for cricothyroidotomy include:'''
***Inability to secure [[airway]] through an [[endotracheal tube]]
***Major [[trauma]] to [[facial]] [[muscles]], [[pharynx]], [[larynx]].
***[[Congenital deformities]] and [[upper airway]] [[stenosis]].

*'''Contraindications for cricothyroidotomy:'''
**[[Age]], in [[pediatrics]] younger than 12 years old needle [[cricothyrotomy]] is indicated because of less potential damage to the [[larynx]] and surrounding structures.
**Massive [[trauma]] to the [[larynx]] or [[cricoid cartilage]]
**Inability to identify surface landmarks due to [[obesity]], [[cervical]] trauma.
**When [[Orotracheal intubation|orotracheal]] and [[Nasotracheal intubation|nasotracheal]] [[intubation]] are viable options
**[[Airway obstruction]] distal to [[subglottic airway]], e.g. [[tracheal stenosis]]
**[[Laryngeal cancer]]: Other than for an extreme airway [[emergency]], [[cricothyroidotomy]] must be avoided to not to seed the [[soft tissue]] of the [[neck]] with [[cancer]] cells
**[[Coagulopathy]] (other than [[emergency]] situation)

*'''Complications of cricothyroidotomy:'''
**[[Esophageal]] perforation if the blade penetrates too deeply.
**[[Subcutaneous emphysema]]
**Rupture of vital [[vessels]] such as a [[carotid artery]], excessive [[bleeding]], and [[hemorrhage]].

*'''Indications of definitive airway management in patients with maxillofacial injury:'''
**Absent spontaneous [[breathing]]
**[[Comatose]] [[patients]]([[Glasgow coma score]] < 9)
**[[Airway]] injury or [[obstruction]]
**Persistent [[oxygen saturation]] below 90%
**High risk for [[aspiration]]
**[[Systemic shock]]([[Systolic Blood Pressure Intervention|Systolic Blood Pressure]]<80mmHg)
**"Cannot intubate, cannot ventilate" situations

==Complications of airway management==

Airway management complications are common, these complications usually occur in [[intensive care units]] and [[emergency department]]<nowiki/>s, summary of airway management related complactions include:<ref name="CookMacDougall-Davis2012">{{cite journal|last1=Cook|first1=T.M.|last2=MacDougall-Davis|first2=S.R.|title=Complications and failure of airway management|journal=British Journal of Anaesthesia|volume=109|year=2012|pages=i68–i85|issn=00070912|doi=10.1093/bja/aes393}}</ref>

*[[Patient]] harm/death associated with suboptimal care
*[[Hypoxia]] is the most common cause of [[airway]]-related deaths
*[[Obesity]]
*[[Pulmonary]] [[aspiration]] remains the leading cause of airway-related [[anesthetic]] deaths
*Failure in airway management techniques

{{#ev:youtube|ycQs27YVE60}}

==Related Chapters==

*[[intubation|Intubation]]
*[[endotracheal tube|Endotracheal Tube]]
*[[laryngeal mask airway|Laryngeal Mask Airway]]
*[[oropharyngeal airway|Oropharyngeal Airway]]
*[[nasopharyngeal airway|Nasopharyngeal Airway]]
*[[Ventilation (physiology)|Ventilation]]
*[[Cricothyrotomy]]
*[[Tracheotomy]]

==References==
{{reflist|2}}
[[Category:Emergency medicine]]
[[Category:First aid]]
[[Category:anesthesia]]
[[Category:Intensive care medicine]]

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Airway management

2021-05-26T03:46:19Z

Shaik Aisha sultana: /* Techniques for airway management */

__NOTOC__
{{SI}}
{{CMG}}{{AE}}{{Nnasiri}}

==Overview==
''Airway management'' is the process of ensuring that there is an open pathway between a patient’s [[lung]]s and the outside world, and the [[lungs]] are safe from [[Pulmonary aspiration|aspiration]]. [[Airway]] loss is a major cause of preventable prehospital death in [[trauma]] patients. Airway management complications are common, especially in [[trauma]] patients because of associated [[pathology]], lack of complete evaluation before [[intubation]], unanticipated difficulty during ventilation and [[intubation]]. Additionally, [[trauma]] [[patients]] are at increased risk of [[airway obstruction]], aspiration, [[hypoxia]] and [[hypotension]], and [[vital sign|other unstable vital]] The providers must have skillset related to working with a variety of tools and techniques used in airway management and knowledge of the important [[anatomical]], [[physiological]], and [[pathological]] features related to the airway. They also should know the differences between the adult versus [[pediatric]] and [[neonatal]] airways as these [[anatomical]] and physiological differences are critical, impactful on patients lives and knowing these leads to effective control and management of the [[airway]]. Some of the indications for managing the [[airway]] in patients include [[respiratory failure]], altered sensorium([[Glasgow Coma Scale]] less than or equal to 8), rapid deterioration of [[mental status]], [[airway]] injury or compromise, injuries causing a high risk for [[aspiration]]-which includes all penetrating injuries to the [[abdomen]] or [[chest wall]]. Inadequate [[airway]] management may lead to [[cardiovascular]] arrest and compromise life-saving interventions in a [[trauma]] patient. Several [[airway]] control devices and techniques are available to assist [[healthcare]] providers in order to maintain the airway by [[ventilation]] and [[oxygenation]]. These include [[bag valve mask]] ([[Bag valve mask|BVM]]) [[ventilation]], direct [[laryngoscopy]] with [[endotracheal intubation]] (ETI) and adjunct [[Supraglottitis|supraglottic]] [[airway]] devices such as the [[laryngeal]] mask airway.

==Functional anatomy of the upper airway==
For a successful approach to [[airway]] management, [[health care providers]] must have knowledge of important [[anatomical]], [[physiological]], and [[pathological]] features related to the airway as well as knowledge of the various equipment and methods that can be utilized for this purpose. Also, the difference between airway management in adults, [[pediatrics]], and [[neonates]] is very critical.<ref name="pmid3056703">{{cite journal |vauthors=Morris IR |title=Functional anatomy of the upper airway |journal=Emerg. Med. Clin. North Am. |volume=6 |issue=4 |pages=639–69 |date=November 1988 |pmid=3056703 |doi= |url=}}</ref>

*The [[upper airway]] is consists of the [[pharynx]] and [[nasal]] cavities, the [[larynx]] and [[trachea]] may be included, and the [[oral cavity]] provides an alternate air entry into the [[respiratory system]].
*The nose is a bony and [[cartilage|cartilaginous]] structure attached to the facial [[skeleton]] and is divided into the two [[nasal]] cavities. The nose functions as a heater and humidifier of inspired air, it is also helps in [[phonation]] and [[vocal resonation]] and houses the [[olfactory]] receptors. The [[paranasal sinuses]] drain into the nasal cavities.
*An [[endotracheal tube]] passes through the [[nose]] or mouth into the [[trachea]] to protect the [[airway]] and achieve positive-pressure [[ventilation]]. The mouth opens posteriorly into the [[oropharynx]] and becomes part of the [[gastrointestinal system]], helps the [[digestion]] and also plays a role as an alternate pathway for [[respiration]]. It is also involved in [[phonation]].
*[[Orotracheal intubation]] can be used as an alternative to [[nasal]] [[intubation]] to achieve [[airway]] protection and maintain [[ventilation]]; but depending upon the condition of the [[patient]] and difficulty due to [[anatomical]] shape of [[upper airway]], this route may not be doable, for instance in supine unconscious persons, the backward movement of the [[tongue]] and lower [[jaw]] may cause [[airway obstruction]] and performing [[orotracheal intubation]] may not be the optimal way of managing airway.
*The [[pharynx]] is a membrane-lined cavity behind the [[mouth]] and [[nose]], extends from the base of the [[skull]] to the [[cricoid cartilage]] at the level of sixth [[cervical vertebrae]] which is an entrance to the [[esophagus]]. [[Anterior]]<nowiki/>ly it opens into the [[nasal cavity]], the [[mouth]], and the [[larynx]], which divide it into the naso-, oro-, and [[laryngopharynx]], respectively. The [[pharynx]] is involved with the act of [[swallowing]].
*The [[larynx]] consists of [[Cartilages of the larynx|cartilages]] and fibro-elastic membranes covered by a sheet of [[muscles]] and [[mucous membrane]]. It functions as an open valve in [[respiration]], helps in [[phonation]], and [[swallowing]]. The [[larynx]] extends from its entrance which is formed by the [[Aryepiglottic fold|aryepiglottic folds]], to the lower border of the [[cricoid cartilage]] till the tip of the [[epiglottis]], and bulges [[posterior]]<nowiki/>ly into the [[laryngopharynx]].
*The trachea is formed by U-shaped [[cartilaginous]] rings in anterior and [[trachealis muscle]] in [[posterior]], it extends from the lower edge of the [[cricoid cartilage]] to the [[carina]] where it divides into the [[mainstem bronchus]]. In order to place [[endotracheal tube]] in proper way, tip of the tube should be at mid [[Tracheal bronchus|tracheal]] level.

[[File:UpperRespiratorySystem.png|400px|thumb|left|upper airway system[https://commons.wikimedia.org/wiki/File:Blausen_0872_UpperRespiratorySystem.pngBlausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436.]]] 

==Recommendations for evaluation of airway==
The basic approach in airway management in the [[emergency]] setting includes:<ref name="RosenbergPhero2014">{{cite journal|last1=Rosenberg|first1=M. B|last2=Phero|first2=J. C|last3=Becker|first3=D. E|title=Essentials of Airway Management, Oxygenation, and Ventilation: Part 2: Advanced Airway Devices: Supraglottic Airways|journal=Anesthesia Progress|volume=61|issue=3|year=2014|pages=113–118|issn=0003-3006|doi=10.2344/0003-3006-61.3.113}}</ref>

:*Protection from [[aspiration]] and [[pneumonia]] related to that.
:*Providing adequate [[oxygenation]] and [[ventilation]].

Following are steps that must be considered prior to conducting airway management, these include:

:*'''History:''' An [[airway]] [[history]] should be conducted whenever it is possible before airway management in all [[patients]] to detect medical, [[surgical]], and [[anesthetic]] factors that may indicate the presence of a difficult [[airway]]. A detailed review of previous [[anesthetic]] records, if available, may provide useful information about airway management.

:*'''Physical Examination:''' An airway [[physical examination]] should be conducted before the initiation of airway management. The goal of [[physical examination]] is to detect physical characteristics that may indicate the presence of a difficult airway because an unsuccessful [[upper airway]] management is associated with increase in [[mortality]] and [[morbidity]].

:*'''Additional Evaluation:''' Additional evaluation may be indicated in some [[patients]] to characterize the likelihood or nature of the anticipated difficult airway. Certain diagnostic tests (e.g., [[radiography]], [[computed tomography]] scans, [[fluoroscopy]]) can identify a variety of acquired or congenital features in patients with difficult airways

==Techniques for airway management==
The decision about whether an airway intervention is required or not is crucial for patient's [[Survival rate|survival]] and depends on first responders skills and quick assessment and decision. These crucial steps requires techniques which are used universally in order to manage [[patient]]'s airway. Following are initial evaluation methods which had been developed to assist patient's [[ventilation]] and keep the [[airway]] patent, these techniques include:<ref name="RoychoudhuryJose2016">{{cite journal|last1=Roychoudhury|first1=Ajoy|last2=Jose|first2=Anson|last3=Nagori|first3=ShakilAhmed|last4=Agarwal|first4=Bhaskar|last5=Bhutia|first5=Ongkila|title=Management of maxillofacial trauma in emergency: An update of challenges and controversies|journal=Journal of Emergencies, Trauma, and Shock|volume=9|issue=2|year=2016|pages=73|issn=0974-2700|doi=10.4103/0974-2700.179456}}</ref><ref name="pmid18946431">{{cite journal |vauthors=Agrò FE, Cataldo R, Mattei A |title=New devices and techniques for airway management |journal=Minerva Anestesiol |volume=75 |issue=3 |pages=141–9 |date=March 2009 |pmid=18946431 |doi= |url=}}</ref><ref name="pmid29560073">{{cite journal |vauthors=Gleason JM, Christian BR, Barton ED |title=Nasal Cannula Apneic Oxygenation Prevents Desaturation During Endotracheal Intubation: An Integrative Literature Review |journal=West J Emerg Med |volume=19 |issue=2 |pages=403–411 |date=March 2018 |pmid=29560073 |pmc=5851518 |doi=10.5811/westjem.2017.12.34699 |url=}}</ref><ref name="LawBroemling2013">{{cite journal|last1=Law|first1=J. Adam|last2=Broemling|first2=Natasha|last3=Cooper|first3=Richard M.|last4=Drolet|first4=Pierre|last5=Duggan|first5=Laura V.|last6=Griesdale|first6=Donald E.|last7=Hung|first7=Orlando R.|last8=Jones|first8=Philip M.|last9=Kovacs|first9=George|last10=Massey|first10=Simon|last11=Morris|first11=Ian R.|last12=Mullen|first12=Timothy|last13=Murphy|first13=Michael F.|last14=Preston|first14=Roanne|last15=Naik|first15=Viren N.|last16=Scott|first16=Jeanette|last17=Stacey|first17=Shean|last18=Turkstra|first18=Timothy P.|last19=Wong|first19=David T.|title=The difficult airway with recommendations for management – Part 1 – Difficult tracheal intubation encountered in an unconscious/induced patient|journal=Canadian Journal of Anesthesia/Journal canadien d'anesthésie|volume=60|issue=11|year=2013|pages=1089–1118|issn=0832-610X|doi=10.1007/s12630-013-0019-3}}</ref><ref name="OkuboGibo2017">{{cite journal|last1=Okubo|first1=Masashi|last2=Gibo|first2=Koichiro|last3=Hagiwara|first3=Yusuke|last4=Nakayama|first4=Yukiko|last5=Hasegawa|first5=Kohei|title=The effectiveness of rapid sequence intubation (RSI) versus non-RSI in emergency department: an analysis of multicenter prospective observational study|journal=International Journal of Emergency Medicine|volume=10|issue=1|year=2017|issn=1865-1372|doi=10.1186/s12245-017-0129-8}}</ref>

*'''Spontaneous breathing:''' When a provider is confronted with an awake [[patient]] having a patent airway. Spontaneous ventilation can be assisted through the placement of a nasal or oral airway. [[Oxygenation]] can be improved by giving [[oxygen]] via nasal [[cannula]], simple [[face mask]], or nonrebreather face mask. Unfortunately, the maximally achieved [[FiO2]] is often overestimated by care providers and [[hypoventilation]] resulting in [[hypercapnia]] cannot be normalized with increase in [[oxygen]] supply.
*'''Mouth-to-Mouth ventilation:''' Mouth-to-mouth or mouth-to-nose ventilation is a useful management technique, however, because of the risk of [[infection]] transmission it is recommended by American heart association that health care providers do "Hands-only" [[CPR]]. Proper face masks should be utilized if they are available.
*'''Bag-mask ventilation:''' It is a standard initial approach to airway management in the prehospital and [[hospital]] settings.

:*Proper preoxygenation prior to [[intubation]] and [[anesthetic]] induction provides patients with improved [[oxygenation]] and increases the time to [[hypoxemia]].
:*Bag-mask [[ventilation]] is a basic essential technique when [[endotracheal tube]] [[intubation]] is difficult, it assists for rapid [[ventilation]] and [[oxygenation]] in patients.
:*Bag-mask [[ventilation]] can be achieved by a single practitioner alone or side by side with a second care provider in an [[Operating room|emergency room or an operating room]]
:*Bag mask [[ventilation]] can also be utilized as a pressure support during spontaneous [[respiration]] in patients with decre<nowiki/>ased [[tidal volume]]<nowiki/>s and insufficient [[ventilation]], very similar to the use of [[CPAP]] or [[BiPAP]] to assist [[patients]] who are spontaneously [[breathing]] but are not adequately ventilating or oxygenating.

*'''Oropharyngeal and nasopharyngeal airways:'''

:*This is used as an adjunct device for spontaneous or [[assisted ventilation]].
:*[[Oropharyngeal]] and [[nasopharyngeal airway]]<nowiki/>s are frequently utilized by prehospital care providers to improve [[oxygenation]] and [[ventilation]].
:*These devices are frequently used until a more definitive [[airway]] is obtained, and there are several circumstances that prohibit their placement (severe head or [[facial]] injuries).

*'''Supraglottic airway devices:''' [[Supraglottic laryngeal cancer|Supraglottic]] airway (SGA) device placement is very useful to keep the [[airway]]<nowiki/>s open, it has advantages in comparison with [[endotracheal tube]] intubation, or other methods, these advantages include:<ref name="pmid27537593">{{cite journal |vauthors=Park SK, Ko G, Choi GJ, Ahn EJ, Kang H |title=Comparison between supraglottic airway devices and endotracheal tubes in patients undergoing laparoscopic surgery: A systematic review and meta-analysis |journal=Medicine (Baltimore) |volume=95 |issue=33 |pages=e4598 |date=August 2016 |pmid=27537593 |doi=10.1097/MD.0000000000004598 |url=}}</ref>

:*They act as a niche between bag and mask ventilation and endo tracheal intubation.
:*Requires less training than ETI
:*It is less invasive than ETI.
:*It can offer better [[ventilation]] during transport than bag-mask [[ventilation]] alone.
:**[[Supraglottitis|Supraglottic]] airway devices can be used as an alternative tool in cases of failed [[intubation]].

*'''[[Endotracheal intubation]]:''' It is the gold standard for definitive airway management in the prehospital setting, it allows for positive pressure [[ventilation]], [[positive end-expiratory pressure]] (PEEP), positive pressure recruitment maneuvers, and protection from [[aspiration]].

:*'''Mallampati classification for assessment of upper airway anatomical Balance:''' It's named after the Indian-born American [[anesthesiologist]] Seshagiri Mallampati, is used to predict the ease of [[endotracheal intubation]].The test assess the distance from the [[tongue]] base to the roof of the [[mouth]] visually. It is an indirect way of assessing how difficult intubation will be.
:*'''Modified Mallampati Scoring:'''
:**Class I: [[Soft palate]], [[uvula]], [[fauces]], [[Pillars of the fauces|pillars]] visible.
:**Class II: [[Soft palate]], a major part of the [[uvula]], [[fauces]] visible.
:**Class III: [[Soft palate]], the base of [[uvula]] visible.
:**Class IV: Only [[hard palate]] visible.

*'''Rapid sequence intubation versus no-medication intubation''':

:*Use of [[pharmacological]] [[muscle relaxant]] eases the [[intubation]] process by relaxing muscles in the [[pharynx]]. [[Rapid sequence induction|Rapid sequence intubation]] ([[RSI]]) techniques incorporate [[pharmacologic]] [[muscle]] relaxation and are utilized by anesthesiologists and [[emergency medicine]] physicians. However, the disadvantage of these techniques is the elimination of a patient's ability to breathe spontaneously if the [[intubation]] fails. There is a debate that optimal intubating conditions should be achieved first before trying to attempt [[intubation]] in the prehospital setting. Time is an important factor and critical in prehospital [[airway]] management of [[patients]], due to [[trauma]], [[cardiac arrest]], [[hypoxemia]], or aspiration risk. Administration of the [[Neuromuscular blocking agents|neuromuscular blocking agent]] is associated with a reduction in time from rapid sequence [[intubation]] administration to the end of [[intubation]] attempt.

[[File:Glidescope 02.jpg|400px|thumb|left|Photograph of an anesthesiologist using the Glidescope video laryngoscope to intubate the trachea of a morbidly obese elderly person with challenging airway anatomy[https://en.wikipedia.org/wiki/Airway_managementI (DiverDave (talk)) created this work entirely by myself. (Original uploaded on en.wikipedia)]]] 

==Management of the Airway in Patients with Trauma==
===Suspected Spinal Cord Injury===

*In [[patients]] with suspected [[trauma]], extreme caution must be taken in aligning the [[head]] and [[neck]]. The [[cervical spine]] must be maintained in a neutral mid-line position, the exception to this is physical resistance.<ref name="ThiboutotNicole2009">{{cite journal|last1=Thiboutot|first1=François|last2=Nicole|first2=Pierre C.|last3=Trépanier|first3=Claude A.|last4=Turgeon|first4=Alexis F.|last5=Lessard|first5=Martin R.|title=Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial|journal=Canadian Journal of Anesthesia/Journal Canadien d'anesthésie|volume=56|issue=6|year=2009|pages=412–418|issn=0832-610X|doi=10.1007/s12630-009-9089-7}}</ref><ref>{{cite journal|doi=10.1016/j.jclinane.2005.04.003 [Indexed for MEDLINE]}}</ref><ref name="KrishnamoorthyDagal2014">{{cite journal|last1=Krishnamoorthy|first1=Vijay|last2=Dagal|first2=Arman|last3=Austin|first3=Naola|title=Airway management in cervical spine injury|journal=International Journal of Critical Illness and Injury Science|volume=4|issue=1|year=2014|pages=50|issn=2229-5151|doi=10.4103/2229-5151.128013}}</ref><ref name="GhafoorMartin2005">{{cite journal|last1=Ghafoor|first1=Abid U.|last2=Martin|first2=Timothy W.|last3=Gopalakrishnan|first3=Senthil|last4=Viswamitra|first4=Sanjaya|title=Caring for the patients with cervical spine injuries: what have we learned?|journal=Journal of Clinical Anesthesia|volume=17|issue=8|year=2005|pages=640–649|issn=09528180|doi=10.1016/j.jclinane.2005.04.003}}</ref><ref name="SriganeshBusse2018">{{cite journal|last1=Sriganesh|first1=Kamath|last2=Busse|first2=JasonW|last3=Shanthanna|first3=Harsha|last4=Ramesh|first4=VenkatapuraJ|title=Airway management in the presence of cervical spine instability: A cross-sectional survey of the members of the Indian Society of Neuroanaesthesiology and Critical Care|journal=Indian Journal of Anaesthesia|volume=62|issue=2|year=2018|pages=115|issn=0019-5049|doi=10.4103/ija.IJA_671_17}}</ref>

*'''Neck Maneuvers During Airway Management:'''
**Immobilizing patient's [[neck]] by using sandbag-collar-tape on hardboard in a pre-hospital care setting.
**Applying pressure on cricoid with [[anterior]] half of hard [[cervical collar]] removed and another hand behind the [[posterior]] [[cervical collar]].
**Manual in-line stabilization is the technique of choice in any suspected [[cervical spine]] injury, during endotracheal intubation. In this technique, head grasped firmly at the [[mastoid process]] and the occiput.

*Traction should be avoided as it may distract the [[cervical spine]] and cause more [[neurological]] damage, even after manual in-line stabilization.

*Jaw thrust is the only basic [[airway]] opening maneuver appropriate for any [[patient]] with a suspected [[cervical spine injury]]. This method is used when head-tilt/chin-lift can be potentially dangerous to use on a patient who may have a [[cervical spine injury]]. In jaw-thrust maneuver, first care provider lifts the [[hyoid bone]] and [[tongue]] away from the [[posterior]] [[pharyngeal]] wall by pulling the [[mandible]] forward, displacing the [[tongue]] anteriorly.
*[[Suction]] and use of [[forceps]] under direct vision using a [[laryngoscope]] with the [[head]] and [[neck]] maintained in the neutral position.
*In order to minimize the risk of [[hypoxic]] damage from [[airway obstruction]] in an [[unconscious]] patient, proper positioning is done by placing patients in the [[lateral]] side with log rolling technique.

===Approach to airway management of a patient with Maxillo-Facial Injury===
[[Airway]] management of patients with [[maxillofacial]] trauma is challenging and vital because it's directly affecting the patient's survival. [[Endotracheal intubation]] is the [[Gold standard (test)|gold standard]] procedure to secure the [[airway]] in [[trauma]] [[patients]], however, in these [[patients]] passage of [[endotracheal tube]] may not be possible because the oral cavity, [[pharynx]], and [[larynx]] may be filled with [[blood]], secretions, [[soft tissue]], and [[bone]] fragments. Another reason for this is that the risk of [[aspiration]] and [[regurgitation]] is high in these patients.<ref name="BarakBahouth2015">{{cite journal|last1=Barak|first1=Michal|last2=Bahouth|first2=Hany|last3=Leiser|first3=Yoav|last4=Abu El-Naaj|first4=Imad|title=Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach|journal=BioMed Research International|volume=2015|year=2015|pages=1–9|issn=2314-6133|doi=10.1155/2015/724032}}</ref><ref name="pmid21655009">{{cite journal |vauthors=Raval CB, Rashiduddin M |title=Airway management in patients with maxillofacial trauma - A retrospective study of 177 cases |journal=Saudi J Anaesth |volume=5 |issue=1 |pages=9–14 |date=January 2011 |pmid=21655009 |pmc=3101764 |doi=10.4103/1658-354X.76476 |url=}}</ref><ref name="pmid7588664">{{cite journal |vauthors=Brimacombe J, Tucker P, Simons S |title=The laryngeal mask airway for awake diagnostic bronchoscopy. A retrospective study of 200 consecutive patients |journal=Eur J Anaesthesiol |volume=12 |issue=4 |pages=357–61 |date=July 1995 |pmid=7588664 |doi= |url=}}</ref><ref name="HsiaoPacheco-Fowler2008">{{cite journal|last1=Hsiao|first1=James|last2=Pacheco-Fowler|first2=Victor|title=Cricothyroidotomy|journal=New England Journal of Medicine|volume=358|issue=22|year=2008|pages=e25|issn=0028-4793|doi=10.1056/NEJMvcm0706755}}</ref>

*In such circumstances, there are numerous [[airway]] devices are available to rescue patients with [[maxillofacial]] injuries, some of these devices include:<ref name="BarakBahouth2015">{{cite journal|last1=Barak|first1=Michal|last2=Bahouth|first2=Hany|last3=Leiser|first3=Yoav|last4=Abu El-Naaj|first4=Imad|title=Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach|journal=BioMed Research International|volume=2015|year=2015|pages=1–9|issn=2314-6133|doi=10.1155/2015/724032}}</ref><ref name="MeyerPatel2014">{{cite journal|last1=Meyer|first1=TanyaK|last2=Patel|first2=SapnaA|title=Surgical Airway|journal=International Journal of Critical Illness and Injury Science|volume=4|issue=1|year=2014|pages=71|issn=2229-5151|doi=10.4103/2229-5151.128016}}</ref>
**Flexible [[fiberoptic]] [[bronchoscopy]] (FOB), enable an indirect view of [[vocal cords]].
**[[Laryngeal mask airway]] (LMA) may be inserted blindly since it does not require a view of the [[vocal cords]]. Another option for securing the [[airway]] in these patients is to pass the endotracheal tube after placing an LMA for them.
*Final option for establishing the airway in [[patients]] with [[maxillofacial]] injury is [[surgery]] by [[cricothyroidotomy]].
**[[Cricothyroidotomy]] also known as [[cricothyrotomy]] is a procedure done by trained [[health care providers]], they make a small [[incision]] through the skin and [[cricoid]] membrane which lies between the [[thyroid]] and [[cricoid]] [[cartilage]]<nowiki/>s, followed by inserting a [[tracheostomy tube]] to open alternative way of [[ventilation]] and [[oxygenation]] in the [[emergency]] situation which uses of [[endotracheal intubation]] is almost impossible or difficult and time-consuming.
**'''Indication for cricothyroidotomy include:'''
***Inability to secure [[airway]] through an [[endotracheal tube]]
***Major [[trauma]] to [[facial]] [[muscles]], [[pharynx]], [[larynx]].
***[[Congenital deformities]] and [[upper airway]] [[stenosis]].

*'''Contraindications for cricothyroidotomy:'''
**[[Age]], in [[pediatrics]] younger than 12 years old needle [[cricothyrotomy]] is indicated because of less potential damage to the [[larynx]] and surrounding structures.
**Massive [[trauma]] to the [[larynx]] or [[cricoid cartilage]]
**Inability to identify surface landmarks due to [[obesity]], [[cervical]] trauma.
**When [[Orotracheal intubation|orotracheal]] and [[Nasotracheal intubation|nasotracheal]] [[intubation]] are viable options
**[[Airway obstruction]] distal to [[subglottic airway]], e.g. [[tracheal stenosis]]
**[[Laryngeal cancer]]: Other than for an extreme airway [[emergency]], [[cricothyroidotomy]] must be avoided to not to seed the [[soft tissue]] of the [[neck]] with [[cancer]] cells
**[[Coagulopathy]] (other than [[emergency]] situation)

*'''Complications of cricothyroidotomy:'''
**[[Esophageal]] perforation if the blade penetrates too deeply.
**[[Subcutaneous emphysema]]
**Rupture of vital [[vessels]] such as a [[carotid artery]], excessive [[bleeding]], and [[hemorrhage]].

*'''Indications of definitive airway management in patients with maxillofacial injury:'''
**Absent spontaneous [[breathing]]
**[[Comatose]] [[patients]]([[Glasgow coma score]] < 9)
**[[Airway]] injury or [[obstruction]]
**Persistent [[oxygen saturation]] below 90%
**High risk for [[aspiration]]
**[[Systemic shock]]([[Systolic Blood Pressure Intervention|Systolic Blood Pressure]]<80mmHg)
**"Cannot intubate, cannot ventilate" situations

==Complications of airway management==

Airway management complications are common, these complications usually occur in [[intensive care units]] and [[emergency department]]<nowiki/>s, summary of airway management related complactions include:<ref name="CookMacDougall-Davis2012">{{cite journal|last1=Cook|first1=T.M.|last2=MacDougall-Davis|first2=S.R.|title=Complications and failure of airway management|journal=British Journal of Anaesthesia|volume=109|year=2012|pages=i68–i85|issn=00070912|doi=10.1093/bja/aes393}}</ref>

*[[Patient]] harm/death associated with suboptimal care
*[[Hypoxia]] is the most common cause of [[airway]]-related deaths
*[[Obesity]]
*[[Pulmonary]] [[aspiration]] remains the leading cause of airway-related [[anesthetic]] deaths
*Failure in airway management techniques

{{#ev:youtube|ycQs27YVE60}}

==Related Chapters==

*[[intubation|Intubation]]
*[[endotracheal tube|Endotracheal Tube]]
*[[laryngeal mask airway|Laryngeal Mask Airway]]
*[[oropharyngeal airway|Oropharyngeal Airway]]
*[[nasopharyngeal airway|Nasopharyngeal Airway]]
*[[Ventilation (physiology)|Ventilation]]
*[[Cricothyrotomy]]
*[[Tracheotomy]]

==References==
{{reflist|2}}
[[Category:Emergency medicine]]
[[Category:First aid]]
[[Category:anesthesia]]
[[Category:Intensive care medicine]]

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Airway management

2021-05-26T03:43:34Z

Shaik Aisha sultana: /* Techniques for airway management */

__NOTOC__
{{SI}}
{{CMG}}{{AE}}{{Nnasiri}}

==Overview==
''Airway management'' is the process of ensuring that there is an open pathway between a patient’s [[lung]]s and the outside world, and the [[lungs]] are safe from [[Pulmonary aspiration|aspiration]]. [[Airway]] loss is a major cause of preventable prehospital death in [[trauma]] patients. Airway management complications are common, especially in [[trauma]] patients because of associated [[pathology]], lack of complete evaluation before [[intubation]], unanticipated difficulty during ventilation and [[intubation]]. Additionally, [[trauma]] [[patients]] are at increased risk of [[airway obstruction]], aspiration, [[hypoxia]] and [[hypotension]], and [[vital sign|other unstable vital]] The providers must have skillset related to working with a variety of tools and techniques used in airway management and knowledge of the important [[anatomical]], [[physiological]], and [[pathological]] features related to the airway. They also should know the differences between the adult versus [[pediatric]] and [[neonatal]] airways as these [[anatomical]] and physiological differences are critical, impactful on patients lives and knowing these leads to effective control and management of the [[airway]]. Some of the indications for managing the [[airway]] in patients include [[respiratory failure]], altered sensorium([[Glasgow Coma Scale]] less than or equal to 8), rapid deterioration of [[mental status]], [[airway]] injury or compromise, injuries causing a high risk for [[aspiration]]-which includes all penetrating injuries to the [[abdomen]] or [[chest wall]]. Inadequate [[airway]] management may lead to [[cardiovascular]] arrest and compromise life-saving interventions in a [[trauma]] patient. Several [[airway]] control devices and techniques are available to assist [[healthcare]] providers in order to maintain the airway by [[ventilation]] and [[oxygenation]]. These include [[bag valve mask]] ([[Bag valve mask|BVM]]) [[ventilation]], direct [[laryngoscopy]] with [[endotracheal intubation]] (ETI) and adjunct [[Supraglottitis|supraglottic]] [[airway]] devices such as the [[laryngeal]] mask airway.

==Functional anatomy of the upper airway==
For a successful approach to [[airway]] management, [[health care providers]] must have knowledge of important [[anatomical]], [[physiological]], and [[pathological]] features related to the airway as well as knowledge of the various equipment and methods that can be utilized for this purpose. Also, the difference between airway management in adults, [[pediatrics]], and [[neonates]] is very critical.<ref name="pmid3056703">{{cite journal |vauthors=Morris IR |title=Functional anatomy of the upper airway |journal=Emerg. Med. Clin. North Am. |volume=6 |issue=4 |pages=639–69 |date=November 1988 |pmid=3056703 |doi= |url=}}</ref>

*The [[upper airway]] is consists of the [[pharynx]] and [[nasal]] cavities, the [[larynx]] and [[trachea]] may be included, and the [[oral cavity]] provides an alternate air entry into the [[respiratory system]].
*The nose is a bony and [[cartilage|cartilaginous]] structure attached to the facial [[skeleton]] and is divided into the two [[nasal]] cavities. The nose functions as a heater and humidifier of inspired air, it is also helps in [[phonation]] and [[vocal resonation]] and houses the [[olfactory]] receptors. The [[paranasal sinuses]] drain into the nasal cavities.
*An [[endotracheal tube]] passes through the [[nose]] or mouth into the [[trachea]] to protect the [[airway]] and achieve positive-pressure [[ventilation]]. The mouth opens posteriorly into the [[oropharynx]] and becomes part of the [[gastrointestinal system]], helps the [[digestion]] and also plays a role as an alternate pathway for [[respiration]]. It is also involved in [[phonation]].
*[[Orotracheal intubation]] can be used as an alternative to [[nasal]] [[intubation]] to achieve [[airway]] protection and maintain [[ventilation]]; but depending upon the condition of the [[patient]] and difficulty due to [[anatomical]] shape of [[upper airway]], this route may not be doable, for instance in supine unconscious persons, the backward movement of the [[tongue]] and lower [[jaw]] may cause [[airway obstruction]] and performing [[orotracheal intubation]] may not be the optimal way of managing airway.
*The [[pharynx]] is a membrane-lined cavity behind the [[mouth]] and [[nose]], extends from the base of the [[skull]] to the [[cricoid cartilage]] at the level of sixth [[cervical vertebrae]] which is an entrance to the [[esophagus]]. [[Anterior]]<nowiki/>ly it opens into the [[nasal cavity]], the [[mouth]], and the [[larynx]], which divide it into the naso-, oro-, and [[laryngopharynx]], respectively. The [[pharynx]] is involved with the act of [[swallowing]].
*The [[larynx]] consists of [[Cartilages of the larynx|cartilages]] and fibro-elastic membranes covered by a sheet of [[muscles]] and [[mucous membrane]]. It functions as an open valve in [[respiration]], helps in [[phonation]], and [[swallowing]]. The [[larynx]] extends from its entrance which is formed by the [[Aryepiglottic fold|aryepiglottic folds]], to the lower border of the [[cricoid cartilage]] till the tip of the [[epiglottis]], and bulges [[posterior]]<nowiki/>ly into the [[laryngopharynx]].
*The trachea is formed by U-shaped [[cartilaginous]] rings in anterior and [[trachealis muscle]] in [[posterior]], it extends from the lower edge of the [[cricoid cartilage]] to the [[carina]] where it divides into the [[mainstem bronchus]]. In order to place [[endotracheal tube]] in proper way, tip of the tube should be at mid [[Tracheal bronchus|tracheal]] level.

[[File:UpperRespiratorySystem.png|400px|thumb|left|upper airway system[https://commons.wikimedia.org/wiki/File:Blausen_0872_UpperRespiratorySystem.pngBlausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436.]]] 

==Recommendations for evaluation of airway==
The basic approach in airway management in the [[emergency]] setting includes:<ref name="RosenbergPhero2014">{{cite journal|last1=Rosenberg|first1=M. B|last2=Phero|first2=J. C|last3=Becker|first3=D. E|title=Essentials of Airway Management, Oxygenation, and Ventilation: Part 2: Advanced Airway Devices: Supraglottic Airways|journal=Anesthesia Progress|volume=61|issue=3|year=2014|pages=113–118|issn=0003-3006|doi=10.2344/0003-3006-61.3.113}}</ref>

:*Protection from [[aspiration]] and [[pneumonia]] related to that.
:*Providing adequate [[oxygenation]] and [[ventilation]].

Following are steps that must be considered prior to conducting airway management, these include:

:*'''History:''' An [[airway]] [[history]] should be conducted whenever it is possible before airway management in all [[patients]] to detect medical, [[surgical]], and [[anesthetic]] factors that may indicate the presence of a difficult [[airway]]. A detailed review of previous [[anesthetic]] records, if available, may provide useful information about airway management.

:*'''Physical Examination:''' An airway [[physical examination]] should be conducted before the initiation of airway management. The goal of [[physical examination]] is to detect physical characteristics that may indicate the presence of a difficult airway because an unsuccessful [[upper airway]] management is associated with increase in [[mortality]] and [[morbidity]].

:*'''Additional Evaluation:''' Additional evaluation may be indicated in some [[patients]] to characterize the likelihood or nature of the anticipated difficult airway. Certain diagnostic tests (e.g., [[radiography]], [[computed tomography]] scans, [[fluoroscopy]]) can identify a variety of acquired or congenital features in patients with difficult airways

==Techniques for airway management==
The decision about whether an airway intervention is required or not is crucial for patient's [[Survival rate|survival]] and depends on first responders skills and quick assessment and decision. These crucial steps requires techniques which are used universally in order to manage [[patient]]'s airway. Following are initial evaluation methods which had been developed to assist patient's [[ventilation]] and keep the [[airway]] patent, these techniques include:<ref name="RoychoudhuryJose2016">{{cite journal|last1=Roychoudhury|first1=Ajoy|last2=Jose|first2=Anson|last3=Nagori|first3=ShakilAhmed|last4=Agarwal|first4=Bhaskar|last5=Bhutia|first5=Ongkila|title=Management of maxillofacial trauma in emergency: An update of challenges and controversies|journal=Journal of Emergencies, Trauma, and Shock|volume=9|issue=2|year=2016|pages=73|issn=0974-2700|doi=10.4103/0974-2700.179456}}</ref><ref name="pmid18946431">{{cite journal |vauthors=Agrò FE, Cataldo R, Mattei A |title=New devices and techniques for airway management |journal=Minerva Anestesiol |volume=75 |issue=3 |pages=141–9 |date=March 2009 |pmid=18946431 |doi= |url=}}</ref><ref name="pmid29560073">{{cite journal |vauthors=Gleason JM, Christian BR, Barton ED |title=Nasal Cannula Apneic Oxygenation Prevents Desaturation During Endotracheal Intubation: An Integrative Literature Review |journal=West J Emerg Med |volume=19 |issue=2 |pages=403–411 |date=March 2018 |pmid=29560073 |pmc=5851518 |doi=10.5811/westjem.2017.12.34699 |url=}}</ref><ref name="LawBroemling2013">{{cite journal|last1=Law|first1=J. Adam|last2=Broemling|first2=Natasha|last3=Cooper|first3=Richard M.|last4=Drolet|first4=Pierre|last5=Duggan|first5=Laura V.|last6=Griesdale|first6=Donald E.|last7=Hung|first7=Orlando R.|last8=Jones|first8=Philip M.|last9=Kovacs|first9=George|last10=Massey|first10=Simon|last11=Morris|first11=Ian R.|last12=Mullen|first12=Timothy|last13=Murphy|first13=Michael F.|last14=Preston|first14=Roanne|last15=Naik|first15=Viren N.|last16=Scott|first16=Jeanette|last17=Stacey|first17=Shean|last18=Turkstra|first18=Timothy P.|last19=Wong|first19=David T.|title=The difficult airway with recommendations for management – Part 1 – Difficult tracheal intubation encountered in an unconscious/induced patient|journal=Canadian Journal of Anesthesia/Journal canadien d'anesthésie|volume=60|issue=11|year=2013|pages=1089–1118|issn=0832-610X|doi=10.1007/s12630-013-0019-3}}</ref><ref name="OkuboGibo2017">{{cite journal|last1=Okubo|first1=Masashi|last2=Gibo|first2=Koichiro|last3=Hagiwara|first3=Yusuke|last4=Nakayama|first4=Yukiko|last5=Hasegawa|first5=Kohei|title=The effectiveness of rapid sequence intubation (RSI) versus non-RSI in emergency department: an analysis of multicenter prospective observational study|journal=International Journal of Emergency Medicine|volume=10|issue=1|year=2017|issn=1865-1372|doi=10.1186/s12245-017-0129-8}}</ref>

*'''Spontaneous breathing:''' When a provider is confronted with an awake [[patient]] having a patent airway. Spontaneous ventilation can be assisted through the placement of a nasal or oral airway. [[Oxygenation]] can be improved by giving [[oxygen]] via nasal [[cannula]], simple [[face mask]], or nonrebreather face mask. Unfortunately, the maximally achieved [[FiO2]] is often overestimated by care providers and [[hypoventilation]] resulting in [[hypercapnia]] cannot be normalized with increase in [[oxygen]] supply.
*'''Mouth-to-Mouth ventilation:''' Mouth-to-mouth or mouth-to-nose ventilation is a useful management technique, however, because of the risk of [[infection]] transmission it is recommended by American heart association that health care providers do "Hands-only" [[CPR]]. Proper face masks should be utilized if they are available.
*'''Bag-mask ventilation:''' It is a standard initial approach to airway management in the prehospital and [[hospital]] settings.

:*Proper preoxygenation prior to [[intubation]] and [[anesthetic]] induction provides patients with improved [[oxygenation]] and increases the time to [[hypoxemia]].
:*Bag-mask [[ventilation]] is a basic essential technique when [[endotracheal tube]] [[intubation]] is difficult, it assists for rapid [[ventilation]] and [[oxygenation]] in patients.
:*Bag-mask [[ventilation]] can be achieved by a single practitioner alone or side by side with a second care provider in an [[Operating room|emergency room or an operating room]]
:*Bag mask [[ventilation]] can also be utilized as a pressure support during spontaneous [[respiration]] in patients with decre<nowiki/>ased [[tidal volume]]<nowiki/>s and insufficient [[ventilation]], very similar to the use of [[CPAP]] or [[BiPAP]] to assist [[patients]] who are spontaneously [[breathing]] but are not adequately ventilating or oxygenating.

*'''Oropharyngeal and nasopharyngeal airways:'''

:*This is used as an adjunct device for spontaneous or [[assisted ventilation]].
:*[[Oropharyngeal]] and [[nasopharyngeal airway]]<nowiki/>s are frequently utilized by prehospital care providers to improve [[oxygenation]] and [[ventilation]].
:*These devices are frequently used until a more definitive [[airway]] is obtained, and there are several circumstances that prohibit their placement (severe head or [[facial]] injuries).

*'''Supraglottic airway devices:''' [[Supraglottic laryngeal cancer|Supraglottic]] airway (SGA) device placement is very useful to keep the [[airway]]<nowiki/>s open, it has advantages in comparison with [[endotracheal tube]] intubation, or other methods, these advantages are include:<ref name="pmid27537593">{{cite journal |vauthors=Park SK, Ko G, Choi GJ, Ahn EJ, Kang H |title=Comparison between supraglottic airway devices and endotracheal tubes in patients undergoing laparoscopic surgery: A systematic review and meta-analysis |journal=Medicine (Baltimore) |volume=95 |issue=33 |pages=e4598 |date=August 2016 |pmid=27537593 |doi=10.1097/MD.0000000000004598 |url=}}</ref>

:*Requires less training than ETI.
:*It is less invasive than ETI.
:*It can offer better [[ventilation]] during transport than bag-mask [[ventilation]] alone.
:**[[Supraglottitis|Supraglottic]] airway devices can be used as an alternative tool in cases of failed [[intubation]].

*'''[[Endotracheal intubation]]:''' It is the gold standard for definitive airway management in the prehospital setting, it allows for positive pressure [[ventilation]], [[positive end-expiratory pressure]] (PEEP), positive pressure recruitment maneuvers, and protection from [[aspiration]].

:*'''Mallampati classification for assessment of upper airway anatomical Balance:''' It's named after the Indian-born American [[anesthesiologist]] Seshagiri Mallampati, is used to predict the ease of [[endotracheal intubation]].The test assess the distance from the [[tongue]] base to the roof of the [[mouth]] visually. It is an indirect way of assessing how difficult intubation will be.
:*'''Modified Mallampati Scoring:'''
:**Class I: [[Soft palate]], [[uvula]], [[fauces]], [[Pillars of the fauces|pillars]] visible.
:**Class II: [[Soft palate]], a major part of the [[uvula]], [[fauces]] visible.
:**Class III: [[Soft palate]], the base of [[uvula]] visible.
:**Class IV: Only [[hard palate]] visible.

*'''Rapid sequence intubation versus no-medication intubation''':

:*Use of [[pharmacological]] [[muscle relaxant]] eases the [[intubation]] process by relaxing muscles in the [[pharynx]]. [[Rapid sequence induction|Rapid sequence intubation]] ([[RSI]]) techniques incorporate [[pharmacologic]] [[muscle]] relaxation and are utilized by anesthesiologists and [[emergency medicine]] physicians. However, the disadvantage of these techniques is the elimination of a patient's ability to breathe spontaneously if the [[intubation]] fails. There is a debate that optimal intubating conditions should be achieved first before trying to attempt [[intubation]] in the prehospital setting. Time is an important factor and critical in prehospital [[airway]] management of [[patients]], due to [[trauma]], [[cardiac arrest]], [[hypoxemia]], or aspiration risk. Administration of the [[Neuromuscular blocking agents|neuromuscular blocking agent]] is associated with a reduction in time from rapid sequence [[intubation]] administration to the end of [[intubation]] attempt.

[[File:Glidescope 02.jpg|400px|thumb|left|Photograph of an anesthesiologist using the Glidescope video laryngoscope to intubate the trachea of a morbidly obese elderly person with challenging airway anatomy[https://en.wikipedia.org/wiki/Airway_managementI (DiverDave (talk)) created this work entirely by myself. (Original uploaded on en.wikipedia)]]] 

==Management of the Airway in Patients with Trauma==
===Suspected Spinal Cord Injury===

*In [[patients]] with suspected [[trauma]], extreme caution must be taken in aligning the [[head]] and [[neck]]. The [[cervical spine]] must be maintained in a neutral mid-line position, the exception to this is physical resistance.<ref name="ThiboutotNicole2009">{{cite journal|last1=Thiboutot|first1=François|last2=Nicole|first2=Pierre C.|last3=Trépanier|first3=Claude A.|last4=Turgeon|first4=Alexis F.|last5=Lessard|first5=Martin R.|title=Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial|journal=Canadian Journal of Anesthesia/Journal Canadien d'anesthésie|volume=56|issue=6|year=2009|pages=412–418|issn=0832-610X|doi=10.1007/s12630-009-9089-7}}</ref><ref>{{cite journal|doi=10.1016/j.jclinane.2005.04.003 [Indexed for MEDLINE]}}</ref><ref name="KrishnamoorthyDagal2014">{{cite journal|last1=Krishnamoorthy|first1=Vijay|last2=Dagal|first2=Arman|last3=Austin|first3=Naola|title=Airway management in cervical spine injury|journal=International Journal of Critical Illness and Injury Science|volume=4|issue=1|year=2014|pages=50|issn=2229-5151|doi=10.4103/2229-5151.128013}}</ref><ref name="GhafoorMartin2005">{{cite journal|last1=Ghafoor|first1=Abid U.|last2=Martin|first2=Timothy W.|last3=Gopalakrishnan|first3=Senthil|last4=Viswamitra|first4=Sanjaya|title=Caring for the patients with cervical spine injuries: what have we learned?|journal=Journal of Clinical Anesthesia|volume=17|issue=8|year=2005|pages=640–649|issn=09528180|doi=10.1016/j.jclinane.2005.04.003}}</ref><ref name="SriganeshBusse2018">{{cite journal|last1=Sriganesh|first1=Kamath|last2=Busse|first2=JasonW|last3=Shanthanna|first3=Harsha|last4=Ramesh|first4=VenkatapuraJ|title=Airway management in the presence of cervical spine instability: A cross-sectional survey of the members of the Indian Society of Neuroanaesthesiology and Critical Care|journal=Indian Journal of Anaesthesia|volume=62|issue=2|year=2018|pages=115|issn=0019-5049|doi=10.4103/ija.IJA_671_17}}</ref>

*'''Neck Maneuvers During Airway Management:'''
**Immobilizing patient's [[neck]] by using sandbag-collar-tape on hardboard in a pre-hospital care setting.
**Applying pressure on cricoid with [[anterior]] half of hard [[cervical collar]] removed and another hand behind the [[posterior]] [[cervical collar]].
**Manual in-line stabilization is the technique of choice in any suspected [[cervical spine]] injury, during endotracheal intubation. In this technique, head grasped firmly at the [[mastoid process]] and the occiput.

*Traction should be avoided as it may distract the [[cervical spine]] and cause more [[neurological]] damage, even after manual in-line stabilization.

*Jaw thrust is the only basic [[airway]] opening maneuver appropriate for any [[patient]] with a suspected [[cervical spine injury]]. This method is used when head-tilt/chin-lift can be potentially dangerous to use on a patient who may have a [[cervical spine injury]]. In jaw-thrust maneuver, first care provider lifts the [[hyoid bone]] and [[tongue]] away from the [[posterior]] [[pharyngeal]] wall by pulling the [[mandible]] forward, displacing the [[tongue]] anteriorly.
*[[Suction]] and use of [[forceps]] under direct vision using a [[laryngoscope]] with the [[head]] and [[neck]] maintained in the neutral position.
*In order to minimize the risk of [[hypoxic]] damage from [[airway obstruction]] in an [[unconscious]] patient, proper positioning is done by placing patients in the [[lateral]] side with log rolling technique.

===Approach to airway management of a patient with Maxillo-Facial Injury===
[[Airway]] management of patients with [[maxillofacial]] trauma is challenging and vital because it's directly affecting the patient's survival. [[Endotracheal intubation]] is the [[Gold standard (test)|gold standard]] procedure to secure the [[airway]] in [[trauma]] [[patients]], however, in these [[patients]] passage of [[endotracheal tube]] may not be possible because the oral cavity, [[pharynx]], and [[larynx]] may be filled with [[blood]], secretions, [[soft tissue]], and [[bone]] fragments. Another reason for this is that the risk of [[aspiration]] and [[regurgitation]] is high in these patients.<ref name="BarakBahouth2015">{{cite journal|last1=Barak|first1=Michal|last2=Bahouth|first2=Hany|last3=Leiser|first3=Yoav|last4=Abu El-Naaj|first4=Imad|title=Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach|journal=BioMed Research International|volume=2015|year=2015|pages=1–9|issn=2314-6133|doi=10.1155/2015/724032}}</ref><ref name="pmid21655009">{{cite journal |vauthors=Raval CB, Rashiduddin M |title=Airway management in patients with maxillofacial trauma - A retrospective study of 177 cases |journal=Saudi J Anaesth |volume=5 |issue=1 |pages=9–14 |date=January 2011 |pmid=21655009 |pmc=3101764 |doi=10.4103/1658-354X.76476 |url=}}</ref><ref name="pmid7588664">{{cite journal |vauthors=Brimacombe J, Tucker P, Simons S |title=The laryngeal mask airway for awake diagnostic bronchoscopy. A retrospective study of 200 consecutive patients |journal=Eur J Anaesthesiol |volume=12 |issue=4 |pages=357–61 |date=July 1995 |pmid=7588664 |doi= |url=}}</ref><ref name="HsiaoPacheco-Fowler2008">{{cite journal|last1=Hsiao|first1=James|last2=Pacheco-Fowler|first2=Victor|title=Cricothyroidotomy|journal=New England Journal of Medicine|volume=358|issue=22|year=2008|pages=e25|issn=0028-4793|doi=10.1056/NEJMvcm0706755}}</ref>

*In such circumstances, there are numerous [[airway]] devices are available to rescue patients with [[maxillofacial]] injuries, some of these devices include:<ref name="BarakBahouth2015">{{cite journal|last1=Barak|first1=Michal|last2=Bahouth|first2=Hany|last3=Leiser|first3=Yoav|last4=Abu El-Naaj|first4=Imad|title=Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach|journal=BioMed Research International|volume=2015|year=2015|pages=1–9|issn=2314-6133|doi=10.1155/2015/724032}}</ref><ref name="MeyerPatel2014">{{cite journal|last1=Meyer|first1=TanyaK|last2=Patel|first2=SapnaA|title=Surgical Airway|journal=International Journal of Critical Illness and Injury Science|volume=4|issue=1|year=2014|pages=71|issn=2229-5151|doi=10.4103/2229-5151.128016}}</ref>
**Flexible [[fiberoptic]] [[bronchoscopy]] (FOB), enable an indirect view of [[vocal cords]].
**[[Laryngeal mask airway]] (LMA) may be inserted blindly since it does not require a view of the [[vocal cords]]. Another option for securing the [[airway]] in these patients is to pass the endotracheal tube after placing an LMA for them.
*Final option for establishing the airway in [[patients]] with [[maxillofacial]] injury is [[surgery]] by [[cricothyroidotomy]].
**[[Cricothyroidotomy]] also known as [[cricothyrotomy]] is a procedure done by trained [[health care providers]], they make a small [[incision]] through the skin and [[cricoid]] membrane which lies between the [[thyroid]] and [[cricoid]] [[cartilage]]<nowiki/>s, followed by inserting a [[tracheostomy tube]] to open alternative way of [[ventilation]] and [[oxygenation]] in the [[emergency]] situation which uses of [[endotracheal intubation]] is almost impossible or difficult and time-consuming.
**'''Indication for cricothyroidotomy include:'''
***Inability to secure [[airway]] through an [[endotracheal tube]]
***Major [[trauma]] to [[facial]] [[muscles]], [[pharynx]], [[larynx]].
***[[Congenital deformities]] and [[upper airway]] [[stenosis]].

*'''Contraindications for cricothyroidotomy:'''
**[[Age]], in [[pediatrics]] younger than 12 years old needle [[cricothyrotomy]] is indicated because of less potential damage to the [[larynx]] and surrounding structures.
**Massive [[trauma]] to the [[larynx]] or [[cricoid cartilage]]
**Inability to identify surface landmarks due to [[obesity]], [[cervical]] trauma.
**When [[Orotracheal intubation|orotracheal]] and [[Nasotracheal intubation|nasotracheal]] [[intubation]] are viable options
**[[Airway obstruction]] distal to [[subglottic airway]], e.g. [[tracheal stenosis]]
**[[Laryngeal cancer]]: Other than for an extreme airway [[emergency]], [[cricothyroidotomy]] must be avoided to not to seed the [[soft tissue]] of the [[neck]] with [[cancer]] cells
**[[Coagulopathy]] (other than [[emergency]] situation)

*'''Complications of cricothyroidotomy:'''
**[[Esophageal]] perforation if the blade penetrates too deeply.
**[[Subcutaneous emphysema]]
**Rupture of vital [[vessels]] such as a [[carotid artery]], excessive [[bleeding]], and [[hemorrhage]].

*'''Indications of definitive airway management in patients with maxillofacial injury:'''
**Absent spontaneous [[breathing]]
**[[Comatose]] [[patients]]([[Glasgow coma score]] < 9)
**[[Airway]] injury or [[obstruction]]
**Persistent [[oxygen saturation]] below 90%
**High risk for [[aspiration]]
**[[Systemic shock]]([[Systolic Blood Pressure Intervention|Systolic Blood Pressure]]<80mmHg)
**"Cannot intubate, cannot ventilate" situations

==Complications of airway management==

Airway management complications are common, these complications usually occur in [[intensive care units]] and [[emergency department]]<nowiki/>s, summary of airway management related complactions include:<ref name="CookMacDougall-Davis2012">{{cite journal|last1=Cook|first1=T.M.|last2=MacDougall-Davis|first2=S.R.|title=Complications and failure of airway management|journal=British Journal of Anaesthesia|volume=109|year=2012|pages=i68–i85|issn=00070912|doi=10.1093/bja/aes393}}</ref>

*[[Patient]] harm/death associated with suboptimal care
*[[Hypoxia]] is the most common cause of [[airway]]-related deaths
*[[Obesity]]
*[[Pulmonary]] [[aspiration]] remains the leading cause of airway-related [[anesthetic]] deaths
*Failure in airway management techniques

{{#ev:youtube|ycQs27YVE60}}

==Related Chapters==

*[[intubation|Intubation]]
*[[endotracheal tube|Endotracheal Tube]]
*[[laryngeal mask airway|Laryngeal Mask Airway]]
*[[oropharyngeal airway|Oropharyngeal Airway]]
*[[nasopharyngeal airway|Nasopharyngeal Airway]]
*[[Ventilation (physiology)|Ventilation]]
*[[Cricothyrotomy]]
*[[Tracheotomy]]

==References==
{{reflist|2}}
[[Category:Emergency medicine]]
[[Category:First aid]]
[[Category:anesthesia]]
[[Category:Intensive care medicine]]

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Airway management

2021-05-26T03:40:02Z

Shaik Aisha sultana: /* Recommendations for evaluation of airway */

__NOTOC__
{{SI}}
{{CMG}}{{AE}}{{Nnasiri}}

==Overview==
''Airway management'' is the process of ensuring that there is an open pathway between a patient’s [[lung]]s and the outside world, and the [[lungs]] are safe from [[Pulmonary aspiration|aspiration]]. [[Airway]] loss is a major cause of preventable prehospital death in [[trauma]] patients. Airway management complications are common, especially in [[trauma]] patients because of associated [[pathology]], lack of complete evaluation before [[intubation]], unanticipated difficulty during ventilation and [[intubation]]. Additionally, [[trauma]] [[patients]] are at increased risk of [[airway obstruction]], aspiration, [[hypoxia]] and [[hypotension]], and [[vital sign|other unstable vital]] The providers must have skillset related to working with a variety of tools and techniques used in airway management and knowledge of the important [[anatomical]], [[physiological]], and [[pathological]] features related to the airway. They also should know the differences between the adult versus [[pediatric]] and [[neonatal]] airways as these [[anatomical]] and physiological differences are critical, impactful on patients lives and knowing these leads to effective control and management of the [[airway]]. Some of the indications for managing the [[airway]] in patients include [[respiratory failure]], altered sensorium([[Glasgow Coma Scale]] less than or equal to 8), rapid deterioration of [[mental status]], [[airway]] injury or compromise, injuries causing a high risk for [[aspiration]]-which includes all penetrating injuries to the [[abdomen]] or [[chest wall]]. Inadequate [[airway]] management may lead to [[cardiovascular]] arrest and compromise life-saving interventions in a [[trauma]] patient. Several [[airway]] control devices and techniques are available to assist [[healthcare]] providers in order to maintain the airway by [[ventilation]] and [[oxygenation]]. These include [[bag valve mask]] ([[Bag valve mask|BVM]]) [[ventilation]], direct [[laryngoscopy]] with [[endotracheal intubation]] (ETI) and adjunct [[Supraglottitis|supraglottic]] [[airway]] devices such as the [[laryngeal]] mask airway.

==Functional anatomy of the upper airway==
For a successful approach to [[airway]] management, [[health care providers]] must have knowledge of important [[anatomical]], [[physiological]], and [[pathological]] features related to the airway as well as knowledge of the various equipment and methods that can be utilized for this purpose. Also, the difference between airway management in adults, [[pediatrics]], and [[neonates]] is very critical.<ref name="pmid3056703">{{cite journal |vauthors=Morris IR |title=Functional anatomy of the upper airway |journal=Emerg. Med. Clin. North Am. |volume=6 |issue=4 |pages=639–69 |date=November 1988 |pmid=3056703 |doi= |url=}}</ref>

*The [[upper airway]] is consists of the [[pharynx]] and [[nasal]] cavities, the [[larynx]] and [[trachea]] may be included, and the [[oral cavity]] provides an alternate air entry into the [[respiratory system]].
*The nose is a bony and [[cartilage|cartilaginous]] structure attached to the facial [[skeleton]] and is divided into the two [[nasal]] cavities. The nose functions as a heater and humidifier of inspired air, it is also helps in [[phonation]] and [[vocal resonation]] and houses the [[olfactory]] receptors. The [[paranasal sinuses]] drain into the nasal cavities.
*An [[endotracheal tube]] passes through the [[nose]] or mouth into the [[trachea]] to protect the [[airway]] and achieve positive-pressure [[ventilation]]. The mouth opens posteriorly into the [[oropharynx]] and becomes part of the [[gastrointestinal system]], helps the [[digestion]] and also plays a role as an alternate pathway for [[respiration]]. It is also involved in [[phonation]].
*[[Orotracheal intubation]] can be used as an alternative to [[nasal]] [[intubation]] to achieve [[airway]] protection and maintain [[ventilation]]; but depending upon the condition of the [[patient]] and difficulty due to [[anatomical]] shape of [[upper airway]], this route may not be doable, for instance in supine unconscious persons, the backward movement of the [[tongue]] and lower [[jaw]] may cause [[airway obstruction]] and performing [[orotracheal intubation]] may not be the optimal way of managing airway.
*The [[pharynx]] is a membrane-lined cavity behind the [[mouth]] and [[nose]], extends from the base of the [[skull]] to the [[cricoid cartilage]] at the level of sixth [[cervical vertebrae]] which is an entrance to the [[esophagus]]. [[Anterior]]<nowiki/>ly it opens into the [[nasal cavity]], the [[mouth]], and the [[larynx]], which divide it into the naso-, oro-, and [[laryngopharynx]], respectively. The [[pharynx]] is involved with the act of [[swallowing]].
*The [[larynx]] consists of [[Cartilages of the larynx|cartilages]] and fibro-elastic membranes covered by a sheet of [[muscles]] and [[mucous membrane]]. It functions as an open valve in [[respiration]], helps in [[phonation]], and [[swallowing]]. The [[larynx]] extends from its entrance which is formed by the [[Aryepiglottic fold|aryepiglottic folds]], to the lower border of the [[cricoid cartilage]] till the tip of the [[epiglottis]], and bulges [[posterior]]<nowiki/>ly into the [[laryngopharynx]].
*The trachea is formed by U-shaped [[cartilaginous]] rings in anterior and [[trachealis muscle]] in [[posterior]], it extends from the lower edge of the [[cricoid cartilage]] to the [[carina]] where it divides into the [[mainstem bronchus]]. In order to place [[endotracheal tube]] in proper way, tip of the tube should be at mid [[Tracheal bronchus|tracheal]] level.

[[File:UpperRespiratorySystem.png|400px|thumb|left|upper airway system[https://commons.wikimedia.org/wiki/File:Blausen_0872_UpperRespiratorySystem.pngBlausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436.]]] 

==Recommendations for evaluation of airway==
The basic approach in airway management in the [[emergency]] setting includes:<ref name="RosenbergPhero2014">{{cite journal|last1=Rosenberg|first1=M. B|last2=Phero|first2=J. C|last3=Becker|first3=D. E|title=Essentials of Airway Management, Oxygenation, and Ventilation: Part 2: Advanced Airway Devices: Supraglottic Airways|journal=Anesthesia Progress|volume=61|issue=3|year=2014|pages=113–118|issn=0003-3006|doi=10.2344/0003-3006-61.3.113}}</ref>

:*Protection from [[aspiration]] and [[pneumonia]] related to that.
:*Providing adequate [[oxygenation]] and [[ventilation]].

Following are steps that must be considered prior to conducting airway management, these include:

:*'''History:''' An [[airway]] [[history]] should be conducted whenever it is possible before airway management in all [[patients]] to detect medical, [[surgical]], and [[anesthetic]] factors that may indicate the presence of a difficult [[airway]]. A detailed review of previous [[anesthetic]] records, if available, may provide useful information about airway management.

:*'''Physical Examination:''' An airway [[physical examination]] should be conducted before the initiation of airway management. The goal of [[physical examination]] is to detect physical characteristics that may indicate the presence of a difficult airway because an unsuccessful [[upper airway]] management is associated with increase in [[mortality]] and [[morbidity]].

:*'''Additional Evaluation:''' Additional evaluation may be indicated in some [[patients]] to characterize the likelihood or nature of the anticipated difficult airway. Certain diagnostic tests (e.g., [[radiography]], [[computed tomography]] scans, [[fluoroscopy]]) can identify a variety of acquired or congenital features in patients with difficult airways

==Techniques for airway management==
The decision about whether an airway intervention is required or not is crucial for patient's [[Survival rate|survival]] and depends on first responders skills and quick assessment and decision. These crucial steps requires techniques which are used universally in order to manage [[patient]]'s airway. Following are initial evaluation methods which had been developed to assist patient's [[ventilation]] and keep the [[airway]] patent, these techniques include:<ref name="RoychoudhuryJose2016">{{cite journal|last1=Roychoudhury|first1=Ajoy|last2=Jose|first2=Anson|last3=Nagori|first3=ShakilAhmed|last4=Agarwal|first4=Bhaskar|last5=Bhutia|first5=Ongkila|title=Management of maxillofacial trauma in emergency: An update of challenges and controversies|journal=Journal of Emergencies, Trauma, and Shock|volume=9|issue=2|year=2016|pages=73|issn=0974-2700|doi=10.4103/0974-2700.179456}}</ref><ref name="pmid18946431">{{cite journal |vauthors=Agrò FE, Cataldo R, Mattei A |title=New devices and techniques for airway management |journal=Minerva Anestesiol |volume=75 |issue=3 |pages=141–9 |date=March 2009 |pmid=18946431 |doi= |url=}}</ref><ref name="pmid29560073">{{cite journal |vauthors=Gleason JM, Christian BR, Barton ED |title=Nasal Cannula Apneic Oxygenation Prevents Desaturation During Endotracheal Intubation: An Integrative Literature Review |journal=West J Emerg Med |volume=19 |issue=2 |pages=403–411 |date=March 2018 |pmid=29560073 |pmc=5851518 |doi=10.5811/westjem.2017.12.34699 |url=}}</ref><ref name="LawBroemling2013">{{cite journal|last1=Law|first1=J. Adam|last2=Broemling|first2=Natasha|last3=Cooper|first3=Richard M.|last4=Drolet|first4=Pierre|last5=Duggan|first5=Laura V.|last6=Griesdale|first6=Donald E.|last7=Hung|first7=Orlando R.|last8=Jones|first8=Philip M.|last9=Kovacs|first9=George|last10=Massey|first10=Simon|last11=Morris|first11=Ian R.|last12=Mullen|first12=Timothy|last13=Murphy|first13=Michael F.|last14=Preston|first14=Roanne|last15=Naik|first15=Viren N.|last16=Scott|first16=Jeanette|last17=Stacey|first17=Shean|last18=Turkstra|first18=Timothy P.|last19=Wong|first19=David T.|title=The difficult airway with recommendations for management – Part 1 – Difficult tracheal intubation encountered in an unconscious/induced patient|journal=Canadian Journal of Anesthesia/Journal canadien d'anesthésie|volume=60|issue=11|year=2013|pages=1089–1118|issn=0832-610X|doi=10.1007/s12630-013-0019-3}}</ref><ref name="OkuboGibo2017">{{cite journal|last1=Okubo|first1=Masashi|last2=Gibo|first2=Koichiro|last3=Hagiwara|first3=Yusuke|last4=Nakayama|first4=Yukiko|last5=Hasegawa|first5=Kohei|title=The effectiveness of rapid sequence intubation (RSI) versus non-RSI in emergency department: an analysis of multicenter prospective observational study|journal=International Journal of Emergency Medicine|volume=10|issue=1|year=2017|issn=1865-1372|doi=10.1186/s12245-017-0129-8}}</ref>

*'''Spontaneous breathing:''' When a provider is confronted with an awake [[patient]] having a patent airway. Spontaneous ventilation can be assisted through the placement of a nasal or oral airway. [[Oxygenation]] can be improved by giving [[oxygen]] via nasal [[cannula]], simple [[face mask]], or nonrebreather face mask. Unfortunately, the maximally achieved [[FiO2]] is often overestimated by care providers and [[hypoventilation]] resulting in [[hypercapnia]] cannot be normalized with increase in [[oxygen]] supply.
*'''Mouth-to-Mouth ventilation:''' Mouth-to-mouth or mouth-to-nose ventilation is a useful management technique, however, because of the risk of [[infection]] transmission it is recommended by American heart association that health care providers do "Hands-only" [[CPR]]. Proper face masks should be utilized if they are available.
*'''Bag-mask ventilation:''' It is a standard initial approach to airway management in the prehospital and [[hospital]] settings.

:*Proper preoxygenation prior to [[intubation]] and [[anesthetic]] induction provides patients with improved [[oxygenation]] and increases the time to [[hypoxemia]].
:*Bag-mask [[ventilation]] is a basic essential technique when [[endotracheal tube]] [[intubation]] is difficult, it assists for rapid [[ventilation]] and [[oxygenation]] in patients.
:*Bag-mask [[ventilation]] can be applied by a practitioner alone or side by side with a second care provider in an [[operating room]].
:*Bag mask [[ventilation]] can also be utilized as a pressure support during spontaneous [[respiration]] in patients with decre<nowiki/>ased [[tidal volume]]<nowiki/>s and insufficient [[ventilation]], very similar to the use of [[CPAP]] or [[BiPAP]] to assist [[patients]] who are spontaneously [[breathing]] but are not adequately oxygenating or ventilating.

*'''Oropharyngeal and nasopharyngeal airways:'''

:*This is used as an adjunct device for spontaneous or [[assisted ventilation]].
:*[[Oropharyngeal]] and [[nasopharyngeal airway]]<nowiki/>s are frequently utilized by prehospital care providers to improve [[oxygenation]] and [[ventilation]].
:*These devices are frequently used until a more definitive [[airway]] is obtained, and there are several circumstances that prohibit their placement (severe head or [[facial]] injuries).

*'''Supraglottic airway devices:''' [[Supraglottic laryngeal cancer|Supraglottic]] airway (SGA) device placement is very useful to keep the [[airway]]<nowiki/>s open, it has advantages in comparison with [[endotracheal tube]] intubation, or other methods, these advantages are include:<ref name="pmid27537593">{{cite journal |vauthors=Park SK, Ko G, Choi GJ, Ahn EJ, Kang H |title=Comparison between supraglottic airway devices and endotracheal tubes in patients undergoing laparoscopic surgery: A systematic review and meta-analysis |journal=Medicine (Baltimore) |volume=95 |issue=33 |pages=e4598 |date=August 2016 |pmid=27537593 |doi=10.1097/MD.0000000000004598 |url=}}</ref>

:*Requires less training than ETI.
:*It is less invasive than ETI.
:*It can offer better [[ventilation]] during transport than bag-mask [[ventilation]] alone.
:**[[Supraglottitis|Supraglottic]] airway devices can be used as an alternative tool in cases of failed [[intubation]].

*'''[[Endotracheal intubation]]:''' It is the gold standard for definitive airway management in the prehospital setting, it allows for positive pressure [[ventilation]], [[positive end-expiratory pressure]] (PEEP), positive pressure recruitment maneuvers, and protection from [[aspiration]].

:*'''Mallampati classification for assessment of upper airway anatomical Balance:''' It's named after the Indian-born American [[anesthesiologist]] Seshagiri Mallampati, is used to predict the ease of [[endotracheal intubation]].The test assess the distance from the [[tongue]] base to the roof of the [[mouth]] visually. It is an indirect way of assessing how difficult intubation will be.
:*'''Modified Mallampati Scoring:'''
:**Class I: [[Soft palate]], [[uvula]], [[fauces]], [[Pillars of the fauces|pillars]] visible.
:**Class II: [[Soft palate]], a major part of the [[uvula]], [[fauces]] visible.
:**Class III: [[Soft palate]], the base of [[uvula]] visible.
:**Class IV: Only [[hard palate]] visible.

*'''Rapid sequence intubation versus no-medication intubation''':

:*Use of [[pharmacological]] [[muscle relaxant]] eases the [[intubation]] process by relaxing muscles in the [[pharynx]]. [[Rapid sequence induction|Rapid sequence intubation]] ([[RSI]]) techniques incorporate [[pharmacologic]] [[muscle]] relaxation and are utilized by anesthesiologists and [[emergency medicine]] physicians. However, the disadvantage of these techniques is the elimination of a patient's ability to breathe spontaneously if the [[intubation]] fails. There is a debate that optimal intubating conditions should be achieved first before trying to attempt [[intubation]] in the prehospital setting. Time is an important factor and critical in prehospital [[airway]] management of [[patients]], due to [[trauma]], [[cardiac arrest]], [[hypoxemia]], or aspiration risk. Administration of the [[Neuromuscular blocking agents|neuromuscular blocking agent]] is associated with a reduction in time from rapid sequence [[intubation]] administration to the end of [[intubation]] attempt.

[[File:Glidescope 02.jpg|400px|thumb|left|Photograph of an anesthesiologist using the Glidescope video laryngoscope to intubate the trachea of a morbidly obese elderly person with challenging airway anatomy[https://en.wikipedia.org/wiki/Airway_managementI (DiverDave (talk)) created this work entirely by myself. (Original uploaded on en.wikipedia)]]] 

==Management of the Airway in Patients with Trauma==
===Suspected Spinal Cord Injury===

*In [[patients]] with suspected [[trauma]], extreme caution must be taken in aligning the [[head]] and [[neck]]. The [[cervical spine]] must be maintained in a neutral mid-line position, the exception to this is physical resistance.<ref name="ThiboutotNicole2009">{{cite journal|last1=Thiboutot|first1=François|last2=Nicole|first2=Pierre C.|last3=Trépanier|first3=Claude A.|last4=Turgeon|first4=Alexis F.|last5=Lessard|first5=Martin R.|title=Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial|journal=Canadian Journal of Anesthesia/Journal Canadien d'anesthésie|volume=56|issue=6|year=2009|pages=412–418|issn=0832-610X|doi=10.1007/s12630-009-9089-7}}</ref><ref>{{cite journal|doi=10.1016/j.jclinane.2005.04.003 [Indexed for MEDLINE]}}</ref><ref name="KrishnamoorthyDagal2014">{{cite journal|last1=Krishnamoorthy|first1=Vijay|last2=Dagal|first2=Arman|last3=Austin|first3=Naola|title=Airway management in cervical spine injury|journal=International Journal of Critical Illness and Injury Science|volume=4|issue=1|year=2014|pages=50|issn=2229-5151|doi=10.4103/2229-5151.128013}}</ref><ref name="GhafoorMartin2005">{{cite journal|last1=Ghafoor|first1=Abid U.|last2=Martin|first2=Timothy W.|last3=Gopalakrishnan|first3=Senthil|last4=Viswamitra|first4=Sanjaya|title=Caring for the patients with cervical spine injuries: what have we learned?|journal=Journal of Clinical Anesthesia|volume=17|issue=8|year=2005|pages=640–649|issn=09528180|doi=10.1016/j.jclinane.2005.04.003}}</ref><ref name="SriganeshBusse2018">{{cite journal|last1=Sriganesh|first1=Kamath|last2=Busse|first2=JasonW|last3=Shanthanna|first3=Harsha|last4=Ramesh|first4=VenkatapuraJ|title=Airway management in the presence of cervical spine instability: A cross-sectional survey of the members of the Indian Society of Neuroanaesthesiology and Critical Care|journal=Indian Journal of Anaesthesia|volume=62|issue=2|year=2018|pages=115|issn=0019-5049|doi=10.4103/ija.IJA_671_17}}</ref>

*'''Neck Maneuvers During Airway Management:'''
**Immobilizing patient's [[neck]] by using sandbag-collar-tape on hardboard in a pre-hospital care setting.
**Applying pressure on cricoid with [[anterior]] half of hard [[cervical collar]] removed and another hand behind the [[posterior]] [[cervical collar]].
**Manual in-line stabilization is the technique of choice in any suspected [[cervical spine]] injury, during endotracheal intubation. In this technique, head grasped firmly at the [[mastoid process]] and the occiput.

*Traction should be avoided as it may distract the [[cervical spine]] and cause more [[neurological]] damage, even after manual in-line stabilization.

*Jaw thrust is the only basic [[airway]] opening maneuver appropriate for any [[patient]] with a suspected [[cervical spine injury]]. This method is used when head-tilt/chin-lift can be potentially dangerous to use on a patient who may have a [[cervical spine injury]]. In jaw-thrust maneuver, first care provider lifts the [[hyoid bone]] and [[tongue]] away from the [[posterior]] [[pharyngeal]] wall by pulling the [[mandible]] forward, displacing the [[tongue]] anteriorly.
*[[Suction]] and use of [[forceps]] under direct vision using a [[laryngoscope]] with the [[head]] and [[neck]] maintained in the neutral position.
*In order to minimize the risk of [[hypoxic]] damage from [[airway obstruction]] in an [[unconscious]] patient, proper positioning is done by placing patients in the [[lateral]] side with log rolling technique.

===Approach to airway management of a patient with Maxillo-Facial Injury===
[[Airway]] management of patients with [[maxillofacial]] trauma is challenging and vital because it's directly affecting the patient's survival. [[Endotracheal intubation]] is the [[Gold standard (test)|gold standard]] procedure to secure the [[airway]] in [[trauma]] [[patients]], however, in these [[patients]] passage of [[endotracheal tube]] may not be possible because the oral cavity, [[pharynx]], and [[larynx]] may be filled with [[blood]], secretions, [[soft tissue]], and [[bone]] fragments. Another reason for this is that the risk of [[aspiration]] and [[regurgitation]] is high in these patients.<ref name="BarakBahouth2015">{{cite journal|last1=Barak|first1=Michal|last2=Bahouth|first2=Hany|last3=Leiser|first3=Yoav|last4=Abu El-Naaj|first4=Imad|title=Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach|journal=BioMed Research International|volume=2015|year=2015|pages=1–9|issn=2314-6133|doi=10.1155/2015/724032}}</ref><ref name="pmid21655009">{{cite journal |vauthors=Raval CB, Rashiduddin M |title=Airway management in patients with maxillofacial trauma - A retrospective study of 177 cases |journal=Saudi J Anaesth |volume=5 |issue=1 |pages=9–14 |date=January 2011 |pmid=21655009 |pmc=3101764 |doi=10.4103/1658-354X.76476 |url=}}</ref><ref name="pmid7588664">{{cite journal |vauthors=Brimacombe J, Tucker P, Simons S |title=The laryngeal mask airway for awake diagnostic bronchoscopy. A retrospective study of 200 consecutive patients |journal=Eur J Anaesthesiol |volume=12 |issue=4 |pages=357–61 |date=July 1995 |pmid=7588664 |doi= |url=}}</ref><ref name="HsiaoPacheco-Fowler2008">{{cite journal|last1=Hsiao|first1=James|last2=Pacheco-Fowler|first2=Victor|title=Cricothyroidotomy|journal=New England Journal of Medicine|volume=358|issue=22|year=2008|pages=e25|issn=0028-4793|doi=10.1056/NEJMvcm0706755}}</ref>

*In such circumstances, there are numerous [[airway]] devices are available to rescue patients with [[maxillofacial]] injuries, some of these devices include:<ref name="BarakBahouth2015">{{cite journal|last1=Barak|first1=Michal|last2=Bahouth|first2=Hany|last3=Leiser|first3=Yoav|last4=Abu El-Naaj|first4=Imad|title=Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach|journal=BioMed Research International|volume=2015|year=2015|pages=1–9|issn=2314-6133|doi=10.1155/2015/724032}}</ref><ref name="MeyerPatel2014">{{cite journal|last1=Meyer|first1=TanyaK|last2=Patel|first2=SapnaA|title=Surgical Airway|journal=International Journal of Critical Illness and Injury Science|volume=4|issue=1|year=2014|pages=71|issn=2229-5151|doi=10.4103/2229-5151.128016}}</ref>
**Flexible [[fiberoptic]] [[bronchoscopy]] (FOB), enable an indirect view of [[vocal cords]].
**[[Laryngeal mask airway]] (LMA) may be inserted blindly since it does not require a view of the [[vocal cords]]. Another option for securing the [[airway]] in these patients is to pass the endotracheal tube after placing an LMA for them.
*Final option for establishing the airway in [[patients]] with [[maxillofacial]] injury is [[surgery]] by [[cricothyroidotomy]].
**[[Cricothyroidotomy]] also known as [[cricothyrotomy]] is a procedure done by trained [[health care providers]], they make a small [[incision]] through the skin and [[cricoid]] membrane which lies between the [[thyroid]] and [[cricoid]] [[cartilage]]<nowiki/>s, followed by inserting a [[tracheostomy tube]] to open alternative way of [[ventilation]] and [[oxygenation]] in the [[emergency]] situation which uses of [[endotracheal intubation]] is almost impossible or difficult and time-consuming.
**'''Indication for cricothyroidotomy include:'''
***Inability to secure [[airway]] through an [[endotracheal tube]]
***Major [[trauma]] to [[facial]] [[muscles]], [[pharynx]], [[larynx]].
***[[Congenital deformities]] and [[upper airway]] [[stenosis]].

*'''Contraindications for cricothyroidotomy:'''
**[[Age]], in [[pediatrics]] younger than 12 years old needle [[cricothyrotomy]] is indicated because of less potential damage to the [[larynx]] and surrounding structures.
**Massive [[trauma]] to the [[larynx]] or [[cricoid cartilage]]
**Inability to identify surface landmarks due to [[obesity]], [[cervical]] trauma.
**When [[Orotracheal intubation|orotracheal]] and [[Nasotracheal intubation|nasotracheal]] [[intubation]] are viable options
**[[Airway obstruction]] distal to [[subglottic airway]], e.g. [[tracheal stenosis]]
**[[Laryngeal cancer]]: Other than for an extreme airway [[emergency]], [[cricothyroidotomy]] must be avoided to not to seed the [[soft tissue]] of the [[neck]] with [[cancer]] cells
**[[Coagulopathy]] (other than [[emergency]] situation)

*'''Complications of cricothyroidotomy:'''
**[[Esophageal]] perforation if the blade penetrates too deeply.
**[[Subcutaneous emphysema]]
**Rupture of vital [[vessels]] such as a [[carotid artery]], excessive [[bleeding]], and [[hemorrhage]].

*'''Indications of definitive airway management in patients with maxillofacial injury:'''
**Absent spontaneous [[breathing]]
**[[Comatose]] [[patients]]([[Glasgow coma score]] < 9)
**[[Airway]] injury or [[obstruction]]
**Persistent [[oxygen saturation]] below 90%
**High risk for [[aspiration]]
**[[Systemic shock]]([[Systolic Blood Pressure Intervention|Systolic Blood Pressure]]<80mmHg)
**"Cannot intubate, cannot ventilate" situations

==Complications of airway management==

Airway management complications are common, these complications usually occur in [[intensive care units]] and [[emergency department]]<nowiki/>s, summary of airway management related complactions include:<ref name="CookMacDougall-Davis2012">{{cite journal|last1=Cook|first1=T.M.|last2=MacDougall-Davis|first2=S.R.|title=Complications and failure of airway management|journal=British Journal of Anaesthesia|volume=109|year=2012|pages=i68–i85|issn=00070912|doi=10.1093/bja/aes393}}</ref>

*[[Patient]] harm/death associated with suboptimal care
*[[Hypoxia]] is the most common cause of [[airway]]-related deaths
*[[Obesity]]
*[[Pulmonary]] [[aspiration]] remains the leading cause of airway-related [[anesthetic]] deaths
*Failure in airway management techniques

{{#ev:youtube|ycQs27YVE60}}

==Related Chapters==

*[[intubation|Intubation]]
*[[endotracheal tube|Endotracheal Tube]]
*[[laryngeal mask airway|Laryngeal Mask Airway]]
*[[oropharyngeal airway|Oropharyngeal Airway]]
*[[nasopharyngeal airway|Nasopharyngeal Airway]]
*[[Ventilation (physiology)|Ventilation]]
*[[Cricothyrotomy]]
*[[Tracheotomy]]

==References==
{{reflist|2}}
[[Category:Emergency medicine]]
[[Category:First aid]]
[[Category:anesthesia]]
[[Category:Intensive care medicine]]

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Airway management

2021-05-26T03:30:29Z

Shaik Aisha sultana: /* Functional anatomy of the upper airway */

__NOTOC__
{{SI}}
{{CMG}}{{AE}}{{Nnasiri}}

==Overview==
''Airway management'' is the process of ensuring that there is an open pathway between a patient’s [[lung]]s and the outside world, and the [[lungs]] are safe from [[Pulmonary aspiration|aspiration]]. [[Airway]] loss is a major cause of preventable prehospital death in [[trauma]] patients. Airway management complications are common, especially in [[trauma]] patients because of associated [[pathology]], lack of complete evaluation before [[intubation]], unanticipated difficulty during ventilation and [[intubation]]. Additionally, [[trauma]] [[patients]] are at increased risk of [[airway obstruction]], aspiration, [[hypoxia]] and [[hypotension]], and [[vital sign|other unstable vital]] The providers must have skillset related to working with a variety of tools and techniques used in airway management and knowledge of the important [[anatomical]], [[physiological]], and [[pathological]] features related to the airway. They also should know the differences between the adult versus [[pediatric]] and [[neonatal]] airways as these [[anatomical]] and physiological differences are critical, impactful on patients lives and knowing these leads to effective control and management of the [[airway]]. Some of the indications for managing the [[airway]] in patients include [[respiratory failure]], altered sensorium([[Glasgow Coma Scale]] less than or equal to 8), rapid deterioration of [[mental status]], [[airway]] injury or compromise, injuries causing a high risk for [[aspiration]]-which includes all penetrating injuries to the [[abdomen]] or [[chest wall]]. Inadequate [[airway]] management may lead to [[cardiovascular]] arrest and compromise life-saving interventions in a [[trauma]] patient. Several [[airway]] control devices and techniques are available to assist [[healthcare]] providers in order to maintain the airway by [[ventilation]] and [[oxygenation]]. These include [[bag valve mask]] ([[Bag valve mask|BVM]]) [[ventilation]], direct [[laryngoscopy]] with [[endotracheal intubation]] (ETI) and adjunct [[Supraglottitis|supraglottic]] [[airway]] devices such as the [[laryngeal]] mask airway.

==Functional anatomy of the upper airway==
For a successful approach to [[airway]] management, [[health care providers]] must have knowledge of important [[anatomical]], [[physiological]], and [[pathological]] features related to the airway as well as knowledge of the various equipment and methods that can be utilized for this purpose. Also, the difference between airway management in adults, [[pediatrics]], and [[neonates]] is very critical.<ref name="pmid3056703">{{cite journal |vauthors=Morris IR |title=Functional anatomy of the upper airway |journal=Emerg. Med. Clin. North Am. |volume=6 |issue=4 |pages=639–69 |date=November 1988 |pmid=3056703 |doi= |url=}}</ref>

*The [[upper airway]] is consists of the [[pharynx]] and [[nasal]] cavities, the [[larynx]] and [[trachea]] may be included, and the [[oral cavity]] provides an alternate air entry into the [[respiratory system]].
*The nose is a bony and [[cartilage|cartilaginous]] structure attached to the facial [[skeleton]] and is divided into the two [[nasal]] cavities. The nose functions as a heater and humidifier of inspired air, it is also helps in [[phonation]] and [[vocal resonation]] and houses the [[olfactory]] receptors. The [[paranasal sinuses]] drain into the nasal cavities.
*An [[endotracheal tube]] passes through the [[nose]] or mouth into the [[trachea]] to protect the [[airway]] and achieve positive-pressure [[ventilation]]. The mouth opens posteriorly into the [[oropharynx]] and becomes part of the [[gastrointestinal system]], helps the [[digestion]] and also plays a role as an alternate pathway for [[respiration]]. It is also involved in [[phonation]].
*[[Orotracheal intubation]] can be used as an alternative to [[nasal]] [[intubation]] to achieve [[airway]] protection and maintain [[ventilation]]; but depending upon the condition of the [[patient]] and difficulty due to [[anatomical]] shape of [[upper airway]], this route may not be doable, for instance in supine unconscious persons, the backward movement of the [[tongue]] and lower [[jaw]] may cause [[airway obstruction]] and performing [[orotracheal intubation]] may not be the optimal way of managing airway.
*The [[pharynx]] is a membrane-lined cavity behind the [[mouth]] and [[nose]], extends from the base of the [[skull]] to the [[cricoid cartilage]] at the level of sixth [[cervical vertebrae]] which is an entrance to the [[esophagus]]. [[Anterior]]<nowiki/>ly it opens into the [[nasal cavity]], the [[mouth]], and the [[larynx]], which divide it into the naso-, oro-, and [[laryngopharynx]], respectively. The [[pharynx]] is involved with the act of [[swallowing]].
*The [[larynx]] consists of [[Cartilages of the larynx|cartilages]] and fibro-elastic membranes covered by a sheet of [[muscles]] and [[mucous membrane]]. It functions as an open valve in [[respiration]], helps in [[phonation]], and [[swallowing]]. The [[larynx]] extends from its entrance which is formed by the [[Aryepiglottic fold|aryepiglottic folds]], to the lower border of the [[cricoid cartilage]] till the tip of the [[epiglottis]], and bulges [[posterior]]<nowiki/>ly into the [[laryngopharynx]].
*The trachea is formed by U-shaped [[cartilaginous]] rings in anterior and [[trachealis muscle]] in [[posterior]], it extends from the lower edge of the [[cricoid cartilage]] to the [[carina]] where it divides into the [[mainstem bronchus]]. In order to place [[endotracheal tube]] in proper way, tip of the tube should be at mid [[Tracheal bronchus|tracheal]] level.

[[File:UpperRespiratorySystem.png|400px|thumb|left|upper airway system[https://commons.wikimedia.org/wiki/File:Blausen_0872_UpperRespiratorySystem.pngBlausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436.]]] 

==Recommendations for evaluation of airway==
The basic approach in airway management in the [[emergency]] setting includes:<ref name="RosenbergPhero2014">{{cite journal|last1=Rosenberg|first1=M. B|last2=Phero|first2=J. C|last3=Becker|first3=D. E|title=Essentials of Airway Management, Oxygenation, and Ventilation: Part 2: Advanced Airway Devices: Supraglottic Airways|journal=Anesthesia Progress|volume=61|issue=3|year=2014|pages=113–118|issn=0003-3006|doi=10.2344/0003-3006-61.3.113}}</ref>

:*Protection from [[aspiration]] and [[pneumonia]] related to that.
:*Providing adequate [[oxygenation]] and [[ventilation]].

Following are steps that must be considered prior to conducting airway management, these include:

:*'''History:''' An [[airway]] [[history]] should be conducted whenever it is possible before airway management in all [[patients]] to detect medical, [[surgical]], and [[anesthetic]] factors that may indicate the presence of a difficult [[airway]]. A detailed review of previous [[anesthetic]] records, if available, may provide useful information about airway management.

:*'''Physical Examination:''' An airway [[physical examination]] should be conducted before the initiation of airway management. The goal of [[physical examination]] is to detect physical characteristics that may indicate the presence of a difficult airway because an unsuccessful [[upper airway]] mangaement is associated with increase in [[mortality]] and [[morbidity]].

:*'''Additional Evaluation:''' Additional evaluation may be indicated in some [[patients]] to characterize the likelihood or nature of the anticipated airway difficulty. Certain diagnostic tests (e.g., [[radiography]], [[computed tomography]] scans, [[fluoroscopy]]) can identify a variety of acquired or congenital features in patients with difficult airways

==Techniques for airway management==
The decision about whether an airway intervention is required or not is crucial for patients [[Survival rate|survival]] and depends on first responders skills and qucik assessment and decision. These crucial steps requires techniques which is used universally in order to manage [[patient]]'s airway, followings are initial evaluation and methods which had been developed to assist patient's [[ventilation]] and keep the [[airway]] patent, these techniques include:<ref name="RoychoudhuryJose2016">{{cite journal|last1=Roychoudhury|first1=Ajoy|last2=Jose|first2=Anson|last3=Nagori|first3=ShakilAhmed|last4=Agarwal|first4=Bhaskar|last5=Bhutia|first5=Ongkila|title=Management of maxillofacial trauma in emergency: An update of challenges and controversies|journal=Journal of Emergencies, Trauma, and Shock|volume=9|issue=2|year=2016|pages=73|issn=0974-2700|doi=10.4103/0974-2700.179456}}</ref><ref name="pmid18946431">{{cite journal |vauthors=Agrò FE, Cataldo R, Mattei A |title=New devices and techniques for airway management |journal=Minerva Anestesiol |volume=75 |issue=3 |pages=141–9 |date=March 2009 |pmid=18946431 |doi= |url=}}</ref><ref name="pmid29560073">{{cite journal |vauthors=Gleason JM, Christian BR, Barton ED |title=Nasal Cannula Apneic Oxygenation Prevents Desaturation During Endotracheal Intubation: An Integrative Literature Review |journal=West J Emerg Med |volume=19 |issue=2 |pages=403–411 |date=March 2018 |pmid=29560073 |pmc=5851518 |doi=10.5811/westjem.2017.12.34699 |url=}}</ref><ref name="LawBroemling2013">{{cite journal|last1=Law|first1=J. Adam|last2=Broemling|first2=Natasha|last3=Cooper|first3=Richard M.|last4=Drolet|first4=Pierre|last5=Duggan|first5=Laura V.|last6=Griesdale|first6=Donald E.|last7=Hung|first7=Orlando R.|last8=Jones|first8=Philip M.|last9=Kovacs|first9=George|last10=Massey|first10=Simon|last11=Morris|first11=Ian R.|last12=Mullen|first12=Timothy|last13=Murphy|first13=Michael F.|last14=Preston|first14=Roanne|last15=Naik|first15=Viren N.|last16=Scott|first16=Jeanette|last17=Stacey|first17=Shean|last18=Turkstra|first18=Timothy P.|last19=Wong|first19=David T.|title=The difficult airway with recommendations for management – Part 1 – Difficult tracheal intubation encountered in an unconscious/induced patient|journal=Canadian Journal of Anesthesia/Journal canadien d'anesthésie|volume=60|issue=11|year=2013|pages=1089–1118|issn=0832-610X|doi=10.1007/s12630-013-0019-3}}</ref><ref name="OkuboGibo2017">{{cite journal|last1=Okubo|first1=Masashi|last2=Gibo|first2=Koichiro|last3=Hagiwara|first3=Yusuke|last4=Nakayama|first4=Yukiko|last5=Hasegawa|first5=Kohei|title=The effectiveness of rapid sequence intubation (RSI) versus non-RSI in emergency department: an analysis of multicenter prospective observational study|journal=International Journal of Emergency Medicine|volume=10|issue=1|year=2017|issn=1865-1372|doi=10.1186/s12245-017-0129-8}}</ref>

*'''Spontaneous breathing:''' When a provider is confronted with an awake [[patient]] having a patent airway. Spontaneous ventilation can be assisted through the placement of a nasal or oral airway. [[Oxygenation]] can be improved by giving [[oxygen]] via nasal [[cannula]], simple [[face mask]], or nonrebreather face mask. Unfortunately, the maximally achieved [[FiO2]] is often overestimated by care providers and [[hypoventilation]] resulting in [[hypercapnia]] cannot be normalized with increase [[oxygen]] supply.
*'''Mouth-to-Mouth ventilation:''' Mouth-to-mouth or mouth-to-nose ventilation is a useful management technique, however, because of the risk of [[infection]] transmission it is recommended by American heart association that health care providers do "Hands-only" [[CPR]]. Proper face masks should be utilized if they are available.
*'''Bag-mask ventilation:''' It is a standard initial approach to airway management in the prehospital and [[hospital]] settings.

:*Proper preoxygenation prior to [[intubation]] and [[anesthetic]] induction provides patients with improved [[oxygenation]] and increases the time to [[hypoxemia]].
:*Bag-mask [[ventilation]] is basic essential technique when [[endotracheal tube]] [[intubation]] is difficult, it assists for rapid [[oxygenation]] and [[ventilation]] in patients.
:*Bag-mask [[ventilation]] can be applied by a practitioner alone or side by side with a second care provider in an [[operating room]].
:*Bag mask [[ventilation]] can also be utilized as a pressure support during spontaneous [[respiration]] in patients with decre<nowiki/>ased [[tidal volume]]<nowiki/>s and insufficient [[ventilation]], very similar to the use of [[CPAP]] or [[BiPAP]] to assist [[patients]] who are spontaneously [[breathing]] but are not adequately oxygenating or ventilating.

*'''Oropharyngeal and nasopharyngeal airways:'''

:*This is used as an adjunct device for spontaneous or [[assisted ventilation]].
:*[[Oropharyngeal]] and [[nasopharyngeal airway]]<nowiki/>s are frequently utilized by prehospital care providers to improve [[oxygenation]] and [[ventilation]].
:*These devices are frequently used until a more definitive [[airway]] is obtained, and there are several circumstances that prohibit their placement (severe head or [[facial]] injuries).

*'''Supraglottic airway devices:''' [[Supraglottic laryngeal cancer|Supraglottic]] airway (SGA) device placement is very useful to keep the [[airway]]<nowiki/>s open, it has advantages in comparison with [[endotracheal tube]] intubation, or other methods, these advantages are include:<ref name="pmid27537593">{{cite journal |vauthors=Park SK, Ko G, Choi GJ, Ahn EJ, Kang H |title=Comparison between supraglottic airway devices and endotracheal tubes in patients undergoing laparoscopic surgery: A systematic review and meta-analysis |journal=Medicine (Baltimore) |volume=95 |issue=33 |pages=e4598 |date=August 2016 |pmid=27537593 |doi=10.1097/MD.0000000000004598 |url=}}</ref>

:*Requires less training than ETI.
:*It is less invasive than ETI.
:*It can offer better [[ventilation]] during transport than bag-mask [[ventilation]] alone.
:**[[Supraglottitis|Supraglottic]] airway devices can be used as an alternative tool in cases of failed [[intubation]].

*'''[[Endotracheal intubation]]:''' It is the gold standard for definitive airway management in the prehospital setting, it allows for positive pressure [[ventilation]], [[positive end-expiratory pressure]] (PEEP), positive pressure recruitment maneuvers, and protection from [[aspiration]].

:*'''Mallampati classification for assessment of upper airway anatomical Balance:''' It's named after the Indian-born American [[anesthesiologist]] Seshagiri Mallampati, is used to predict the ease of [[endotracheal intubation]].The test assess the distance from the [[tongue]] base to the roof of the [[mouth]] visually. It is an indirect way of assessing how difficult intubation will be.
:*'''Modified Mallampati Scoring:'''
:**Class I: [[Soft palate]], [[uvula]], [[fauces]], [[Pillars of the fauces|pillars]] visible.
:**Class II: [[Soft palate]], a major part of the [[uvula]], [[fauces]] visible.
:**Class III: [[Soft palate]], the base of [[uvula]] visible.
:**Class IV: Only [[hard palate]] visible.

*'''Rapid sequence intubation versus no-medication intubation''':

:*Use of [[pharmacological]] [[muscle relaxant]] eases the [[intubation]] process by relaxing muscles in the [[pharynx]]. [[Rapid sequence induction|Rapid sequence intubation]] ([[RSI]]) techniques incorporate [[pharmacologic]] [[muscle]] relaxation and are utilized by anesthesiologists and [[emergency medicine]] physicians. However, the disadvantage of these techniques is the elimination of a patient's ability to breathe spontaneously if the [[intubation]] fails. There is a debate that optimal intubating conditions should be achieved first before trying to attempt [[intubation]] in the prehospital setting. Time is an important factor and critical in prehospital [[airway]] management of [[patients]], due to [[trauma]], [[cardiac arrest]], [[hypoxemia]], or aspiration risk. Administration of the [[Neuromuscular blocking agents|neuromuscular blocking agent]] is associated with a reduction in time from rapid sequence [[intubation]] administration to the end of [[intubation]] attempt.

[[File:Glidescope 02.jpg|400px|thumb|left|Photograph of an anesthesiologist using the Glidescope video laryngoscope to intubate the trachea of a morbidly obese elderly person with challenging airway anatomy[https://en.wikipedia.org/wiki/Airway_managementI (DiverDave (talk)) created this work entirely by myself. (Original uploaded on en.wikipedia)]]] 

==Management of the Airway in Patients with Trauma==
===Suspected Spinal Cord Injury===

*In [[patients]] with suspected [[trauma]], extreme caution must be taken in aligning the [[head]] and [[neck]]. The [[cervical spine]] must be maintained in a neutral mid-line position, the exception to this is physical resistance.<ref name="ThiboutotNicole2009">{{cite journal|last1=Thiboutot|first1=François|last2=Nicole|first2=Pierre C.|last3=Trépanier|first3=Claude A.|last4=Turgeon|first4=Alexis F.|last5=Lessard|first5=Martin R.|title=Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial|journal=Canadian Journal of Anesthesia/Journal Canadien d'anesthésie|volume=56|issue=6|year=2009|pages=412–418|issn=0832-610X|doi=10.1007/s12630-009-9089-7}}</ref><ref>{{cite journal|doi=10.1016/j.jclinane.2005.04.003 [Indexed for MEDLINE]}}</ref><ref name="KrishnamoorthyDagal2014">{{cite journal|last1=Krishnamoorthy|first1=Vijay|last2=Dagal|first2=Arman|last3=Austin|first3=Naola|title=Airway management in cervical spine injury|journal=International Journal of Critical Illness and Injury Science|volume=4|issue=1|year=2014|pages=50|issn=2229-5151|doi=10.4103/2229-5151.128013}}</ref><ref name="GhafoorMartin2005">{{cite journal|last1=Ghafoor|first1=Abid U.|last2=Martin|first2=Timothy W.|last3=Gopalakrishnan|first3=Senthil|last4=Viswamitra|first4=Sanjaya|title=Caring for the patients with cervical spine injuries: what have we learned?|journal=Journal of Clinical Anesthesia|volume=17|issue=8|year=2005|pages=640–649|issn=09528180|doi=10.1016/j.jclinane.2005.04.003}}</ref><ref name="SriganeshBusse2018">{{cite journal|last1=Sriganesh|first1=Kamath|last2=Busse|first2=JasonW|last3=Shanthanna|first3=Harsha|last4=Ramesh|first4=VenkatapuraJ|title=Airway management in the presence of cervical spine instability: A cross-sectional survey of the members of the Indian Society of Neuroanaesthesiology and Critical Care|journal=Indian Journal of Anaesthesia|volume=62|issue=2|year=2018|pages=115|issn=0019-5049|doi=10.4103/ija.IJA_671_17}}</ref>

*'''Neck Maneuvers During Airway Management:'''
**Immobilizing patient's [[neck]] by using sandbag-collar-tape on hardboard in a pre-hospital care setting.
**Applying pressure on cricoid with [[anterior]] half of hard [[cervical collar]] removed and another hand behind the [[posterior]] [[cervical collar]].
**Manual in-line stabilization is the technique of choice in any suspected [[cervical spine]] injury, during endotracheal intubation. In this technique, head grasped firmly at the [[mastoid process]] and the occiput.

*Traction should be avoided as it may distract the [[cervical spine]] and cause more [[neurological]] damage, even after manual in-line stabilization.

*Jaw thrust is the only basic [[airway]] opening maneuver appropriate for any [[patient]] with a suspected [[cervical spine injury]]. This method is used when head-tilt/chin-lift can be potentially dangerous to use on a patient who may have a [[cervical spine injury]]. In jaw-thrust maneuver, first care provider lifts the [[hyoid bone]] and [[tongue]] away from the [[posterior]] [[pharyngeal]] wall by pulling the [[mandible]] forward, displacing the [[tongue]] anteriorly.
*[[Suction]] and use of [[forceps]] under direct vision using a [[laryngoscope]] with the [[head]] and [[neck]] maintained in the neutral position.
*In order to minimize the risk of [[hypoxic]] damage from [[airway obstruction]] in an [[unconscious]] patient, proper positioning is done by placing patients in the [[lateral]] side with log rolling technique.

===Approach to airway management of a patient with Maxillo-Facial Injury===
[[Airway]] management of patients with [[maxillofacial]] trauma is challenging and vital because it's directly affecting the patient's survival. [[Endotracheal intubation]] is the [[Gold standard (test)|gold standard]] procedure to secure the [[airway]] in [[trauma]] [[patients]], however, in these [[patients]] passage of [[endotracheal tube]] may not be possible because the oral cavity, [[pharynx]], and [[larynx]] may be filled with [[blood]], secretions, [[soft tissue]], and [[bone]] fragments. Another reason for this is that the risk of [[aspiration]] and [[regurgitation]] is high in these patients.<ref name="BarakBahouth2015">{{cite journal|last1=Barak|first1=Michal|last2=Bahouth|first2=Hany|last3=Leiser|first3=Yoav|last4=Abu El-Naaj|first4=Imad|title=Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach|journal=BioMed Research International|volume=2015|year=2015|pages=1–9|issn=2314-6133|doi=10.1155/2015/724032}}</ref><ref name="pmid21655009">{{cite journal |vauthors=Raval CB, Rashiduddin M |title=Airway management in patients with maxillofacial trauma - A retrospective study of 177 cases |journal=Saudi J Anaesth |volume=5 |issue=1 |pages=9–14 |date=January 2011 |pmid=21655009 |pmc=3101764 |doi=10.4103/1658-354X.76476 |url=}}</ref><ref name="pmid7588664">{{cite journal |vauthors=Brimacombe J, Tucker P, Simons S |title=The laryngeal mask airway for awake diagnostic bronchoscopy. A retrospective study of 200 consecutive patients |journal=Eur J Anaesthesiol |volume=12 |issue=4 |pages=357–61 |date=July 1995 |pmid=7588664 |doi= |url=}}</ref><ref name="HsiaoPacheco-Fowler2008">{{cite journal|last1=Hsiao|first1=James|last2=Pacheco-Fowler|first2=Victor|title=Cricothyroidotomy|journal=New England Journal of Medicine|volume=358|issue=22|year=2008|pages=e25|issn=0028-4793|doi=10.1056/NEJMvcm0706755}}</ref>

*In such circumstances, there are numerous [[airway]] devices are available to rescue patients with [[maxillofacial]] injuries, some of these devices include:<ref name="BarakBahouth2015">{{cite journal|last1=Barak|first1=Michal|last2=Bahouth|first2=Hany|last3=Leiser|first3=Yoav|last4=Abu El-Naaj|first4=Imad|title=Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach|journal=BioMed Research International|volume=2015|year=2015|pages=1–9|issn=2314-6133|doi=10.1155/2015/724032}}</ref><ref name="MeyerPatel2014">{{cite journal|last1=Meyer|first1=TanyaK|last2=Patel|first2=SapnaA|title=Surgical Airway|journal=International Journal of Critical Illness and Injury Science|volume=4|issue=1|year=2014|pages=71|issn=2229-5151|doi=10.4103/2229-5151.128016}}</ref>
**Flexible [[fiberoptic]] [[bronchoscopy]] (FOB), enable an indirect view of [[vocal cords]].
**[[Laryngeal mask airway]] (LMA) may be inserted blindly since it does not require a view of the [[vocal cords]]. Another option for securing the [[airway]] in these patients is to pass the endotracheal tube after placing an LMA for them.
*Final option for establishing the airway in [[patients]] with [[maxillofacial]] injury is [[surgery]] by [[cricothyroidotomy]].
**[[Cricothyroidotomy]] also known as [[cricothyrotomy]] is a procedure done by trained [[health care providers]], they make a small [[incision]] through the skin and [[cricoid]] membrane which lies between the [[thyroid]] and [[cricoid]] [[cartilage]]<nowiki/>s, followed by inserting a [[tracheostomy tube]] to open alternative way of [[ventilation]] and [[oxygenation]] in the [[emergency]] situation which uses of [[endotracheal intubation]] is almost impossible or difficult and time-consuming.
**'''Indication for cricothyroidotomy include:'''
***Inability to secure [[airway]] through an [[endotracheal tube]]
***Major [[trauma]] to [[facial]] [[muscles]], [[pharynx]], [[larynx]].
***[[Congenital deformities]] and [[upper airway]] [[stenosis]].

*'''Contraindications for cricothyroidotomy:'''
**[[Age]], in [[pediatrics]] younger than 12 years old needle [[cricothyrotomy]] is indicated because of less potential damage to the [[larynx]] and surrounding structures.
**Massive [[trauma]] to the [[larynx]] or [[cricoid cartilage]]
**Inability to identify surface landmarks due to [[obesity]], [[cervical]] trauma.
**When [[Orotracheal intubation|orotracheal]] and [[Nasotracheal intubation|nasotracheal]] [[intubation]] are viable options
**[[Airway obstruction]] distal to [[subglottic airway]], e.g. [[tracheal stenosis]]
**[[Laryngeal cancer]]: Other than for an extreme airway [[emergency]], [[cricothyroidotomy]] must be avoided to not to seed the [[soft tissue]] of the [[neck]] with [[cancer]] cells
**[[Coagulopathy]] (other than [[emergency]] situation)

*'''Complications of cricothyroidotomy:'''
**[[Esophageal]] perforation if the blade penetrates too deeply.
**[[Subcutaneous emphysema]]
**Rupture of vital [[vessels]] such as a [[carotid artery]], excessive [[bleeding]], and [[hemorrhage]].

*'''Indications of definitive airway management in patients with maxillofacial injury:'''
**Absent spontaneous [[breathing]]
**[[Comatose]] [[patients]]([[Glasgow coma score]] < 9)
**[[Airway]] injury or [[obstruction]]
**Persistent [[oxygen saturation]] below 90%
**High risk for [[aspiration]]
**[[Systemic shock]]([[Systolic Blood Pressure Intervention|Systolic Blood Pressure]]<80mmHg)
**"Cannot intubate, cannot ventilate" situations

==Complications of airway management==

Airway management complications are common, these complications usually occur in [[intensive care units]] and [[emergency department]]<nowiki/>s, summary of airway management related complactions include:<ref name="CookMacDougall-Davis2012">{{cite journal|last1=Cook|first1=T.M.|last2=MacDougall-Davis|first2=S.R.|title=Complications and failure of airway management|journal=British Journal of Anaesthesia|volume=109|year=2012|pages=i68–i85|issn=00070912|doi=10.1093/bja/aes393}}</ref>

*[[Patient]] harm/death associated with suboptimal care
*[[Hypoxia]] is the most common cause of [[airway]]-related deaths
*[[Obesity]]
*[[Pulmonary]] [[aspiration]] remains the leading cause of airway-related [[anesthetic]] deaths
*Failure in airway management techniques

{{#ev:youtube|ycQs27YVE60}}

==Related Chapters==

*[[intubation|Intubation]]
*[[endotracheal tube|Endotracheal Tube]]
*[[laryngeal mask airway|Laryngeal Mask Airway]]
*[[oropharyngeal airway|Oropharyngeal Airway]]
*[[nasopharyngeal airway|Nasopharyngeal Airway]]
*[[Ventilation (physiology)|Ventilation]]
*[[Cricothyrotomy]]
*[[Tracheotomy]]

==References==
{{reflist|2}}
[[Category:Emergency medicine]]
[[Category:First aid]]
[[Category:anesthesia]]
[[Category:Intensive care medicine]]

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Airway management

2021-05-26T03:22:47Z

Shaik Aisha sultana: /* Overview */

__NOTOC__
{{SI}}
{{CMG}}{{AE}}{{Nnasiri}}

==Overview==
''Airway management'' is the process of ensuring that there is an open pathway between a patient’s [[lung]]s and the outside world, and the [[lungs]] are safe from [[Pulmonary aspiration|aspiration]]. [[Airway]] loss is a major cause of preventable prehospital death in [[trauma]] patients. Airway management complications are common, especially in [[trauma]] patients because of associated [[pathology]], lack of complete evaluation before [[intubation]], unanticipated difficulty during ventilation and [[intubation]]. Additionally, [[trauma]] [[patients]] are at increased risk of [[airway obstruction]], aspiration, [[hypoxia]] and [[hypotension]], and [[vital sign|other unstable vital]] The providers must have skillset related to working with a variety of tools and techniques used in airway management and knowledge of the important [[anatomical]], [[physiological]], and [[pathological]] features related to the airway. They also should know the differences between the adult versus [[pediatric]] and [[neonatal]] airways as these [[anatomical]] and physiological differences are critical, impactful on patients lives and knowing these leads to effective control and management of the [[airway]]. Some of the indications for managing the [[airway]] in patients include [[respiratory failure]], altered sensorium([[Glasgow Coma Scale]] less than or equal to 8), rapid deterioration of [[mental status]], [[airway]] injury or compromise, injuries causing a high risk for [[aspiration]]-which includes all penetrating injuries to the [[abdomen]] or [[chest wall]]. Inadequate [[airway]] management may lead to [[cardiovascular]] arrest and compromise life-saving interventions in a [[trauma]] patient. Several [[airway]] control devices and techniques are available to assist [[healthcare]] providers in order to maintain the airway by [[ventilation]] and [[oxygenation]]. These include [[bag valve mask]] ([[Bag valve mask|BVM]]) [[ventilation]], direct [[laryngoscopy]] with [[endotracheal intubation]] (ETI) and adjunct [[Supraglottitis|supraglottic]] [[airway]] devices such as the [[laryngeal]] mask airway.

==Functional anatomy of the upper airway==
For a successful approach to [[airway]] management, [[health care providers]] must have knowledge of important [[anatomical]], [[physiological]], and [[pathological]] features related to the airway as well as knowledge of the various equipment and methods that can be utilized for this purpose. Also, the difference between airway management in adults, [[pediatrics]], and [[neonates]] is very critical.<ref name="pmid3056703">{{cite journal |vauthors=Morris IR |title=Functional anatomy of the upper airway |journal=Emerg. Med. Clin. North Am. |volume=6 |issue=4 |pages=639–69 |date=November 1988 |pmid=3056703 |doi= |url=}}</ref>

*The [[upper airway]] is consists of the [[pharynx]] and [[nasal]] cavities, the [[larynx]] and [[trachea]] may be included, and the [[oral cavity]] provides an alternate air entry into the [[respiratory system]].
*The nose is a bony and [[cartilage]] structure attached to the facial [[skeleton]] and is divided into the two [[nasal]] cavities. The nose functions as a heater and humidifier of inspired gas, it is also helping in [[phonation]] and [[vocal resonation]] and houses the [[olfactory]] receptors. The [[paranasal sinuses]] drain into the nasal cavities.
*An [[endotracheal tube]] passes through the [[nose]] or mouth into the [[trachea]] to protect the [[airway]] and achieve positive-pressure [[ventilation]]. The mouth opens posteriorly into the [[oropharynx]] and becomes part of the [[gastrointestinal system]], helps the [[digestion]] and also plays a role as an alternate pathway for [[respiration]]. It is also involved in [[phonation]].
*[[Orotracheal intubation]] can be used as an alternative to [[nasal]] [[intubation]] to achieve [[airway]] protection and maintain [[ventilation]]; but depending upon position of [[patient]] who is arriving and difficulty that is due to [[anatomical]] shape of [[upper airway]], this route may not be doable, for instance in supine unconscious persons, the backward movement of the [[tongue]] and lower [[jaw]] may cause [[airway obstruction]] and performing [[orotracheal intubation]] may not be the optimal way of managing airway.
*The [[pharynx]] is a membrane-lined cavity behind the [[mouth]] and [[nose]], extends from the base of the [[skull]] to the [[cricoid cartilage]] at the level of sixth [[cervical vertebrae]] which is an entrance to the [[esophagus]]. [[Anterior]]<nowiki/>ly it opens into the [[nasal cavity]], the [[mouth]], and the [[larynx]], which divide it into the naso-, oro-, and [[laryngopharynx]], respectively. The [[pharynx]] is involved with the act of [[swallowing]].
*The [[larynx]] consists of [[Cartilages of the larynx|cartilages]] and fibro-elastic membranes covered by a sheet of [[muscles]] and [[mucous membrane]]. It functions as an open valve in [[respiration]], helps in [[phonation]], and [[swallowing]]. The [[larynx]] extends from its entrance which is formed by the [[Aryepiglottic fold|aryepiglottic folds]], to the lower border of the [[cricoid cartilage]] till the tip of the [[epiglottis]], and bulges [[posterior]]<nowiki/>ly into the [[laryngopharynx]].
*The trachea is formed by U-shaped [[cartilaginous]] rings in anterior and [[trachealis muscle]] in [[posterior]], it extends from the lower edge of the [[cricoid cartilage]] to the [[carina]] where it divides into the [[mainstem bronchus]]. In order to place [[endotracheal tube]] in proper way, tip of the tube should be at mid [[Tracheal bronchus|tracheal]] level.

[[File:UpperRespiratorySystem.png|400px|thumb|left|upper airway system[https://commons.wikimedia.org/wiki/File:Blausen_0872_UpperRespiratorySystem.pngBlausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436.]]] 

==Recommendations for evaluation of airway==
The basic approach in airway management in the [[emergency]] setting includes:<ref name="RosenbergPhero2014">{{cite journal|last1=Rosenberg|first1=M. B|last2=Phero|first2=J. C|last3=Becker|first3=D. E|title=Essentials of Airway Management, Oxygenation, and Ventilation: Part 2: Advanced Airway Devices: Supraglottic Airways|journal=Anesthesia Progress|volume=61|issue=3|year=2014|pages=113–118|issn=0003-3006|doi=10.2344/0003-3006-61.3.113}}</ref>

:*Protection from [[aspiration]] and [[pneumonia]] related to that.
:*Providing adequate [[oxygenation]] and [[ventilation]].

Following are steps that must be considered prior to conducting airway management, these include:

:*'''History:''' An [[airway]] [[history]] should be conducted whenever it is possible before airway management in all [[patients]] to detect medical, [[surgical]], and [[anesthetic]] factors that may indicate the presence of a difficult [[airway]]. A detailed review of previous [[anesthetic]] records, if available, may provide useful information about airway management.

:*'''Physical Examination:''' An airway [[physical examination]] should be conducted before the initiation of airway management. The goal of [[physical examination]] is to detect physical characteristics that may indicate the presence of a difficult airway because an unsuccessful [[upper airway]] mangaement is associated with increase in [[mortality]] and [[morbidity]].

:*'''Additional Evaluation:''' Additional evaluation may be indicated in some [[patients]] to characterize the likelihood or nature of the anticipated airway difficulty. Certain diagnostic tests (e.g., [[radiography]], [[computed tomography]] scans, [[fluoroscopy]]) can identify a variety of acquired or congenital features in patients with difficult airways

==Techniques for airway management==
The decision about whether an airway intervention is required or not is crucial for patients [[Survival rate|survival]] and depends on first responders skills and qucik assessment and decision. These crucial steps requires techniques which is used universally in order to manage [[patient]]'s airway, followings are initial evaluation and methods which had been developed to assist patient's [[ventilation]] and keep the [[airway]] patent, these techniques include:<ref name="RoychoudhuryJose2016">{{cite journal|last1=Roychoudhury|first1=Ajoy|last2=Jose|first2=Anson|last3=Nagori|first3=ShakilAhmed|last4=Agarwal|first4=Bhaskar|last5=Bhutia|first5=Ongkila|title=Management of maxillofacial trauma in emergency: An update of challenges and controversies|journal=Journal of Emergencies, Trauma, and Shock|volume=9|issue=2|year=2016|pages=73|issn=0974-2700|doi=10.4103/0974-2700.179456}}</ref><ref name="pmid18946431">{{cite journal |vauthors=Agrò FE, Cataldo R, Mattei A |title=New devices and techniques for airway management |journal=Minerva Anestesiol |volume=75 |issue=3 |pages=141–9 |date=March 2009 |pmid=18946431 |doi= |url=}}</ref><ref name="pmid29560073">{{cite journal |vauthors=Gleason JM, Christian BR, Barton ED |title=Nasal Cannula Apneic Oxygenation Prevents Desaturation During Endotracheal Intubation: An Integrative Literature Review |journal=West J Emerg Med |volume=19 |issue=2 |pages=403–411 |date=March 2018 |pmid=29560073 |pmc=5851518 |doi=10.5811/westjem.2017.12.34699 |url=}}</ref><ref name="LawBroemling2013">{{cite journal|last1=Law|first1=J. Adam|last2=Broemling|first2=Natasha|last3=Cooper|first3=Richard M.|last4=Drolet|first4=Pierre|last5=Duggan|first5=Laura V.|last6=Griesdale|first6=Donald E.|last7=Hung|first7=Orlando R.|last8=Jones|first8=Philip M.|last9=Kovacs|first9=George|last10=Massey|first10=Simon|last11=Morris|first11=Ian R.|last12=Mullen|first12=Timothy|last13=Murphy|first13=Michael F.|last14=Preston|first14=Roanne|last15=Naik|first15=Viren N.|last16=Scott|first16=Jeanette|last17=Stacey|first17=Shean|last18=Turkstra|first18=Timothy P.|last19=Wong|first19=David T.|title=The difficult airway with recommendations for management – Part 1 – Difficult tracheal intubation encountered in an unconscious/induced patient|journal=Canadian Journal of Anesthesia/Journal canadien d'anesthésie|volume=60|issue=11|year=2013|pages=1089–1118|issn=0832-610X|doi=10.1007/s12630-013-0019-3}}</ref><ref name="OkuboGibo2017">{{cite journal|last1=Okubo|first1=Masashi|last2=Gibo|first2=Koichiro|last3=Hagiwara|first3=Yusuke|last4=Nakayama|first4=Yukiko|last5=Hasegawa|first5=Kohei|title=The effectiveness of rapid sequence intubation (RSI) versus non-RSI in emergency department: an analysis of multicenter prospective observational study|journal=International Journal of Emergency Medicine|volume=10|issue=1|year=2017|issn=1865-1372|doi=10.1186/s12245-017-0129-8}}</ref>

*'''Spontaneous breathing:''' When a provider is confronted with an awake [[patient]] having a patent airway. Spontaneous ventilation can be assisted through the placement of a nasal or oral airway. [[Oxygenation]] can be improved by giving [[oxygen]] via nasal [[cannula]], simple [[face mask]], or nonrebreather face mask. Unfortunately, the maximally achieved [[FiO2]] is often overestimated by care providers and [[hypoventilation]] resulting in [[hypercapnia]] cannot be normalized with increase [[oxygen]] supply.
*'''Mouth-to-Mouth ventilation:''' Mouth-to-mouth or mouth-to-nose ventilation is a useful management technique, however, because of the risk of [[infection]] transmission it is recommended by American heart association that health care providers do "Hands-only" [[CPR]]. Proper face masks should be utilized if they are available.
*'''Bag-mask ventilation:''' It is a standard initial approach to airway management in the prehospital and [[hospital]] settings.

:*Proper preoxygenation prior to [[intubation]] and [[anesthetic]] induction provides patients with improved [[oxygenation]] and increases the time to [[hypoxemia]].
:*Bag-mask [[ventilation]] is basic essential technique when [[endotracheal tube]] [[intubation]] is difficult, it assists for rapid [[oxygenation]] and [[ventilation]] in patients.
:*Bag-mask [[ventilation]] can be applied by a practitioner alone or side by side with a second care provider in an [[operating room]].
:*Bag mask [[ventilation]] can also be utilized as a pressure support during spontaneous [[respiration]] in patients with decre<nowiki/>ased [[tidal volume]]<nowiki/>s and insufficient [[ventilation]], very similar to the use of [[CPAP]] or [[BiPAP]] to assist [[patients]] who are spontaneously [[breathing]] but are not adequately oxygenating or ventilating.

*'''Oropharyngeal and nasopharyngeal airways:'''

:*This is used as an adjunct device for spontaneous or [[assisted ventilation]].
:*[[Oropharyngeal]] and [[nasopharyngeal airway]]<nowiki/>s are frequently utilized by prehospital care providers to improve [[oxygenation]] and [[ventilation]].
:*These devices are frequently used until a more definitive [[airway]] is obtained, and there are several circumstances that prohibit their placement (severe head or [[facial]] injuries).

*'''Supraglottic airway devices:''' [[Supraglottic laryngeal cancer|Supraglottic]] airway (SGA) device placement is very useful to keep the [[airway]]<nowiki/>s open, it has advantages in comparison with [[endotracheal tube]] intubation, or other methods, these advantages are include:<ref name="pmid27537593">{{cite journal |vauthors=Park SK, Ko G, Choi GJ, Ahn EJ, Kang H |title=Comparison between supraglottic airway devices and endotracheal tubes in patients undergoing laparoscopic surgery: A systematic review and meta-analysis |journal=Medicine (Baltimore) |volume=95 |issue=33 |pages=e4598 |date=August 2016 |pmid=27537593 |doi=10.1097/MD.0000000000004598 |url=}}</ref>

:*Requires less training than ETI.
:*It is less invasive than ETI.
:*It can offer better [[ventilation]] during transport than bag-mask [[ventilation]] alone.
:**[[Supraglottitis|Supraglottic]] airway devices can be used as an alternative tool in cases of failed [[intubation]].

*'''[[Endotracheal intubation]]:''' It is the gold standard for definitive airway management in the prehospital setting, it allows for positive pressure [[ventilation]], [[positive end-expiratory pressure]] (PEEP), positive pressure recruitment maneuvers, and protection from [[aspiration]].

:*'''Mallampati classification for assessment of upper airway anatomical Balance:''' It's named after the Indian-born American [[anesthesiologist]] Seshagiri Mallampati, is used to predict the ease of [[endotracheal intubation]].The test assess the distance from the [[tongue]] base to the roof of the [[mouth]] visually. It is an indirect way of assessing how difficult intubation will be.
:*'''Modified Mallampati Scoring:'''
:**Class I: [[Soft palate]], [[uvula]], [[fauces]], [[Pillars of the fauces|pillars]] visible.
:**Class II: [[Soft palate]], a major part of the [[uvula]], [[fauces]] visible.
:**Class III: [[Soft palate]], the base of [[uvula]] visible.
:**Class IV: Only [[hard palate]] visible.

*'''Rapid sequence intubation versus no-medication intubation''':

:*Use of [[pharmacological]] [[muscle relaxant]] eases the [[intubation]] process by relaxing muscles in the [[pharynx]]. [[Rapid sequence induction|Rapid sequence intubation]] ([[RSI]]) techniques incorporate [[pharmacologic]] [[muscle]] relaxation and are utilized by anesthesiologists and [[emergency medicine]] physicians. However, the disadvantage of these techniques is the elimination of a patient's ability to breathe spontaneously if the [[intubation]] fails. There is a debate that optimal intubating conditions should be achieved first before trying to attempt [[intubation]] in the prehospital setting. Time is an important factor and critical in prehospital [[airway]] management of [[patients]], due to [[trauma]], [[cardiac arrest]], [[hypoxemia]], or aspiration risk. Administration of the [[Neuromuscular blocking agents|neuromuscular blocking agent]] is associated with a reduction in time from rapid sequence [[intubation]] administration to the end of [[intubation]] attempt.

[[File:Glidescope 02.jpg|400px|thumb|left|Photograph of an anesthesiologist using the Glidescope video laryngoscope to intubate the trachea of a morbidly obese elderly person with challenging airway anatomy[https://en.wikipedia.org/wiki/Airway_managementI (DiverDave (talk)) created this work entirely by myself. (Original uploaded on en.wikipedia)]]] 

==Management of the Airway in Patients with Trauma==
===Suspected Spinal Cord Injury===

*In [[patients]] with suspected [[trauma]], extreme caution must be taken in aligning the [[head]] and [[neck]]. The [[cervical spine]] must be maintained in a neutral mid-line position, the exception to this is physical resistance.<ref name="ThiboutotNicole2009">{{cite journal|last1=Thiboutot|first1=François|last2=Nicole|first2=Pierre C.|last3=Trépanier|first3=Claude A.|last4=Turgeon|first4=Alexis F.|last5=Lessard|first5=Martin R.|title=Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial|journal=Canadian Journal of Anesthesia/Journal Canadien d'anesthésie|volume=56|issue=6|year=2009|pages=412–418|issn=0832-610X|doi=10.1007/s12630-009-9089-7}}</ref><ref>{{cite journal|doi=10.1016/j.jclinane.2005.04.003 [Indexed for MEDLINE]}}</ref><ref name="KrishnamoorthyDagal2014">{{cite journal|last1=Krishnamoorthy|first1=Vijay|last2=Dagal|first2=Arman|last3=Austin|first3=Naola|title=Airway management in cervical spine injury|journal=International Journal of Critical Illness and Injury Science|volume=4|issue=1|year=2014|pages=50|issn=2229-5151|doi=10.4103/2229-5151.128013}}</ref><ref name="GhafoorMartin2005">{{cite journal|last1=Ghafoor|first1=Abid U.|last2=Martin|first2=Timothy W.|last3=Gopalakrishnan|first3=Senthil|last4=Viswamitra|first4=Sanjaya|title=Caring for the patients with cervical spine injuries: what have we learned?|journal=Journal of Clinical Anesthesia|volume=17|issue=8|year=2005|pages=640–649|issn=09528180|doi=10.1016/j.jclinane.2005.04.003}}</ref><ref name="SriganeshBusse2018">{{cite journal|last1=Sriganesh|first1=Kamath|last2=Busse|first2=JasonW|last3=Shanthanna|first3=Harsha|last4=Ramesh|first4=VenkatapuraJ|title=Airway management in the presence of cervical spine instability: A cross-sectional survey of the members of the Indian Society of Neuroanaesthesiology and Critical Care|journal=Indian Journal of Anaesthesia|volume=62|issue=2|year=2018|pages=115|issn=0019-5049|doi=10.4103/ija.IJA_671_17}}</ref>

*'''Neck Maneuvers During Airway Management:'''
**Immobilizing patient's [[neck]] by using sandbag-collar-tape on hardboard in a pre-hospital care setting.
**Applying pressure on cricoid with [[anterior]] half of hard [[cervical collar]] removed and another hand behind the [[posterior]] [[cervical collar]].
**Manual in-line stabilization is the technique of choice in any suspected [[cervical spine]] injury, during endotracheal intubation. In this technique, head grasped firmly at the [[mastoid process]] and the occiput.

*Traction should be avoided as it may distract the [[cervical spine]] and cause more [[neurological]] damage, even after manual in-line stabilization.

*Jaw thrust is the only basic [[airway]] opening maneuver appropriate for any [[patient]] with a suspected [[cervical spine injury]]. This method is used when head-tilt/chin-lift can be potentially dangerous to use on a patient who may have a [[cervical spine injury]]. In jaw-thrust maneuver, first care provider lifts the [[hyoid bone]] and [[tongue]] away from the [[posterior]] [[pharyngeal]] wall by pulling the [[mandible]] forward, displacing the [[tongue]] anteriorly.
*[[Suction]] and use of [[forceps]] under direct vision using a [[laryngoscope]] with the [[head]] and [[neck]] maintained in the neutral position.
*In order to minimize the risk of [[hypoxic]] damage from [[airway obstruction]] in an [[unconscious]] patient, proper positioning is done by placing patients in the [[lateral]] side with log rolling technique.

===Approach to airway management of a patient with Maxillo-Facial Injury===
[[Airway]] management of patients with [[maxillofacial]] trauma is challenging and vital because it's directly affecting the patient's survival. [[Endotracheal intubation]] is the [[Gold standard (test)|gold standard]] procedure to secure the [[airway]] in [[trauma]] [[patients]], however, in these [[patients]] passage of [[endotracheal tube]] may not be possible because the oral cavity, [[pharynx]], and [[larynx]] may be filled with [[blood]], secretions, [[soft tissue]], and [[bone]] fragments. Another reason for this is that the risk of [[aspiration]] and [[regurgitation]] is high in these patients.<ref name="BarakBahouth2015">{{cite journal|last1=Barak|first1=Michal|last2=Bahouth|first2=Hany|last3=Leiser|first3=Yoav|last4=Abu El-Naaj|first4=Imad|title=Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach|journal=BioMed Research International|volume=2015|year=2015|pages=1–9|issn=2314-6133|doi=10.1155/2015/724032}}</ref><ref name="pmid21655009">{{cite journal |vauthors=Raval CB, Rashiduddin M |title=Airway management in patients with maxillofacial trauma - A retrospective study of 177 cases |journal=Saudi J Anaesth |volume=5 |issue=1 |pages=9–14 |date=January 2011 |pmid=21655009 |pmc=3101764 |doi=10.4103/1658-354X.76476 |url=}}</ref><ref name="pmid7588664">{{cite journal |vauthors=Brimacombe J, Tucker P, Simons S |title=The laryngeal mask airway for awake diagnostic bronchoscopy. A retrospective study of 200 consecutive patients |journal=Eur J Anaesthesiol |volume=12 |issue=4 |pages=357–61 |date=July 1995 |pmid=7588664 |doi= |url=}}</ref><ref name="HsiaoPacheco-Fowler2008">{{cite journal|last1=Hsiao|first1=James|last2=Pacheco-Fowler|first2=Victor|title=Cricothyroidotomy|journal=New England Journal of Medicine|volume=358|issue=22|year=2008|pages=e25|issn=0028-4793|doi=10.1056/NEJMvcm0706755}}</ref>

*In such circumstances, there are numerous [[airway]] devices are available to rescue patients with [[maxillofacial]] injuries, some of these devices include:<ref name="BarakBahouth2015">{{cite journal|last1=Barak|first1=Michal|last2=Bahouth|first2=Hany|last3=Leiser|first3=Yoav|last4=Abu El-Naaj|first4=Imad|title=Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach|journal=BioMed Research International|volume=2015|year=2015|pages=1–9|issn=2314-6133|doi=10.1155/2015/724032}}</ref><ref name="MeyerPatel2014">{{cite journal|last1=Meyer|first1=TanyaK|last2=Patel|first2=SapnaA|title=Surgical Airway|journal=International Journal of Critical Illness and Injury Science|volume=4|issue=1|year=2014|pages=71|issn=2229-5151|doi=10.4103/2229-5151.128016}}</ref>
**Flexible [[fiberoptic]] [[bronchoscopy]] (FOB), enable an indirect view of [[vocal cords]].
**[[Laryngeal mask airway]] (LMA) may be inserted blindly since it does not require a view of the [[vocal cords]]. Another option for securing the [[airway]] in these patients is to pass the endotracheal tube after placing an LMA for them.
*Final option for establishing the airway in [[patients]] with [[maxillofacial]] injury is [[surgery]] by [[cricothyroidotomy]].
**[[Cricothyroidotomy]] also known as [[cricothyrotomy]] is a procedure done by trained [[health care providers]], they make a small [[incision]] through the skin and [[cricoid]] membrane which lies between the [[thyroid]] and [[cricoid]] [[cartilage]]<nowiki/>s, followed by inserting a [[tracheostomy tube]] to open alternative way of [[ventilation]] and [[oxygenation]] in the [[emergency]] situation which uses of [[endotracheal intubation]] is almost impossible or difficult and time-consuming.
**'''Indication for cricothyroidotomy include:'''
***Inability to secure [[airway]] through an [[endotracheal tube]]
***Major [[trauma]] to [[facial]] [[muscles]], [[pharynx]], [[larynx]].
***[[Congenital deformities]] and [[upper airway]] [[stenosis]].

*'''Contraindications for cricothyroidotomy:'''
**[[Age]], in [[pediatrics]] younger than 12 years old needle [[cricothyrotomy]] is indicated because of less potential damage to the [[larynx]] and surrounding structures.
**Massive [[trauma]] to the [[larynx]] or [[cricoid cartilage]]
**Inability to identify surface landmarks due to [[obesity]], [[cervical]] trauma.
**When [[Orotracheal intubation|orotracheal]] and [[Nasotracheal intubation|nasotracheal]] [[intubation]] are viable options
**[[Airway obstruction]] distal to [[subglottic airway]], e.g. [[tracheal stenosis]]
**[[Laryngeal cancer]]: Other than for an extreme airway [[emergency]], [[cricothyroidotomy]] must be avoided to not to seed the [[soft tissue]] of the [[neck]] with [[cancer]] cells
**[[Coagulopathy]] (other than [[emergency]] situation)

*'''Complications of cricothyroidotomy:'''
**[[Esophageal]] perforation if the blade penetrates too deeply.
**[[Subcutaneous emphysema]]
**Rupture of vital [[vessels]] such as a [[carotid artery]], excessive [[bleeding]], and [[hemorrhage]].

*'''Indications of definitive airway management in patients with maxillofacial injury:'''
**Absent spontaneous [[breathing]]
**[[Comatose]] [[patients]]([[Glasgow coma score]] < 9)
**[[Airway]] injury or [[obstruction]]
**Persistent [[oxygen saturation]] below 90%
**High risk for [[aspiration]]
**[[Systemic shock]]([[Systolic Blood Pressure Intervention|Systolic Blood Pressure]]<80mmHg)
**"Cannot intubate, cannot ventilate" situations

==Complications of airway management==

Airway management complications are common, these complications usually occur in [[intensive care units]] and [[emergency department]]<nowiki/>s, summary of airway management related complactions include:<ref name="CookMacDougall-Davis2012">{{cite journal|last1=Cook|first1=T.M.|last2=MacDougall-Davis|first2=S.R.|title=Complications and failure of airway management|journal=British Journal of Anaesthesia|volume=109|year=2012|pages=i68–i85|issn=00070912|doi=10.1093/bja/aes393}}</ref>

*[[Patient]] harm/death associated with suboptimal care
*[[Hypoxia]] is the most common cause of [[airway]]-related deaths
*[[Obesity]]
*[[Pulmonary]] [[aspiration]] remains the leading cause of airway-related [[anesthetic]] deaths
*Failure in airway management techniques

{{#ev:youtube|ycQs27YVE60}}

==Related Chapters==

*[[intubation|Intubation]]
*[[endotracheal tube|Endotracheal Tube]]
*[[laryngeal mask airway|Laryngeal Mask Airway]]
*[[oropharyngeal airway|Oropharyngeal Airway]]
*[[nasopharyngeal airway|Nasopharyngeal Airway]]
*[[Ventilation (physiology)|Ventilation]]
*[[Cricothyrotomy]]
*[[Tracheotomy]]

==References==
{{reflist|2}}
[[Category:Emergency medicine]]
[[Category:First aid]]
[[Category:anesthesia]]
[[Category:Intensive care medicine]]

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Airway management

2021-05-25T16:23:40Z

Shaik Aisha sultana: /* Overview */

__NOTOC__
{{SI}}
{{CMG}}{{AE}}{{Nnasiri}}

==Overview==
''Airway management'' is the process of ensuring that there is an open pathway between a patient’s [[lung]]s and the outside world, and the [[lungs]] are safe from [[Pulmonary aspiration|aspiration]]. [[Airway]] loss is a major cause of preventable prehospital death in [[trauma]] patients. Airway management complications are common, especially in [[trauma]] patients because of associated [[pathology]], lack of complete evaluation before [[intubation]], unanticipated difficulty during ventilation and [[intubation]]. Additionally, [[trauma]] [[patients]] are at increased risk of [[airway obstruction]], aspiration, [[hypoxia]] and [[hypotension]], and [[vital sign|other unstable vital]] The providers must have skillset related to working with a variety of tools and techniques used in airway management and knowledge of the important [[anatomical]], [[physiological]], and [[pathological]] features related to the airway. They also should know the differences between the adult versus [[pediatric]] and [[neonatal]] airways as these [[anatomical]] and physiological differences are critical, impactful on patients lives and knowing these leads to effective control and management of the [[airway]]. Some of the indications for managing the [[airway]] in patients include [[respiratory failure]], a reduced level of consciousness ([[Glasgow Coma Scale]] less than or equal to 8), rapid deterioration of [[mental status]], [[airway]] injury or compromise, injuries causing a high risk for [[aspiration]], which includes all penetrating injuries to the [[abdomen]] or [[chest wall]]. Inadequate [[airway]] management may lead to [[cardiovascular]] arrest and compromise life-saving interventions in a [[trauma]] patient. Several [[airway]] control devices and techniques are available to assist [[healthcare]] providers in order to maintain [[ventilation]] and [[oxygenation]]. These include [[bag valve mask]] ([[Bag valve mask|BVM]]) [[ventilation]], direct [[laryngoscopy]] with [[endotracheal intubation]] (ETI) and adjunct [[Supraglottitis|supraglottic]] [[airway]] devices such as the [[laryngeal]] mask airway.

==Functional anatomy of the upper airway==
For a successful approach to [[airway]] management, [[health care providers]] must have knowledge of important [[anatomical]], [[physiological]], and [[pathological]] features related to the airway as well as knowledge of the various equipment and methods that can be utilized for this purpose. Also, the difference between airway management in adults, [[pediatrics]], and [[neonates]] is very critical.<ref name="pmid3056703">{{cite journal |vauthors=Morris IR |title=Functional anatomy of the upper airway |journal=Emerg. Med. Clin. North Am. |volume=6 |issue=4 |pages=639–69 |date=November 1988 |pmid=3056703 |doi= |url=}}</ref>

*The [[upper airway]] is consists of the [[pharynx]] and [[nasal]] cavities, the [[larynx]] and [[trachea]] may be included, and the [[oral cavity]] provides an alternate air entry into the [[respiratory system]].
*The nose is a bony and [[cartilage]] structure attached to the facial [[skeleton]] and is divided into the two [[nasal]] cavities. The nose functions as a heater and humidifier of inspired gas, it is also helping in [[phonation]] and [[vocal resonation]] and houses the [[olfactory]] receptors. The [[paranasal sinuses]] drain into the nasal cavities.
*An [[endotracheal tube]] passes through the [[nose]] or mouth into the [[trachea]] to protect the [[airway]] and achieve positive-pressure [[ventilation]]. The mouth opens posteriorly into the [[oropharynx]] and becomes part of the [[gastrointestinal system]], helps the [[digestion]] and also plays a role as an alternate pathway for [[respiration]]. It is also involved in [[phonation]].
*[[Orotracheal intubation]] can be used as an alternative to [[nasal]] [[intubation]] to achieve [[airway]] protection and maintain [[ventilation]]; but depending upon position of [[patient]] who is arriving and difficulty that is due to [[anatomical]] shape of [[upper airway]], this route may not be doable, for instance in supine unconscious persons, the backward movement of the [[tongue]] and lower [[jaw]] may cause [[airway obstruction]] and performing [[orotracheal intubation]] may not be the optimal way of managing airway.
*The [[pharynx]] is a membrane-lined cavity behind the [[mouth]] and [[nose]], extends from the base of the [[skull]] to the [[cricoid cartilage]] at the level of sixth [[cervical vertebrae]] which is an entrance to the [[esophagus]]. [[Anterior]]<nowiki/>ly it opens into the [[nasal cavity]], the [[mouth]], and the [[larynx]], which divide it into the naso-, oro-, and [[laryngopharynx]], respectively. The [[pharynx]] is involved with the act of [[swallowing]].
*The [[larynx]] consists of [[Cartilages of the larynx|cartilages]] and fibro-elastic membranes covered by a sheet of [[muscles]] and [[mucous membrane]]. It functions as an open valve in [[respiration]], helps in [[phonation]], and [[swallowing]]. The [[larynx]] extends from its entrance which is formed by the [[Aryepiglottic fold|aryepiglottic folds]], to the lower border of the [[cricoid cartilage]] till the tip of the [[epiglottis]], and bulges [[posterior]]<nowiki/>ly into the [[laryngopharynx]].
*The trachea is formed by U-shaped [[cartilaginous]] rings in anterior and [[trachealis muscle]] in [[posterior]], it extends from the lower edge of the [[cricoid cartilage]] to the [[carina]] where it divides into the [[mainstem bronchus]]. In order to place [[endotracheal tube]] in proper way, tip of the tube should be at mid [[Tracheal bronchus|tracheal]] level.

[[File:UpperRespiratorySystem.png|400px|thumb|left|upper airway system[https://commons.wikimedia.org/wiki/File:Blausen_0872_UpperRespiratorySystem.pngBlausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436.]]] 

==Recommendations for evaluation of airway==
The basic approach in airway management in the [[emergency]] setting includes:<ref name="RosenbergPhero2014">{{cite journal|last1=Rosenberg|first1=M. B|last2=Phero|first2=J. C|last3=Becker|first3=D. E|title=Essentials of Airway Management, Oxygenation, and Ventilation: Part 2: Advanced Airway Devices: Supraglottic Airways|journal=Anesthesia Progress|volume=61|issue=3|year=2014|pages=113–118|issn=0003-3006|doi=10.2344/0003-3006-61.3.113}}</ref>

:*Protection from [[aspiration]] and [[pneumonia]] related to that.
:*Providing adequate [[oxygenation]] and [[ventilation]].

Following are steps that must be considered prior to conducting airway management, these include:

:*'''History:''' An [[airway]] [[history]] should be conducted whenever it is possible before airway management in all [[patients]] to detect medical, [[surgical]], and [[anesthetic]] factors that may indicate the presence of a difficult [[airway]]. A detailed review of previous [[anesthetic]] records, if available, may provide useful information about airway management.

:*'''Physical Examination:''' An airway [[physical examination]] should be conducted before the initiation of airway management. The goal of [[physical examination]] is to detect physical characteristics that may indicate the presence of a difficult airway because an unsuccessful [[upper airway]] mangaement is associated with increase in [[mortality]] and [[morbidity]].

:*'''Additional Evaluation:''' Additional evaluation may be indicated in some [[patients]] to characterize the likelihood or nature of the anticipated airway difficulty. Certain diagnostic tests (e.g., [[radiography]], [[computed tomography]] scans, [[fluoroscopy]]) can identify a variety of acquired or congenital features in patients with difficult airways

==Techniques for airway management==
The decision about whether an airway intervention is required or not is crucial for patients [[Survival rate|survival]] and depends on first responders skills and qucik assessment and decision. These crucial steps requires techniques which is used universally in order to manage [[patient]]'s airway, followings are initial evaluation and methods which had been developed to assist patient's [[ventilation]] and keep the [[airway]] patent, these techniques include:<ref name="RoychoudhuryJose2016">{{cite journal|last1=Roychoudhury|first1=Ajoy|last2=Jose|first2=Anson|last3=Nagori|first3=ShakilAhmed|last4=Agarwal|first4=Bhaskar|last5=Bhutia|first5=Ongkila|title=Management of maxillofacial trauma in emergency: An update of challenges and controversies|journal=Journal of Emergencies, Trauma, and Shock|volume=9|issue=2|year=2016|pages=73|issn=0974-2700|doi=10.4103/0974-2700.179456}}</ref><ref name="pmid18946431">{{cite journal |vauthors=Agrò FE, Cataldo R, Mattei A |title=New devices and techniques for airway management |journal=Minerva Anestesiol |volume=75 |issue=3 |pages=141–9 |date=March 2009 |pmid=18946431 |doi= |url=}}</ref><ref name="pmid29560073">{{cite journal |vauthors=Gleason JM, Christian BR, Barton ED |title=Nasal Cannula Apneic Oxygenation Prevents Desaturation During Endotracheal Intubation: An Integrative Literature Review |journal=West J Emerg Med |volume=19 |issue=2 |pages=403–411 |date=March 2018 |pmid=29560073 |pmc=5851518 |doi=10.5811/westjem.2017.12.34699 |url=}}</ref><ref name="LawBroemling2013">{{cite journal|last1=Law|first1=J. Adam|last2=Broemling|first2=Natasha|last3=Cooper|first3=Richard M.|last4=Drolet|first4=Pierre|last5=Duggan|first5=Laura V.|last6=Griesdale|first6=Donald E.|last7=Hung|first7=Orlando R.|last8=Jones|first8=Philip M.|last9=Kovacs|first9=George|last10=Massey|first10=Simon|last11=Morris|first11=Ian R.|last12=Mullen|first12=Timothy|last13=Murphy|first13=Michael F.|last14=Preston|first14=Roanne|last15=Naik|first15=Viren N.|last16=Scott|first16=Jeanette|last17=Stacey|first17=Shean|last18=Turkstra|first18=Timothy P.|last19=Wong|first19=David T.|title=The difficult airway with recommendations for management – Part 1 – Difficult tracheal intubation encountered in an unconscious/induced patient|journal=Canadian Journal of Anesthesia/Journal canadien d'anesthésie|volume=60|issue=11|year=2013|pages=1089–1118|issn=0832-610X|doi=10.1007/s12630-013-0019-3}}</ref><ref name="OkuboGibo2017">{{cite journal|last1=Okubo|first1=Masashi|last2=Gibo|first2=Koichiro|last3=Hagiwara|first3=Yusuke|last4=Nakayama|first4=Yukiko|last5=Hasegawa|first5=Kohei|title=The effectiveness of rapid sequence intubation (RSI) versus non-RSI in emergency department: an analysis of multicenter prospective observational study|journal=International Journal of Emergency Medicine|volume=10|issue=1|year=2017|issn=1865-1372|doi=10.1186/s12245-017-0129-8}}</ref>

*'''Spontaneous breathing:''' When a provider is confronted with an awake [[patient]] having a patent airway. Spontaneous ventilation can be assisted through the placement of a nasal or oral airway. [[Oxygenation]] can be improved by giving [[oxygen]] via nasal [[cannula]], simple [[face mask]], or nonrebreather face mask. Unfortunately, the maximally achieved [[FiO2]] is often overestimated by care providers and [[hypoventilation]] resulting in [[hypercapnia]] cannot be normalized with increase [[oxygen]] supply.
*'''Mouth-to-Mouth ventilation:''' Mouth-to-mouth or mouth-to-nose ventilation is a useful management technique, however, because of the risk of [[infection]] transmission it is recommended by American heart association that health care providers do "Hands-only" [[CPR]]. Proper face masks should be utilized if they are available.
*'''Bag-mask ventilation:''' It is a standard initial approach to airway management in the prehospital and [[hospital]] settings.

:*Proper preoxygenation prior to [[intubation]] and [[anesthetic]] induction provides patients with improved [[oxygenation]] and increases the time to [[hypoxemia]].
:*Bag-mask [[ventilation]] is basic essential technique when [[endotracheal tube]] [[intubation]] is difficult, it assists for rapid [[oxygenation]] and [[ventilation]] in patients.
:*Bag-mask [[ventilation]] can be applied by a practitioner alone or side by side with a second care provider in an [[operating room]].
:*Bag mask [[ventilation]] can also be utilized as a pressure support during spontaneous [[respiration]] in patients with decre<nowiki/>ased [[tidal volume]]<nowiki/>s and insufficient [[ventilation]], very similar to the use of [[CPAP]] or [[BiPAP]] to assist [[patients]] who are spontaneously [[breathing]] but are not adequately oxygenating or ventilating.

*'''Oropharyngeal and nasopharyngeal airways:'''

:*This is used as an adjunct device for spontaneous or [[assisted ventilation]].
:*[[Oropharyngeal]] and [[nasopharyngeal airway]]<nowiki/>s are frequently utilized by prehospital care providers to improve [[oxygenation]] and [[ventilation]].
:*These devices are frequently used until a more definitive [[airway]] is obtained, and there are several circumstances that prohibit their placement (severe head or [[facial]] injuries).

*'''Supraglottic airway devices:''' [[Supraglottic laryngeal cancer|Supraglottic]] airway (SGA) device placement is very useful to keep the [[airway]]<nowiki/>s open, it has advantages in comparison with [[endotracheal tube]] intubation, or other methods, these advantages are include:<ref name="pmid27537593">{{cite journal |vauthors=Park SK, Ko G, Choi GJ, Ahn EJ, Kang H |title=Comparison between supraglottic airway devices and endotracheal tubes in patients undergoing laparoscopic surgery: A systematic review and meta-analysis |journal=Medicine (Baltimore) |volume=95 |issue=33 |pages=e4598 |date=August 2016 |pmid=27537593 |doi=10.1097/MD.0000000000004598 |url=}}</ref>

:*Requires less training than ETI.
:*It is less invasive than ETI.
:*It can offer better [[ventilation]] during transport than bag-mask [[ventilation]] alone.
:**[[Supraglottitis|Supraglottic]] airway devices can be used as an alternative tool in cases of failed [[intubation]].

*'''[[Endotracheal intubation]]:''' It is the gold standard for definitive airway management in the prehospital setting, it allows for positive pressure [[ventilation]], [[positive end-expiratory pressure]] (PEEP), positive pressure recruitment maneuvers, and protection from [[aspiration]].

:*'''Mallampati classification for assessment of upper airway anatomical Balance:''' It's named after the Indian-born American [[anesthesiologist]] Seshagiri Mallampati, is used to predict the ease of [[endotracheal intubation]].The test assess the distance from the [[tongue]] base to the roof of the [[mouth]] visually. It is an indirect way of assessing how difficult intubation will be.
:*'''Modified Mallampati Scoring:'''
:**Class I: [[Soft palate]], [[uvula]], [[fauces]], [[Pillars of the fauces|pillars]] visible.
:**Class II: [[Soft palate]], a major part of the [[uvula]], [[fauces]] visible.
:**Class III: [[Soft palate]], the base of [[uvula]] visible.
:**Class IV: Only [[hard palate]] visible.

*'''Rapid sequence intubation versus no-medication intubation''':

:*Use of [[pharmacological]] [[muscle relaxant]] eases the [[intubation]] process by relaxing muscles in the [[pharynx]]. [[Rapid sequence induction|Rapid sequence intubation]] ([[RSI]]) techniques incorporate [[pharmacologic]] [[muscle]] relaxation and are utilized by anesthesiologists and [[emergency medicine]] physicians. However, the disadvantage of these techniques is the elimination of a patient's ability to breathe spontaneously if the [[intubation]] fails. There is a debate that optimal intubating conditions should be achieved first before trying to attempt [[intubation]] in the prehospital setting. Time is an important factor and critical in prehospital [[airway]] management of [[patients]], due to [[trauma]], [[cardiac arrest]], [[hypoxemia]], or aspiration risk. Administration of the [[Neuromuscular blocking agents|neuromuscular blocking agent]] is associated with a reduction in time from rapid sequence [[intubation]] administration to the end of [[intubation]] attempt.

[[File:Glidescope 02.jpg|400px|thumb|left|Photograph of an anesthesiologist using the Glidescope video laryngoscope to intubate the trachea of a morbidly obese elderly person with challenging airway anatomy[https://en.wikipedia.org/wiki/Airway_managementI (DiverDave (talk)) created this work entirely by myself. (Original uploaded on en.wikipedia)]]] 

==Management of the Airway in Patients with Trauma==
===Suspected Spinal Cord Injury===

*In [[patients]] with suspected [[trauma]], extreme caution must be taken in aligning the [[head]] and [[neck]]. The [[cervical spine]] must be maintained in a neutral mid-line position, the exception to this is physical resistance.<ref name="ThiboutotNicole2009">{{cite journal|last1=Thiboutot|first1=François|last2=Nicole|first2=Pierre C.|last3=Trépanier|first3=Claude A.|last4=Turgeon|first4=Alexis F.|last5=Lessard|first5=Martin R.|title=Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial|journal=Canadian Journal of Anesthesia/Journal Canadien d'anesthésie|volume=56|issue=6|year=2009|pages=412–418|issn=0832-610X|doi=10.1007/s12630-009-9089-7}}</ref><ref>{{cite journal|doi=10.1016/j.jclinane.2005.04.003 [Indexed for MEDLINE]}}</ref><ref name="KrishnamoorthyDagal2014">{{cite journal|last1=Krishnamoorthy|first1=Vijay|last2=Dagal|first2=Arman|last3=Austin|first3=Naola|title=Airway management in cervical spine injury|journal=International Journal of Critical Illness and Injury Science|volume=4|issue=1|year=2014|pages=50|issn=2229-5151|doi=10.4103/2229-5151.128013}}</ref><ref name="GhafoorMartin2005">{{cite journal|last1=Ghafoor|first1=Abid U.|last2=Martin|first2=Timothy W.|last3=Gopalakrishnan|first3=Senthil|last4=Viswamitra|first4=Sanjaya|title=Caring for the patients with cervical spine injuries: what have we learned?|journal=Journal of Clinical Anesthesia|volume=17|issue=8|year=2005|pages=640–649|issn=09528180|doi=10.1016/j.jclinane.2005.04.003}}</ref><ref name="SriganeshBusse2018">{{cite journal|last1=Sriganesh|first1=Kamath|last2=Busse|first2=JasonW|last3=Shanthanna|first3=Harsha|last4=Ramesh|first4=VenkatapuraJ|title=Airway management in the presence of cervical spine instability: A cross-sectional survey of the members of the Indian Society of Neuroanaesthesiology and Critical Care|journal=Indian Journal of Anaesthesia|volume=62|issue=2|year=2018|pages=115|issn=0019-5049|doi=10.4103/ija.IJA_671_17}}</ref>

*'''Neck Maneuvers During Airway Management:'''
**Immobilizing patient's [[neck]] by using sandbag-collar-tape on hardboard in a pre-hospital care setting.
**Applying pressure on cricoid with [[anterior]] half of hard [[cervical collar]] removed and another hand behind the [[posterior]] [[cervical collar]].
**Manual in-line stabilization is the technique of choice in any suspected [[cervical spine]] injury, during endotracheal intubation. In this technique, head grasped firmly at the [[mastoid process]] and the occiput.

*Traction should be avoided as it may distract the [[cervical spine]] and cause more [[neurological]] damage, even after manual in-line stabilization.

*Jaw thrust is the only basic [[airway]] opening maneuver appropriate for any [[patient]] with a suspected [[cervical spine injury]]. This method is used when head-tilt/chin-lift can be potentially dangerous to use on a patient who may have a [[cervical spine injury]]. In jaw-thrust maneuver, first care provider lifts the [[hyoid bone]] and [[tongue]] away from the [[posterior]] [[pharyngeal]] wall by pulling the [[mandible]] forward, displacing the [[tongue]] anteriorly.
*[[Suction]] and use of [[forceps]] under direct vision using a [[laryngoscope]] with the [[head]] and [[neck]] maintained in the neutral position.
*In order to minimize the risk of [[hypoxic]] damage from [[airway obstruction]] in an [[unconscious]] patient, proper positioning is done by placing patients in the [[lateral]] side with log rolling technique.

===Approach to airway management of a patient with Maxillo-Facial Injury===
[[Airway]] management of patients with [[maxillofacial]] trauma is challenging and vital because it's directly affecting the patient's survival. [[Endotracheal intubation]] is the [[Gold standard (test)|gold standard]] procedure to secure the [[airway]] in [[trauma]] [[patients]], however, in these [[patients]] passage of [[endotracheal tube]] may not be possible because the oral cavity, [[pharynx]], and [[larynx]] may be filled with [[blood]], secretions, [[soft tissue]], and [[bone]] fragments. Another reason for this is that the risk of [[aspiration]] and [[regurgitation]] is high in these patients.<ref name="BarakBahouth2015">{{cite journal|last1=Barak|first1=Michal|last2=Bahouth|first2=Hany|last3=Leiser|first3=Yoav|last4=Abu El-Naaj|first4=Imad|title=Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach|journal=BioMed Research International|volume=2015|year=2015|pages=1–9|issn=2314-6133|doi=10.1155/2015/724032}}</ref><ref name="pmid21655009">{{cite journal |vauthors=Raval CB, Rashiduddin M |title=Airway management in patients with maxillofacial trauma - A retrospective study of 177 cases |journal=Saudi J Anaesth |volume=5 |issue=1 |pages=9–14 |date=January 2011 |pmid=21655009 |pmc=3101764 |doi=10.4103/1658-354X.76476 |url=}}</ref><ref name="pmid7588664">{{cite journal |vauthors=Brimacombe J, Tucker P, Simons S |title=The laryngeal mask airway for awake diagnostic bronchoscopy. A retrospective study of 200 consecutive patients |journal=Eur J Anaesthesiol |volume=12 |issue=4 |pages=357–61 |date=July 1995 |pmid=7588664 |doi= |url=}}</ref><ref name="HsiaoPacheco-Fowler2008">{{cite journal|last1=Hsiao|first1=James|last2=Pacheco-Fowler|first2=Victor|title=Cricothyroidotomy|journal=New England Journal of Medicine|volume=358|issue=22|year=2008|pages=e25|issn=0028-4793|doi=10.1056/NEJMvcm0706755}}</ref>

*In such circumstances, there are numerous [[airway]] devices are available to rescue patients with [[maxillofacial]] injuries, some of these devices include:<ref name="BarakBahouth2015">{{cite journal|last1=Barak|first1=Michal|last2=Bahouth|first2=Hany|last3=Leiser|first3=Yoav|last4=Abu El-Naaj|first4=Imad|title=Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach|journal=BioMed Research International|volume=2015|year=2015|pages=1–9|issn=2314-6133|doi=10.1155/2015/724032}}</ref><ref name="MeyerPatel2014">{{cite journal|last1=Meyer|first1=TanyaK|last2=Patel|first2=SapnaA|title=Surgical Airway|journal=International Journal of Critical Illness and Injury Science|volume=4|issue=1|year=2014|pages=71|issn=2229-5151|doi=10.4103/2229-5151.128016}}</ref>
**Flexible [[fiberoptic]] [[bronchoscopy]] (FOB), enable an indirect view of [[vocal cords]].
**[[Laryngeal mask airway]] (LMA) may be inserted blindly since it does not require a view of the [[vocal cords]]. Another option for securing the [[airway]] in these patients is to pass the endotracheal tube after placing an LMA for them.
*Final option for establishing the airway in [[patients]] with [[maxillofacial]] injury is [[surgery]] by [[cricothyroidotomy]].
**[[Cricothyroidotomy]] also known as [[cricothyrotomy]] is a procedure done by trained [[health care providers]], they make a small [[incision]] through the skin and [[cricoid]] membrane which lies between the [[thyroid]] and [[cricoid]] [[cartilage]]<nowiki/>s, followed by inserting a [[tracheostomy tube]] to open alternative way of [[ventilation]] and [[oxygenation]] in the [[emergency]] situation which uses of [[endotracheal intubation]] is almost impossible or difficult and time-consuming.
**'''Indication for cricothyroidotomy include:'''
***Inability to secure [[airway]] through an [[endotracheal tube]]
***Major [[trauma]] to [[facial]] [[muscles]], [[pharynx]], [[larynx]].
***[[Congenital deformities]] and [[upper airway]] [[stenosis]].

*'''Contraindications for cricothyroidotomy:'''
**[[Age]], in [[pediatrics]] younger than 12 years old needle [[cricothyrotomy]] is indicated because of less potential damage to the [[larynx]] and surrounding structures.
**Massive [[trauma]] to the [[larynx]] or [[cricoid cartilage]]
**Inability to identify surface landmarks due to [[obesity]], [[cervical]] trauma.
**When [[Orotracheal intubation|orotracheal]] and [[Nasotracheal intubation|nasotracheal]] [[intubation]] are viable options
**[[Airway obstruction]] distal to [[subglottic airway]], e.g. [[tracheal stenosis]]
**[[Laryngeal cancer]]: Other than for an extreme airway [[emergency]], [[cricothyroidotomy]] must be avoided to not to seed the [[soft tissue]] of the [[neck]] with [[cancer]] cells
**[[Coagulopathy]] (other than [[emergency]] situation)

*'''Complications of cricothyroidotomy:'''
**[[Esophageal]] perforation if the blade penetrates too deeply.
**[[Subcutaneous emphysema]]
**Rupture of vital [[vessels]] such as a [[carotid artery]], excessive [[bleeding]], and [[hemorrhage]].

*'''Indications of definitive airway management in patients with maxillofacial injury:'''
**Absent spontaneous [[breathing]]
**[[Comatose]] [[patients]]([[Glasgow coma score]] < 9)
**[[Airway]] injury or [[obstruction]]
**Persistent [[oxygen saturation]] below 90%
**High risk for [[aspiration]]
**[[Systemic shock]]([[Systolic Blood Pressure Intervention|Systolic Blood Pressure]]<80mmHg)
**"Cannot intubate, cannot ventilate" situations

==Complications of airway management==

Airway management complications are common, these complications usually occur in [[intensive care units]] and [[emergency department]]<nowiki/>s, summary of airway management related complactions include:<ref name="CookMacDougall-Davis2012">{{cite journal|last1=Cook|first1=T.M.|last2=MacDougall-Davis|first2=S.R.|title=Complications and failure of airway management|journal=British Journal of Anaesthesia|volume=109|year=2012|pages=i68–i85|issn=00070912|doi=10.1093/bja/aes393}}</ref>

*[[Patient]] harm/death associated with suboptimal care
*[[Hypoxia]] is the most common cause of [[airway]]-related deaths
*[[Obesity]]
*[[Pulmonary]] [[aspiration]] remains the leading cause of airway-related [[anesthetic]] deaths
*Failure in airway management techniques

{{#ev:youtube|ycQs27YVE60}}

==Related Chapters==

*[[intubation|Intubation]]
*[[endotracheal tube|Endotracheal Tube]]
*[[laryngeal mask airway|Laryngeal Mask Airway]]
*[[oropharyngeal airway|Oropharyngeal Airway]]
*[[nasopharyngeal airway|Nasopharyngeal Airway]]
*[[Ventilation (physiology)|Ventilation]]
*[[Cricothyrotomy]]
*[[Tracheotomy]]

==References==
{{reflist|2}}
[[Category:Emergency medicine]]
[[Category:First aid]]
[[Category:anesthesia]]
[[Category:Intensive care medicine]]

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File:Evaluation.jpg

2021-02-01T21:41:52Z

Shaik Aisha sultana: Shaik Aisha sultana uploaded a new version of File:Evaluation.jpg

File:Evaluation.jpg

2021-02-01T21:38:08Z

Shaik Aisha sultana:

File:Evaluation of Vomiting.png

2021-02-01T21:34:43Z

Shaik Aisha sultana:

Nausea and vomiting pathophysiology

2021-02-01T21:31:58Z

Shaik Aisha sultana: /* Pathophysiology */

__NOTOC__
{{Nausea and vomiting}}
{{CMG}} {{AE}} {{VVS}}
==Overview==
The physiology of [[nausea and vomiting]] encompass [[psychological]] states, the central nervous system, the [[autonomic nervous system]], gastric [[dysrhythmias]], and the [[endocrine]] system. Each individual has a threshold for nausea that changes minute by minute. Stimuli giving rise to nausea and vomiting originate from visceral, vestibular, and chemoreceptor trigger zone inputs which are mediated by serotonin/dopamine, histamine/acetylcholine, and serotonin/dopamine, respectively.

==Pathophysiology==
The physiology of [[nausea and vomiting]] encompass [[psychological]] states, the central nervous system, the [[autonomic nervous system]], gastric [[dysrhythmias]], and the [[endocrine]] system. Each individual has a threshold for nausea that changes minute by minute. At any given moment, the threshold depends on the interaction of certain inherent factors of the individual with the more changeable psychological states of [[anxiety]], [[anticipation]], [[expectation]], and adaptation. Stimuli giving rise to nausea and vomiting originate from visceral, vestibular, and chemoreceptor trigger zone inputs which are mediated by serotonin/dopamine, histamine/acetylcholine, and serotonin/dopamine, respectively. These relationships between these areas are the basis of the pharmacotherapy.<ref name="pmid26770271">{{cite journal |vauthors=Singh P, Yoon SS, Kuo B |title=Nausea: a review of pathophysiology and therapeutics |journal=Therap Adv Gastroenterol |volume=9 |issue=1 |pages=98–112 |date=January 2016 |pmid=26770271 |pmc=4699282 |doi=10.1177/1756283X15618131 |url=}}</ref>

<gallery>
vomiting physiology.jpg
</gallery>
===Vomiting Center===
The vomiting center lies in the medulla oblongata and comprises the reticular formation and the nucleus of the tractus solitarius.

When there is stimulus, it activates motor pathways descend from this center and trigger vomiting.

These efferent pathways travel within the 5th, 7th, 9th, 10th, and 12th cranial nerves to the upper gastrointestinal tract, within vagal and sympathetic nerves to the lower tract, and within spinal nerves to the diaphragm and abdominal muscles.

The vomiting center can be activated directly by irritants or indirectly following input from gastrointestinal tract, cerebral cortex and thalamus, vestibular region, and chemoreceptor trigger zone (CRTZ). <ref name="urlwww.eshare-org.co.cc">{{cite web |url=http://www.eshare-org.co.cc/2010/02/textbook-of-medical-physiology-guyton.html |title=www.eshare-org.co.cc |format= |work= |accessdate=}}</ref>

The CRTZ is closest in proximity, lying between the medulla and the floor of the fourth ventricle, and it is not protected by the blood-brain barrier.

The chemoreceptor trigger zone at the base of the fourth ventricle has numerous [[Dopamine receptor D2|dopamine D2 receptors]], [[5-HT receptor|serotonin 5-HT3 receptors]], [[opioid receptor]]s, [[acetylcholine receptor]]s, and receptors for [[substance P]]. Stimulation of different receptors are involved in different pathways leading to emesis, in the final common pathway substance P appears to be involved.<ref>Hornby PJ. Central neurocircuitry associated with emesis. Am J Med 2001;111:106S-12S. PMID 11749934.</ref>

The vestibular system which sends information to the brain via [[cranial nerve VIII]] (vestibulocochlear nerve). It plays a major role in [[motion sickness]] and is rich in [[Muscarinic acetylcholine receptor|muscarinic receptors]] and [[histamine receptor|histamine H1 receptors]].

[[Vagus nerve|Cranial nerve X]] (vagus nerve), which is activated when the pharynx is irritated, leading to a gag reflex.

Vagal and [[enteric nervous system]] inputs that transmit information regarding the state of the [[gastrointestinal system]]. Irritation of the GI mucosa by chemotherapy, radiation, distention or acute infectious [[gastroenteritis]] activates the 5-HT3 receptors of these inputs.

The CNS mediates vomiting arising from psychiatric disorders and stress.

===Vomiting:===
The act of vomiting consists of 3 steps:<ref name="pmid2235641">{{cite journal |vauthors=Rhodes VA |title=Nausea, vomiting, and retching |journal=Nurs Clin North Am |volume=25 |issue=4 |pages=885–900 |date=December 1990 |pmid=2235641 |doi= |url=}}</ref>

* [['''Nausea''']] is an unpleasant and difficult to describe psychic experience. Physiologically,[[ nausea ]]is typically associated with decreased gastric motility and increased tone in the [[small intestine]]. Also, there is often [[retroperistalsis|reverse peristalsis]] in the proximal small intestine.
*[[ '''Retching''']] ("dry heaves") refers to spasmodic respiratory movements conducted with a closed[[ glottis]]. While this is occurring, the [[antrum of the stomach]] contracts and the [[fundus]] and [[cardia]] relax.
* [['''Emesis''' ]]is when gastric and often small intestinal contents are propelled up to and out of the mouth.

and is caused by three types of outputs initiated by the[[ medulla]]:[[ Motor]], [[parasympathetic nervous system]] (PNS) and [[sympathetic nervous system]] (SNS).

*Increased [[saliva]]tion to protect the [[tooth enamel|enamel]] of [[teeth]] from stomach acids (excessive vomiting leads to [[dental caries|caries]]). This is part of the PNS output.
*[[Retroperistalsis|Reverse peristalsis]], starting from the middle of the [[small intestine]], sweeping up the contents of the digestive tract into the stomach, through the relaxed pyloric sphincter.
*A lowering of intrathoracic pressure (by inspiration against a closed [[glottis]]), coupled with an increase in abdominal pressure as the [[abdomen|abdominal muscles]] contract, propels stomach contents into the [[esophagus]] without involvement of the reverse peristalsis. The [[cardia|lower esophageal sphincter]] relaxes.
*Vomiting also initiates a SNS response causing both sweating and increased heart rate.

The [[neurotransmitter]]s that regulate vomiting are poorly understood, but inhibitors of [[dopamine]], [[histamine]] and [[serotonin]] are all used to suppress vomiting, suggesting that these play a role in the initiation or maintenance of a vomiting cycle. [[Vasopressin]] and neurokinin may also be involved.

===Content===
As the stomach secretes acid, vomit contains a high concentration of [[hydronium|hydronium ion]]s and is thus strongly acidic. Recent food intake will be reflected in the gastric vomit.

The content of the vomitus (vomit) may be of medical interest.

Fresh [[blood]] in the vomit is called [[hematemesis]] ("blood vomiting").

Old blood bears resemblance to coffee grounds (as the [[iron]] in the blood is [[oxidation|oxidized]]), and is termed "coffee ground vomiting".

[[Bile]] can enter the vomit during subsequent heaves due to [[duodenum|duodenal]] contraction if the vomiting is severe.

[[Fecal vomiting]] is often a consequence of [[intestinal obstruction]], and is treated as a warning sign of this potentially serious problem ("signum mali ominis"); such vomiting is sometimes called "miserere". If food has recently been consumed, then partly digested food may show up in the vomit.

 

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Emergency medicine]]
[[Category:Gastroenterology]]
[[Category:Obstetrics]]
[[Category:Needs overview]]

Nausea and vomiting pathophysiology

2021-02-01T21:31:05Z

Shaik Aisha sultana:

__NOTOC__
{{Nausea and vomiting}}
{{CMG}} {{AE}} {{VVS}}
==Overview==
The physiology of [[nausea and vomiting]] encompass [[psychological]] states, the central nervous system, the [[autonomic nervous system]], gastric [[dysrhythmias]], and the [[endocrine]] system. Each individual has a threshold for nausea that changes minute by minute. Stimuli giving rise to nausea and vomiting originate from visceral, vestibular, and chemoreceptor trigger zone inputs which are mediated by serotonin/dopamine, histamine/acetylcholine, and serotonin/dopamine, respectively.

==Pathophysiology==
The physiology of [[nausea and vomiting]] encompass [[psychological]] states, the central nervous system, the [[autonomic nervous system]], gastric [[dysrhythmias]], and the [[endocrine]] system. Each individual has a threshold for nausea that changes minute by minute. At any given moment, the threshold depends on the interaction of certain inherent factors of the individual with the more changeable psychological states of [[anxiety]], [[anticipation]], [[expectation]], and adaptation. Stimuli giving rise to nausea and vomiting originate from visceral, vestibular, and chemoreceptor trigger zone inputs which are mediated by serotonin/dopamine, histamine/acetylcholine, and serotonin/dopamine, respectively. These relationships between these areas are the basis of the pharmacotherapy.<ref name="pmid26770271">{{cite journal |vauthors=Singh P, Yoon SS, Kuo B |title=Nausea: a review of pathophysiology and therapeutics |journal=Therap Adv Gastroenterol |volume=9 |issue=1 |pages=98–112 |date=January 2016 |pmid=26770271 |pmc=4699282 |doi=10.1177/1756283X15618131 |url=}}</ref>

<gallery>
Example.jpg|Caption1
Example.jpg|Caption2
</gallery>
===Vomiting Center===
The vomiting center lies in the medulla oblongata and comprises the reticular formation and the nucleus of the tractus solitarius.

When there is stimulus, it activates motor pathways descend from this center and trigger vomiting.

These efferent pathways travel within the 5th, 7th, 9th, 10th, and 12th cranial nerves to the upper gastrointestinal tract, within vagal and sympathetic nerves to the lower tract, and within spinal nerves to the diaphragm and abdominal muscles.

The vomiting center can be activated directly by irritants or indirectly following input from gastrointestinal tract, cerebral cortex and thalamus, vestibular region, and chemoreceptor trigger zone (CRTZ). <ref name="urlwww.eshare-org.co.cc">{{cite web |url=http://www.eshare-org.co.cc/2010/02/textbook-of-medical-physiology-guyton.html |title=www.eshare-org.co.cc |format= |work= |accessdate=}}</ref>

The CRTZ is closest in proximity, lying between the medulla and the floor of the fourth ventricle, and it is not protected by the blood-brain barrier.

The chemoreceptor trigger zone at the base of the fourth ventricle has numerous [[Dopamine receptor D2|dopamine D2 receptors]], [[5-HT receptor|serotonin 5-HT3 receptors]], [[opioid receptor]]s, [[acetylcholine receptor]]s, and receptors for [[substance P]]. Stimulation of different receptors are involved in different pathways leading to emesis, in the final common pathway substance P appears to be involved.<ref>Hornby PJ. Central neurocircuitry associated with emesis. Am J Med 2001;111:106S-12S. PMID 11749934.</ref>

The vestibular system which sends information to the brain via [[cranial nerve VIII]] (vestibulocochlear nerve). It plays a major role in [[motion sickness]] and is rich in [[Muscarinic acetylcholine receptor|muscarinic receptors]] and [[histamine receptor|histamine H1 receptors]].

[[Vagus nerve|Cranial nerve X]] (vagus nerve), which is activated when the pharynx is irritated, leading to a gag reflex.

Vagal and [[enteric nervous system]] inputs that transmit information regarding the state of the [[gastrointestinal system]]. Irritation of the GI mucosa by chemotherapy, radiation, distention or acute infectious [[gastroenteritis]] activates the 5-HT3 receptors of these inputs.

The CNS mediates vomiting arising from psychiatric disorders and stress.

===Vomiting:===
The act of vomiting consists of 3 steps:<ref name="pmid2235641">{{cite journal |vauthors=Rhodes VA |title=Nausea, vomiting, and retching |journal=Nurs Clin North Am |volume=25 |issue=4 |pages=885–900 |date=December 1990 |pmid=2235641 |doi= |url=}}</ref>

* [['''Nausea''']] is an unpleasant and difficult to describe psychic experience. Physiologically,[[ nausea ]]is typically associated with decreased gastric motility and increased tone in the [[small intestine]]. Also, there is often [[retroperistalsis|reverse peristalsis]] in the proximal small intestine.
*[[ '''Retching''']] ("dry heaves") refers to spasmodic respiratory movements conducted with a closed[[ glottis]]. While this is occurring, the [[antrum of the stomach]] contracts and the [[fundus]] and [[cardia]] relax.
* [['''Emesis''' ]]is when gastric and often small intestinal contents are propelled up to and out of the mouth.

and is caused by three types of outputs initiated by the[[ medulla]]:[[ Motor]], [[parasympathetic nervous system]] (PNS) and [[sympathetic nervous system]] (SNS).

*Increased [[saliva]]tion to protect the [[tooth enamel|enamel]] of [[teeth]] from stomach acids (excessive vomiting leads to [[dental caries|caries]]). This is part of the PNS output.
*[[Retroperistalsis|Reverse peristalsis]], starting from the middle of the [[small intestine]], sweeping up the contents of the digestive tract into the stomach, through the relaxed pyloric sphincter.
*A lowering of intrathoracic pressure (by inspiration against a closed [[glottis]]), coupled with an increase in abdominal pressure as the [[abdomen|abdominal muscles]] contract, propels stomach contents into the [[esophagus]] without involvement of the reverse peristalsis. The [[cardia|lower esophageal sphincter]] relaxes.
*Vomiting also initiates a SNS response causing both sweating and increased heart rate.

The [[neurotransmitter]]s that regulate vomiting are poorly understood, but inhibitors of [[dopamine]], [[histamine]] and [[serotonin]] are all used to suppress vomiting, suggesting that these play a role in the initiation or maintenance of a vomiting cycle. [[Vasopressin]] and neurokinin may also be involved.

===Content===
As the stomach secretes acid, vomit contains a high concentration of [[hydronium|hydronium ion]]s and is thus strongly acidic. Recent food intake will be reflected in the gastric vomit.

The content of the vomitus (vomit) may be of medical interest.

Fresh [[blood]] in the vomit is called [[hematemesis]] ("blood vomiting").

Old blood bears resemblance to coffee grounds (as the [[iron]] in the blood is [[oxidation|oxidized]]), and is termed "coffee ground vomiting".

[[Bile]] can enter the vomit during subsequent heaves due to [[duodenum|duodenal]] contraction if the vomiting is severe.

[[Fecal vomiting]] is often a consequence of [[intestinal obstruction]], and is treated as a warning sign of this potentially serious problem ("signum mali ominis"); such vomiting is sometimes called "miserere". If food has recently been consumed, then partly digested food may show up in the vomit.

 

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Emergency medicine]]
[[Category:Gastroenterology]]
[[Category:Obstetrics]]
[[Category:Needs overview]]

File:Evaluation.pdf

2021-02-01T21:21:08Z

Shaik Aisha sultana:

Nausea and vomiting pathophysiology

2021-02-01T21:06:01Z

Shaik Aisha sultana: /* Pathophysiology */

__NOTOC__
{{Nausea and vomiting}}
{{CMG}} {{AE}} {{VVS}}
==Overview==
The physiology of [[nausea and vomiting]] encompass [[psychological]] states, the central nervous system, the [[autonomic nervous system]], gastric [[dysrhythmias]], and the [[endocrine]] system. Each individual has a threshold for nausea that changes minute by minute. Stimuli giving rise to nausea and vomiting originate from visceral, vestibular, and chemoreceptor trigger zone inputs which are mediated by serotonin/dopamine, histamine/acetylcholine, and serotonin/dopamine, respectively.

==Pathophysiology==
The physiology of [[nausea and vomiting]] encompass [[psychological]] states, the central nervous system, the [[autonomic nervous system]], gastric [[dysrhythmias]], and the [[endocrine]] system. Each individual has a threshold for nausea that changes minute by minute. At any given moment, the threshold depends on the interaction of certain inherent factors of the individual with the more changeable psychological states of [[anxiety]], [[anticipation]], [[expectation]], and adaptation. Stimuli giving rise to nausea and vomiting originate from visceral, vestibular, and chemoreceptor trigger zone inputs which are mediated by serotonin/dopamine, histamine/acetylcholine, and serotonin/dopamine, respectively. These relationships between these areas are the basis of the pharmacotherapy.<ref name="pmid26770271">{{cite journal |vauthors=Singh P, Yoon SS, Kuo B |title=Nausea: a review of pathophysiology and therapeutics |journal=Therap Adv Gastroenterol |volume=9 |issue=1 |pages=98–112 |date=January 2016 |pmid=26770271 |pmc=4699282 |doi=10.1177/1756283X15618131 |url=}}</ref>
https://www.wikidoc.org/images/e/e0/Vomiting_physiology.jpg
===Vomiting Center===
The vomiting center lies in the medulla oblongata and comprises the reticular formation and the nucleus of the tractus solitarius.

When there is stimulus, it activates motor pathways descend from this center and trigger vomiting.

These efferent pathways travel within the 5th, 7th, 9th, 10th, and 12th cranial nerves to the upper gastrointestinal tract, within vagal and sympathetic nerves to the lower tract, and within spinal nerves to the diaphragm and abdominal muscles.

The vomiting center can be activated directly by irritants or indirectly following input from gastrointestinal tract, cerebral cortex and thalamus, vestibular region, and chemoreceptor trigger zone (CRTZ). <ref name="urlwww.eshare-org.co.cc">{{cite web |url=http://www.eshare-org.co.cc/2010/02/textbook-of-medical-physiology-guyton.html |title=www.eshare-org.co.cc |format= |work= |accessdate=}}</ref>

The CRTZ is closest in proximity, lying between the medulla and the floor of the fourth ventricle, and it is not protected by the blood-brain barrier.

The chemoreceptor trigger zone at the base of the fourth ventricle has numerous [[Dopamine receptor D2|dopamine D2 receptors]], [[5-HT receptor|serotonin 5-HT3 receptors]], [[opioid receptor]]s, [[acetylcholine receptor]]s, and receptors for [[substance P]]. Stimulation of different receptors are involved in different pathways leading to emesis, in the final common pathway substance P appears to be involved.<ref>Hornby PJ. Central neurocircuitry associated with emesis. Am J Med 2001;111:106S-12S. PMID 11749934.</ref>

The vestibular system which sends information to the brain via [[cranial nerve VIII]] (vestibulocochlear nerve). It plays a major role in [[motion sickness]] and is rich in [[Muscarinic acetylcholine receptor|muscarinic receptors]] and [[histamine receptor|histamine H1 receptors]].

[[Vagus nerve|Cranial nerve X]] (vagus nerve), which is activated when the pharynx is irritated, leading to a gag reflex.

Vagal and [[enteric nervous system]] inputs that transmit information regarding the state of the [[gastrointestinal system]]. Irritation of the GI mucosa by chemotherapy, radiation, distention or acute infectious [[gastroenteritis]] activates the 5-HT3 receptors of these inputs.

The CNS mediates vomiting arising from psychiatric disorders and stress.

===Vomiting:===
The act of vomiting consists of 3 steps:<ref name="pmid2235641">{{cite journal |vauthors=Rhodes VA |title=Nausea, vomiting, and retching |journal=Nurs Clin North Am |volume=25 |issue=4 |pages=885–900 |date=December 1990 |pmid=2235641 |doi= |url=}}</ref>

* [['''Nausea''']] is an unpleasant and difficult to describe psychic experience. Physiologically,[[ nausea ]]is typically associated with decreased gastric motility and increased tone in the [[small intestine]]. Also, there is often [[retroperistalsis|reverse peristalsis]] in the proximal small intestine.
*[[ '''Retching''']] ("dry heaves") refers to spasmodic respiratory movements conducted with a closed[[ glottis]]. While this is occurring, the [[antrum of the stomach]] contracts and the [[fundus]] and [[cardia]] relax.
* [['''Emesis''' ]]is when gastric and often small intestinal contents are propelled up to and out of the mouth.

and is caused by three types of outputs initiated by the[[ medulla]]:[[ Motor]], [[parasympathetic nervous system]] (PNS) and [[sympathetic nervous system]] (SNS).

*Increased [[saliva]]tion to protect the [[tooth enamel|enamel]] of [[teeth]] from stomach acids (excessive vomiting leads to [[dental caries|caries]]). This is part of the PNS output.
*[[Retroperistalsis|Reverse peristalsis]], starting from the middle of the [[small intestine]], sweeping up the contents of the digestive tract into the stomach, through the relaxed pyloric sphincter.
*A lowering of intrathoracic pressure (by inspiration against a closed [[glottis]]), coupled with an increase in abdominal pressure as the [[abdomen|abdominal muscles]] contract, propels stomach contents into the [[esophagus]] without involvement of the reverse peristalsis. The [[cardia|lower esophageal sphincter]] relaxes.
*Vomiting also initiates a SNS response causing both sweating and increased heart rate.

The [[neurotransmitter]]s that regulate vomiting are poorly understood, but inhibitors of [[dopamine]], [[histamine]] and [[serotonin]] are all used to suppress vomiting, suggesting that these play a role in the initiation or maintenance of a vomiting cycle. [[Vasopressin]] and neurokinin may also be involved.

===Content===
As the stomach secretes acid, vomit contains a high concentration of [[hydronium|hydronium ion]]s and is thus strongly acidic. Recent food intake will be reflected in the gastric vomit.

The content of the vomitus (vomit) may be of medical interest.

Fresh [[blood]] in the vomit is called [[hematemesis]] ("blood vomiting").

Old blood bears resemblance to coffee grounds (as the [[iron]] in the blood is [[oxidation|oxidized]]), and is termed "coffee ground vomiting".

[[Bile]] can enter the vomit during subsequent heaves due to [[duodenum|duodenal]] contraction if the vomiting is severe.

[[Fecal vomiting]] is often a consequence of [[intestinal obstruction]], and is treated as a warning sign of this potentially serious problem ("signum mali ominis"); such vomiting is sometimes called "miserere". If food has recently been consumed, then partly digested food may show up in the vomit.

 

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Emergency medicine]]
[[Category:Gastroenterology]]
[[Category:Obstetrics]]
[[Category:Needs overview]]

File:Vomiting physiology.jpg

2021-02-01T20:54:26Z

Shaik Aisha sultana:

Nausea and vomiting differential diagnosis

2021-02-01T20:42:18Z

Shaik Aisha sultana:

__NOTOC__
{{Nausea and vomiting}}
==Overview==
Differential diagnosis of vomiting may be a result of a range of causes, including GI (obstructive and inflammatory) etiologies, CNS disease, pulmonary problems, renal disease, endocrine/metabolic disorders, drugs (either as side effects or in over dosages), psychiatric disorders, strep throat, pregnancy or stress.<ref name="pmid17668843">{{cite journal |vauthors=Scorza K, Williams A, Phillips JD, Shaw J |title=Evaluation of nausea and vomiting |journal=Am Fam Physician |volume=76 |issue=1 |pages=76–84 |date=July 2007 |pmid=17668843 |doi= |url=}}</ref>

==Differential diagnosis==
The causes of nausea and vomiting can be differentiated as GI and Non GI causes:

===GI causes===

====[[Inflammatory]]:====
[[Esophagitis]]

[[Gastritis]]

[[Hepatitis]]

[[Enteritis]]

[[Pancreatitis]]

====[[Obstructive]]:====
Esophageal [[malignancies]]

[[Gastric outlet obstruction ]] , may be due to[[ malignancy]]

[[Pyloric stenosis]]

Strangulated [[hernia]]s

Small bowel obstruction due to[[ adhesion]],[[ intussusception]] or[[ volvulus]]

[[Diverticulitis]]

====Functional:====
[[Esophageal dysmotility]]

[[Achalasia Cardia]]

[[Gastroparesis]] due to [[autonomic dysfunction]]

[[Ileus]]-[[ Hypokalemia]]

[[Ogilvie Syndrome]]

===Non GI causes can be===

====CNS causes:====
[[Migraine]]

[[Pseudotumor cerebri]]<ref name="pmid14724837">{{cite journal |vauthors=Hasler WL, Chey WD |title=Nausea and vomiting |journal=Gastroenterology |volume=125 |issue=6 |pages=1860–7 |date=December 2003 |pmid=14724837 |doi=10.1053/j.gastro.2003.09.040 |url=}}</ref>

[[Meningitis]]

Space occupying lesions

[[Labrynthitis]]

====Metabolic:====
Acidosis- [[DK]]A, [[Lactic acidosis]]

====Others:====
[[Alcoholism]]

[[Chemotherapy]]<ref>{{cite journal|doi=10.1002/j.1875-9114.1990.tb02560.x}}</ref>

[[Opiate]] therapy

[[Antibiotics]]

[[Pregnancy]]

[[Sea sickness]]

 

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Emergency medicine]]
[[Category:Gastroenterology]]
[[Category:Obstetrics]]
[[Category:Needs content]]

Nausea and vomiting differential diagnosis

2021-02-01T20:30:39Z

Shaik Aisha sultana:

__NOTOC__
{{Nausea and vomiting}}
==Overview==
Differential diagnosis of vomiting may be a result of a range of causes, including GI (obstructive and inflammatory) etiologies, CNS disease, pulmonary problems, renal disease, endocrine/metabolic disorders, drugs (either as side effects or in over dosages), psychiatric disorders, strep throat, pregnancy or stress.

==Differential diagnosis==
The causes of nausea and vomiting can be differentiated as GI and Non GI causes:

===GI causes===

====[[Inflammatory]]:====
[[Esophagitis]]

[[Gastritis]]

[[Hepatitis]]

[[Enteritis]]

[[Pancreatitis]]

====[[Obstructive]]:====
Esophageal [[malignancies]]

[[Gastric outlet obstruction ]] , may be due to[[ malignancy]]

[[Pyloric stenosis]]

Strangulated [[hernia]]s

Small bowel obstruction due to[[ adhesion]],[[ intussusception]] or[[ volvulus]]

[[Diverticulitis]]

====Functional:====
[[Esophageal dysmotility]]

[[Achalasia Cardia]]

[[Gastroparesis]] due to [[autonomic dysfunction]]

[[Ileus]]-[[ Hypokalemia]]

[[Ogilvie Syndrome]]

===Non GI causes can be===

====CNS causes:====
[[Migraine]]

[[Pseudotumor cerebri]]<ref name="pmid14724837">{{cite journal |vauthors=Hasler WL, Chey WD |title=Nausea and vomiting |journal=Gastroenterology |volume=125 |issue=6 |pages=1860–7 |date=December 2003 |pmid=14724837 |doi=10.1053/j.gastro.2003.09.040 |url=}}</ref>

[[Meningitis]]

Space occupying lesions

[[Labrynthitis]]

====Metabolic:====
Acidosis- [[DK]]A, [[Lactic acidosis]]

====Others:====
[[Alcoholism]]

[[Chemotherapy]]<ref>{{cite journal|doi=10.1002/j.1875-9114.1990.tb02560.x}}</ref>

[[Opiate]] therapy

[[Antibiotics]]

[[Pregnancy]]

[[Sea sickness]]

 

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Emergency medicine]]
[[Category:Gastroenterology]]
[[Category:Obstetrics]]
[[Category:Needs content]]

Nausea and vomiting causes

2021-02-01T20:29:34Z

Shaik Aisha sultana:

__NOTOC__
{{Nausea and vomiting}}
{{CMG}}; {{AE}} {{VVS}} {{KS}}

==Overview==
Life threatening causes of nausea and vomiting include [[acute coronary syndrome]], [[anaphylaxis]], and [[heart failure]]. Other common causes of nausea and vomiting are [[food allergies]], [[food poisoning]], [[gastroenteritis]], and [[gastroesophageal reflux]].

==Causes==
===Life Threatening Causes===

*[[Acute Coronary Syndromes]]<ref name="pmid637006">{{cite journal |vauthors=Ahmed SS, Gupta RC, Brancato RR |title=Significance of nausea and vomiting during acute myocardial infarction |journal=Am Heart J |volume=95 |issue=5 |pages=671–2 |date=May 1978 |pmid=637006 |doi=10.1016/0002-8703(78)90311-3 |url=}}</ref>
*[[Anaphylaxis]]
*[[Angina pectoris]]
*[[Heart failure]]

===Common Causes===

*[[Chemotherapy]]<ref>{{cite journal|doi=10.1002/j.1875-9114.1990.tb02560.x}}</ref>

*[[Food allergies]]
*[[Food poisoning]]
*[[Migraine]]
*[[Morning sickness]]
*[[Rotavirus]]
*[[Viral gastroenteritis]]

===Causes by Organ System===

{| style="width: 80%; height: 100px; text-align: justify; text-justify: distribute;" border="1"
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" |'''Cardiovascular'''
| style="width:75%" bgcolor="Beige" ; border="1" |[[Acute Coronary Syndromes]], [[amyloidosis]], [[anaphylaxis]], [[angina pectoris]], [[aortic arch anomalies]], [[cardiac arrhythmia]], [[cerebral aneurysm]], [[cerebral arteriovenous malformation]], [[cerebrovascular disease]], [[myocardial infarction]], [[heart failure]], [[hypercalcemia]], [[hypertension]], [[hypercalcemia]], [[hypocalcemia]], [[hypokalemia]]
|- bgcolor="LightSteelBlue"
|'''Chemical / poisoning'''
| bgcolor="Beige" |[[1,2-Dichloroethene]], [[2-Ethylhexanol]], [[1,3-Dichloropropene]], [[abrin]], [[aconitine]], [[adamsite]], [[ammonium chloride]], [[amnesic shellfish poisoning]], [[arsenic Poisoning]], [[barium oxalate]], [[barium sulfate]], [[butanethiol]], [[camphor|camphor poisoning]], [[capsaicin]], [[carbon monoxide poisoning]], [[chloromethane]], [[cicuta]], [[ciguatera]], [[cinchonism]], [[coprinopsis atramentaria]], [[cyanogen]], [[daunorubicin]], [[diethyl ether]], [[digitalis purpurea]], [[dioxathion]], [[dioxin]], [[endosulfan]], [[ergotism]], [[fluoride poisoning]], [[fluoxymesterone]], [[ginkgo]], [[Green Tobacco Sickness|green tobacco sickness]], [[heavy metal ingestion]], [[Iodomethane]], [[Iron poisoning]], [[Iron(II) sulfate]], [[lead poisoning]], [[lenvatinib]], [[lewisite]], [[lindane]], [[lithium]], [[lobelia]], [[metal fume fever]], [[mushroom poisoning]], [[N-Ethyl-3-piperidyl benzilate]], [[nerve agent]], [[nicotine poisoning]], [[N-Nitroso-N-methylurea]], [[PFPP]], [[pesticide]], [[potassium bromide]], [[phytohaemagglutinin]], [[smoke inhalation]], [[snakebites]], [[temik]], [[theobromine]]
|- bgcolor="LightSteelBlue"
|'''Dermatologic'''
| bgcolor="Beige" |[[Abscess]], [[decompression sickness]], [[exercise urticaria]]
|-
|- bgcolor="LightSteelBlue"
|'''Drug Side Effect'''<ref name="pmid17668843">{{cite journal |vauthors=Scorza K, Williams A, Phillips JD, Shaw J |title=Evaluation of nausea and vomiting |journal=Am Fam Physician |volume=76 |issue=1 |pages=76–84 |date=July 2007 |pmid=17668843 |doi= |url=}}</ref>
| bgcolor="Beige" |[[2C-E]], [[2C-I]], [[2C-T-7]], [[5-Hydroxytryptophan]], [[5-MeO-AMT]], [[ABVD]], [[acamprosate calcium]], [[acetaminophen]], [[acetoxyketobemidone]], [[acetylcysteine]], [[acetylsalicylic acid]],[[acyclovir]], [[aclarubicin]], [[actinomycin D]], [[alatrofloxacin Injection (patient information)|alatrofloxacin]], [[albuterol]], [[aldesleukin]], [[alemtuzumab]], [[allylprodine]], [[alpha-Methyltryptamine]], [[alprazolam]], [[altretamine]], [[amifostine]], [[amineptine]], [[aminocaproic acid]], [[aminoglutethimide]], [[aminopterin]], [[aminosalicylic acid]], [[amitriptyline (patient information)|amitriptyline]], [[amoxicillin]], [[amphotericin B]], [[amrinone]], [[amyl nitrite]], [[anadenanthera peregrina]], [[analgesic]], [[anastrozole]], [[anesthesia]], [[anticonvulsants]], [[antigout]], [[antihistamine]], [[antihypertensives]],[[antiretroviral drug]], [[apremilast]], [[apomorphine hydrochloride]], [[aprepitant]], [[aripiprazole]], [[armodafinil]], [[asparaginase (patient information)|asparaginase]], [[aspirin]], [[atomoxetine]], [[atosiban]], [[atropine]], [[auranofin]], [[axitinib]], [[azacitidine]], [[azathioprine]], [[azithromycin]], [[aztreonam]], [[barbiturate]], [[barium Sulfate]], [[basiliximab]], [[bCG vaccine]], [[Belladonna Alkaloid Combinations and Phenobarbital|belladonna alkaloid]] [[benzodiazepine]], [[benztropine]], [[benzphetamine]], [[benzylpiperazine]], [[betaine]], [[beta-lactam antibiotic]], [[Bevacizumab|bevacizumab]], [[beta blockers]], [[bezafibrate]], [[bicalutamide]], [[bleomycin]], [[blinatumomab]], [[botulinum antitoxin]], [[bortezomib]], [[bosutinib]], [[botulinum toxin]], [[bromelain]], [[bromocriptine]], [[bromomethane]], [[bronchodilator]], [[butalbital]], [[buprenorphine]], [[bupropion]], [[busulfan]], [[butanethiol]], [[butorphanol]], [[cabergoline]], [[calcitonin]], [[calcitriol]], [[calcium carbamide]], [[calcium channel antagonists]], [[capecitabine]], [[capsaicin]], [[carbamates]], [[Carbidopa and Levodopa|carbidopa and levodopa]], [[carboplatin]], [[carmustine]], [[carprofen]], [[carvedilol]], [[caspofungin]], [[cefaclor]], [[cefixime]], [[ceritinib]], [[cetrorelix]], [[cefoperazone Sodium Injection (patient information)|cefoperazone sodium]], [[cefotaxime sodium]], [[cefotetan disodium]], [[cefprozil]], [[ceftibuten]], [[cefuroxime]], [[ceftibuten]], [[ceftaroline fosamil]], [[cefuroxime]], [[cephalosporin]], [[cetuximab]], [[cetuximab injection ]] , [[cevimeline]], [[chelation therapy]], [[chemotherapy]], [[chloral hydrate]], [[chlordiazepoxide]], [[chloromethane]], [[chlorothiazide]], [[chlorpropamide]], [[CHOP]], [[cimicifuga racemosa]], [[ciprofloxacin]], [[cisplatin]], [[citalopram]], [[cladribine]], [[clarithromycin]], [[clindamycin]], [[clofarabine]], [[clofibrate]], [[clomifene]], [[clorazepate]], [[clozapine]], [[cobicistat]], [[co-codamol]], [[codeine]], [[colchicine]], [[colestyramine]], [[combined oral contraceptive pill]], [[conjugated estrogens/bazedoxifene]], [[contraceptive patch]], [[crizotinib]], [[cyclobenzaprine]], [[cyclophosphamide]], [[cytisine]], [[cytarabine]], [[cytarabine liposome]], [[cytisine]],[[capsaicin]], [[dacarbazine ]] , [[dactinomycin ]] , [[dalfampridine]], [[danazol]], [[dantrolene]], [[daptomycin]], [[Darbepoetin Alfa Injection|darbepoetin alfa Injection]] , [[darunavir ]] , [[daunorubicin ]] , [[deferasirox ]] , [[deferiprone]], [[defibrotide]], [[denileukin diftitox]], [[desmopressin]], [[dexamethasone]], [[dexchlorpheniramine]], [[dexrazoxane]], [[Dextroamphetamine and Amphetamine|dextroamphetamine and amphetamine]], [[dextromethorphan]], [[dextropropoxyphene]], [[diazepam]], [[diazinon]], [[dicofol]], [[didanosine]], [[diethyl ether]], [[diethylcathinone]], [[diflunisal]], [[digitoxin]], [[digoxin]], [[diethylcathinone]], [[diethyl ether]], [[dimercaprol]], [[dinoprostone]], [[dipyridamole]], [[disulfiram ]] , [[diuretic]], [[docetaxel ]] , [[dofetilide ]] , [[dolasetron ]] , [[donepezil ]] , [[doripenem]], [[dosulepin hydrochloride]], [[doxorubicin hydrochloride]], [[doxycycline]], [[Drospirenone and Ethinyl estradiol|drospirenone and ethinyl estradiol]], [[DTPA]], [[duloxetine]], [[ecallantide]], [[eculizumab]], [[efavirenz]], [[elvitegravir]], [[enfuvirtide]], [[entecavir]], [[epinephrine (aerosol)]], [[ergometrine]], [[ergotamine]], [[eribulin]], [[erlotinib]], [[erythromycin]], [[estradiol valerate and estradiol valerate/dienogest]], [[eslicarbazepine acetate]], [[ethcathinone]], [[ethchlorvynol]], [[ethosuximide]], [[ethynodiol diacetate and ethinyl estradiol]], [[ethyl carbamate]], [[emetine]], [[emtricitabine]], [[Emtricitabine, Rilpivirine Hydrochloride, And Tenofovir Disoproxil Fumarate|rilpivirine hydrochloride, and tenofovir disoproxil fumarate]], [[endosulfan]], [[entacapone]], [[efavirenz]], [[enfuvirtide]], [[entecavir ]] , [[elosulfase alfa]], [[epinephrine (aerosol)]], [[epirubicin hydrochloride]], [[epoetin Alfa ]] , [[eribulin]], [[eliglustat]], [[erlotinib ]] , [[erythromycin]], [[estradiol]], [[estrogen and Progestin (Oral Contraceptives) ]] , [[ethcathinone]], [[ethchlorvynol]], [[ethyl carbamate]], [[ethylmorphine]], [[etidronate ]] , [[etodolac]], [[etoposide]], [[exemestane]], [[exenatide]], [[felbamate]], [[fentanyl Oral Transmucosal ]] [[fexofenadine]], [[filgrastim]], [[fioricet]], [[flavoxate]], [[fludarabine phosphate]], [[fluorouracil]], [[flurazepam]],[[Flurbiprofen]], [[floxuridine]], [[fluconazole]], [[flucytosine]], [[fludarabine Phosphate]], [[flunisolide]], [[fluorescein sodium]], [[fluorouracil ]] , [[flurazepam]], [[flurbiprofen]], [[flutamide ]] , [[Fluticasone]], [[foscarnet sodium]], [[fulvestrant]], [[galantamine]], [[gallium nitrate]], [[gabapentin]], [[gamma-Hydroxybutyric acid]], [[gatifloxacin ]] , [[gefitinib ]] , [[gemcitabine]], [[gemeprost]], [[general anaesthesia]], [[gestrinone]], [[glimepiride]], [[glipizide]], [[glucagon]], [[glucarpidase]], [[glycylcycline]], [[glycopyrrolate]], [[glyburide]], [[glyburide and Metformin]], [[glycylcycline]], [[goserelin ]] , [[Graft-versus-host disease]], [[granisetron ]] , [[grifulvin V]], [[guaifenesin]], [[H1 antihistamine]], [[herkinorin]], [[heroin]], [[hydralazine]], [[hydrochlorothiazide]], [[hydrocodone]], [[Hydrocodone bitartrate and Homatropine methylbromide|hydrocodone bitartrate and homatropine methylbromide]], [[hydrocortisone]], [[hydromorphone]], [[hydroxycarbamide]], [[hydroxychloroquine]], [[hydroxocobalamin]], [[hydroxyurea]], [[hydroxyzine]], [[hydroxyprogesterone caproate]], [[Ibogaine]], [[Ibuprofen]], [[Ibrutinib]], [[Ibritumomab tiuxetan]], [[Idarubicin ]] , [[Idursulfase]], [[Ifosfamide ]] , [[Imatinib ]] , [[Imiglucerase]], [[Imipenem]], [[Indinavir]], [[Interferon gamma]], [[Interferon alfa-2b]], [[Iodomethane]], [[Irinotecan hydrochloride]], [[Isoniazid]], [[Isoproterenol (aerosol)]], [[Isopropyl alcohol]], [[Isosorbide mononitrate]], [[Isotretinoin]], [[Itraconazole]], [[Ivacaftor]], [[Ivermectin]], [[Ixabepilone]], [[kaopectate]], [[ketorolac]], [[lacosamide]], [[lactulose]], [[lamivudine]], [[lanreotide]], [[lansoprazole]], [[lanthanum carbonate]], [[lapatinib]], [[lenalidomide]], [[letrozole ]] , [[leuprolide ]] , [[Levodopa and Carbidopa|levodopa and carbidopa]] , [[levofloxacin]], [[levonorgestrel]], [[lidocaine (ointment)]], [[lithium nitrate]], [[lomefloxacin hydrochloride]], [[lorcaserin]], [[lopinavir]], [[loprazolam]], [[lorazepam]], [[lovaza]], [[malaria prophylaxis]], [[mazindol]], [[mechlorethamine ]] , [[medazepam]], [[megestrol ]] , [[melarsoprol]], [[melphalan ]] , [[mercaptopurine]], [[meropenem]], [[mesalamine ]] , [[mescaline]], [[mesna]], [[metformin]], [[methadone]], [[methenamine]], [[methotrexate]], [[methylergonovine]], [[methylketobemidone]], [[methylphenidate]], [[methyprylon]], [[metronidazole]], [[micafungin sodium]], [[mifepristone]], [[milk of magnesia]], [[milnacipran hydrochloride]], [[miltefosine]], [[mirtazapine]], [[misoprostol]], [[mitomycin ]] , [[mitotane]], [[mitoxantrone]], [[moclobemide]], [[monocrotophos]], [[morphine]], [[motofen]], [[moxifloxacin]], [[mycophenolic acid]], [[nabilone]], [[nafcillin]], [[nalbuphine]], [[nalmefene]], [[naloxone]], [[naphthalene]], [[naproxen sodium]], [[natamycin]], [[niacin/simvastatin]], [[nicorandil]], [[nilotinib]], [[nilutamide]], [[nintedanib]], [[nitrazepam]], [[nitrofurantoin]], [[nizatidine]], [[Norethindrone acetate and Ethinyl estradiol|norethindrone acetate and ethinyl estradiol]], [[Norgestimate and Ethinyl estradiol|norgestimate and ethinyl estradiol]], [[Norgestrel and Ethinyl estradiol|norgestrel and ethinyl estradiol]], [[olanzapine ]] , [[olsalazine]], [[omeprazole ]] , [[ondansetron]], [[opioid]], [[oprelvekin]], [[oritavancin]], [[oseltamivir ]] , [[oxaliplatin]], [[oxamniquine]], [[oxazepam]], [[oxcarbazepine]], [[oxybutynin ]] , [[oxycodone and aspirin ]] , [[oxytocin]], [[Paclitaxel]], [[palbociclib]], [[paliperidone ]] , [[palonosetron]], [[panitumumab]], [[pantoprazole]], [[papaverine]], [[paromomycin sulfate]], [[pazopanib hydrochloride]], [[paracetamol]], [[paroxetine]], [[pasireotide]], [[pegaspargase ]] , [[pemetrexed ]] , [[penicillin]], [[pentamidine]], [[pentavalent antimonial]], [[pentetic acid]], [[pentostatin ]] , [[pergolide ]] , [[perhexiline]], [[pertuzumab]], [[pirfenidone]], [[piroxicam]], [[phenelzine]], [[phenoxymethylpenicillin]], [[phentermine]], [[phenylephrine]], [[physostigmine]], [[pholcodine]], [[pilocarpine]], [[pioglitazone ]] , [[piribedil]], [[plerixafor]], [[plicamycin ]] ,[[posaconazole ]] , [[potassium chloride]], [[potassium citrate]], [[praziquantel]], [[pregabalin ]] , [[primaquine phosphate]], [[potassium iodide]], [[primaquine]][[procainamide ]] , [[procarbazine ]] , [[prochlorperazine]], [[progesterone]], [[propiram]], [[propylketobemidone]], [[prosidol]], [[protriptyline ]] , [[pyrantel pamoate]][[pyrazinamide]], [[pyridostigmine]], [[quetiapine ]] , [[quinupristin/dalfopristin]], [[radium chloride]], [[ramelteon]], [[ranolazine ]] , [[ranitidine]], [[rasburicase]], [[rasagiline ]] , [[reserpine]], [[ribavirin]], [[rifabutin]], [[rifaximin]], [[risedronate ]] , [[ritonavir]], [[rituximab ]] , [[rivastigmine ]] , [[rizatriptan ]] , [[ropinirole ]] , [[roflumilast]], [[rotigotine]], [[roxithromycin]], [[rubbing alcohol]], [[salsalate ]] , [[saquinavir mesylate]], [[sarin]], [[sargramostim]], [[stavudine]], [[sativex]], [[saxagliptin hydrochloride and Metformin hydrochloride]], [[secretin human]], [[secobarbital]], [[selegiline ]] , [[seliciclib]], [[serotonin]], [[sibutramine]], [[sipuleucel-T]], [[sodium oxybate]], [[sodium polystyrene sulfonate]], [[sodium stibogluconate]], [[sodium sulfate, potassium sulfate and magnesium sulfate]], [[solanine]], [[spironolactone]], [[Stiripentol]], [[streptozocin]], [[streptomycin]], [[streptozocin]], [[sufentanil]], [[Sulfamethoxazole/Trimethoprim (oral)]], [[sultiame]], [[sumatriptan]], [[sunitinib ]] , [[suramin]],[[tacrolimus]], [[tapentadol]], [[tedizolid]], [[telavancin hydrochloride]], [[telbivudine ]] , [[telithromycin ]] , [[taliglucerase alfa]][[temozolomide]], [[teniposide ]] , [[teriparatide]], [[tetracaine]], [[tetraferric tricitrate decahydrate]], [[tetrahydrocannabinol]], [[tetrahydrozoline]], [[tetramethylsuccinonitrile]], [[tetrodotoxin]], [[thallous Chloride Tl 201]], [[thiabendazole]], [[thiethylperazine]], [[thioguanine]], [[thiotepa ]] , [[Thyroid Medication|thyroid medication]], [[tigecycline]], [[tocopherol]], [[tolcapone ]] , [[tolmetin]], [[topiramate]], [[tolbutamide]], [[topotecan Hydrochloride|topotecan hydrochloride]], [[toremifene]], [[tralomethrin]], [[tramadol]], [[trametinib dimethyl sulfoxide]], [[trandolapril]], [[trastuzumab]], [[trazodone]], [[tretinoin]], [[triamterene]], [[triazolam]], [[triclofos]], [[tricyclic antidepressant]], [[trifluoperazine]], [[trifluoromethylphenylpiperazine]], [[trimeperidine]], [[trimethobenzamide]], [[trimetrexate Glucuronate]], [[tropisetron]], [[trovafloxacin mesylate]], [[valaciclovir]], [[valganciclovir hydrochloride]], [[valproic acid ]] , [[vancomycin]], [[varenicline]], [[venlafaxine]], [[vicodin]], [[vidarabine]], [[vigabatrin]], [[vilazodone]], [[viloxazine]], [[vinblastine ]] , [[vinorelbine Tartrate]], [[vismodegib]], [[von Willebrand factor]], [[voriconazole]], [[vorinostat]], [[vortioxetine]], [[zafirlukast]], [[zidovudine]], [[zolpidem ]] , [[zopiclone]], [[zoledronate]]
|-
|- bgcolor="LightSteelBlue"
|'''Ear Nose Throat'''
| bgcolor="Beige" |[[Balance disorder]], [[decompression sickness]], [[ear infection]], [[epistaxis]], [[glaucoma]], [[labyrinthitis]], [[Ménière's disease]], [[pharyngitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Endocrine'''<ref name="pmid14724837">{{cite journal |vauthors=Hasler WL, Chey WD |title=Nausea and vomiting |journal=Gastroenterology |volume=125 |issue=6 |pages=1860–7 |date=December 2003 |pmid=14724837 |doi=10.1053/j.gastro.2003.09.040 |url=}}</ref>
| bgcolor="Beige" |[[Acromegaly]], [[addison's disease]], [[adrenal failure]], [[adrenal insufficiency]], [[amyloidosis]], [[anorexia nervosa]], [[carcinoid tumours and carcinoid syndrome]], [[contraceptive patch]], [[diabetic gastroparesis]], [[diabetic ketoacidosis]], [[diabetes mellitus]],[[emergency contraception]], [[gangrene]], [[gestational diabetes]], [[hormone replacement therapy (trans)]],[[hypocalcemia]], [[hypoglycemia]], [[hyperparathyroidism]], [[hyperthyroidism]], [[prolactinoma]], [[syndrome of inappropriate antidiuretic hormone]]([[SIADH]]), [[thyrotoxicosis]], [[Estrogen and Progestin (Hormone Replacement Therapy) (patient information)|estrogen and progestin]], [[multiple endocrine neoplasia type 1]]
|- bgcolor="LightSteelBlue"
|'''Environmental'''
| bgcolor="Beige" |[[Bothrops|Bothrops bite]], [[bromomethane]], [[carbon monoxide poisoning]], [[dioxin]], [[heat stroke]], [[hyperthermia]]
|-
|- bgcolor="LightSteelBlue"
|'''Gastroenterologic'''
| bgcolor="Beige" |[[Achalasia]], [[acute abdomen]], [[accessory pancreas]] , [[acute fatty liver of pregnancy]], [[acute pancreatitis]], [[adjustable gastric band]], [[afferent loop syndrome]], [[alcoholic Hepatitis]], [[alcoholism]], [[anastomosis]] [[stenosis]], [[ anorexia nervosa]], [[appendicitis]], [[bacterial gastroenteritis]], [[beef tapeworm]], [[biliary colic]], [[blastocystosis]], [[bowel obstruction]], [[brucella]], [[bulimia nervosa]], [[caecitis]], [[carcinoid tumours and carcinoid syndrome]], [[chronic intestinal pseudo-obstruction]], [[cholecystitis]], [[cholecystolithiasis]], [[ciguatera]], [[colorectal cancer]], [[congenital hypertrophic pyloric stenosis]], [[Crohn's disease]], [[cryptosporidium parvum]], [[cyclic vomiting syndrome]], [[cyclospora cayetanensis]], [[diabetic gastroparesis]], [[dientamoebiasis]], [[diverticulitis]], [[dumping syndrome]], [[enteric Neuropathy]], [[eosinophilic esophagitis]], [[eosinophilic gastroenteritis]], [[epiploic appendagitis]], [[esophageal achalasia]], [[esophageal cancer]], [[esophageal diverticulum]], [[esophageal stenosis]], [[esophagitis]], [[femoral hernia]], [[food allergies]], [[food poisoning]], [[fundic gland polyposis]], [[functional dyspepsia]], [[gastric carcinoma]], [[gastric outlet obstruction]], [[gastritis]], [[gastrocolic fistula]], [[gastroenteritis]], [[gastroesophageal reflux disease]], [[gastrointestinal perforation]], [[gastroparesis]], [[giardiasis]], [[helicobacter pylori infection]], [[Hellp syndrome]], [[hematemesis]], [[hepatic coma]], [[hepatic porphyria]], [[hepatitis]], [[hepatitis A]], [[hepatitis B]], [[hepatitis D]], [[hepatitis E]], [[hepatobiliary disease]], [[hepatotoxicity ]] , [[hernia]], [[hirschsprung disease]], [[Ileus]], [[Intussusception (medical disorder)]], [[Irritable bowel syndrome]], [[Ischemic bowel]], [[Mesenteric ischemia]], [[peptic ulcer]], [[peritonitis]], [[pyloric stenosis]], [[Reye's syndrome]], [[Small bowel bacterial overgrowth syndrome]], [[Small intestine cancer]], [[traveler's diarrhea]]
|- bgcolor="LightSteelBlue"
|'''Genetic'''
| bgcolor="Beige" |[[Acute intermittent porphyria]], [[congenital malformation]], [[Down syndrome]], [[episodic ataxia]], [[familial hemiplegic migraine]], [[fundic gland polyposis]], [[galactosemia]], [[hereditary fructose intolerance]], [[slone's disease]]
|-
|- bgcolor="LightSteelBlue"
|'''Hematologic'''
| bgcolor="Beige" |[[HELLP syndrome]], [[hemorrhage]], [[mastocytosis]], [[porphyria]], [[splenic infarction]], [[thrombotic thrombocytopenic purpura]]
|-
|- bgcolor="LightSteelBlue"
|'''Iatrogenic'''
| bgcolor="Beige" |[[Essure]], [[dumping syndrome]], [[high doses of ionizing radiation]], [[Instillation abortion]], [[Minimally Invasive Thorasic Spinal Fusion|minimally Invasive thorasic spinal fusion]]
|-
|- bgcolor="LightSteelBlue"
|'''Infectious Disease'''
| bgcolor="Beige" |[[Infections|Acute infections]], [[acute viral nasopharyngitis (common cold)]], [[AIDS]], [[aseptic meningitis]], [[astrovirus]], [[bacillus cereus|bacillus cereus infection]], [[bacterial gastroenteritis]], [[Barcoo Fever|barcoo fever]], [[beef tapeworm]], [[blastocystosis]], [[brucella]], [[colorado tick fever]], [[community-acquired pneumonia]], [[croup]], [[cryptosporidium parvum|cryptosporidium parvum infection]], [[cyclospora cayetanensis|cyclospora cayetanensis infection]], [[dengue fever]], [[diarrheal shellfish poisoning]], [[dientamoebiasis]], [[diphtheria]], [[Duke's disease]], [[ebola]], [[giardia lamblia]], [[Hantavirus pulmonary syndrome]], [[helicobacter pylori infection]], [[henipavirus]], [[hepatitis B]], [[hepatitis D]], [[hepatitis E]], [[hookworm]], [[human ehrlichiosis]], [[Influenza]], [[Intestinal parasite]], [[lassa fever]], [[listeria monocytogenes]], [[malaria]], [[meningococcemia]], [[Naegleria fowleri]], [[norovirus]], [[norwalk Virus]], [[pfiesteria piscicida]], [[poliomyelitis]], [[Q fever]], [[Rocky Mountain spotted fever]], [[Scarlet fever]], [[shigella]], [[Sporotrichosis]], [[staphylococcal enteritis]], [[tularemia]], [[vibrio parahaemolyticus]], [[West Nile virus]], [[waterborne diseases]], [[Yellow fever]]
|-
|- bgcolor="LightSteelBlue"
|'''Musculoskeletal / Ortho'''
| bgcolor="Beige" |[[Decompression sickness]]
|-
|- bgcolor="LightSteelBlue"
|'''Neurologic'''
| bgcolor="Beige" |[[Acoustic neuroma]], [[airsickness]], [[altitude sickness]], [[arachnoid cyst]], [[Aseptic meningitis|aseptic meningitis]], [[autonomic neuropathy]], [[balance disorder]], [[benign intracranial hypertension]] ,[[Brain Stem Gliomas|brain stem gliomas]], [[brain tumor]], [[stroke|cerebellar stroke]], [[cerebral aneurysm]], [[cerebral arteriovenous malformation]], [[cerebral hemorrhage]], [[cerebrovascular disease]], [[cerebral oedema]],[[cerebral shunt ]] , [[cerebrovascular disease]], [[ciguatera]], [[concussion]], [[craniopharyngioma]], [[cyclic vomiting syndrome]], [[decompression sickness]], [[encephalitis]], [[enteric Neuropathy|enteric neuropathy]], [[ependymoma]], [[epidural haemorrhage]], [[episodic ataxia]], [[familial hemiplegic migraine]], [[glioblastoma multiforme]], [[glioma]], [[heavy metal ingestion]], [[hemicrania continua]], [[hepatic coma]], [[hydrocephalus]], [[La Crosse encephalitis]], [[Sea sickness]], [[subdural hematoma]], [[Tabes dorsalis]], [[vagal episode]], [[vertebrobasilar insufficiency]], [[vestibular neuritis]]
|-
|- bgcolor="LightSteelBlue"
|'''Nutritional / Metabolic'''
| bgcolor="Beige" |[[5-hydroxytryptophan]], [[acute intermittent porphyria]], [[amnesic shellfish poisoning]], [[amyloidosis]], [[bromelain]], [[cicuta]], [[cimicifuga racemosa]],[[coprinopsis atramentaria]], [[food allergies]], [[food intolerance]], [[food poisoning]], [[galactosemia]], [[ginger]], [[hereditary fructose intolerance]], [[hypercalcemia]], [[hypermagnesemia]], [[hypervitaminosis A]], [[hypervitaminosis]], [[hypocalcemia]], [[hypocholermia]], [[hypoglycemia]], [[hypokalemia]], [[hyponatremia]], [[ketogenic diet]], [[lactose intolerance]], [[metabolic acidosis]], [[pyridoxine deficiency]]
|-
|- bgcolor="LightSteelBlue"
|'''Obstetric/Gynecologic'''
| bgcolor="Beige" |[[Acute fatty liver of pregnancy]], [[breastfeeding complications]], [[childbirth]], [[contraceptive patch]], [[endometriosis]], [[emergency contraception]],[[Estrogen and Progestin (Oral Contraceptives)|estrogen and progestin]], [[essure]], [[gestational diabetes]], [[HELLP syndrome]], [[hydatidiform mole]], [[hyperemesis gravidarum]], [[ovarian cyst]], [[ovarian hyperstimulation syndrome]], [[ovarian torsion]], [[pregnancy]], [[salpingitis]], [[twisted ovarian cyst]]
|-
|- bgcolor="LightSteelBlue"
|'''Oncologic'''
| bgcolor="Beige" |[[Acoustic neuroma]], [[Brain Stem Gliomas|brain stem gliomas]], [[brain tumor]], [[cancer]], [[carcinoid tumours and carcinoid syndrome]], [[colorectal cancer]][[craniopharyngioma]], [[ependymoma]], [[esophageal cancer]], [[gastric carcinoma]], [[glioblastoma multiforme]], [[glioma]], [[Kaposi's sarcoma]], [[Non-Hodgkin lymphoma]], [[osteosarcoma]], [[prolactinoma]], [[Zollinger-Ellison Syndrome]]
|-
|- bgcolor="LightSteelBlue"
|'''Opthalmologic'''
| bgcolor="Beige" |[[Acute angle-closure glaucoma]], [[glaucoma]], [[refractive error]]
|-
|- bgcolor="LightSteelBlue"
|'''Overdose / Toxicity'''
| bgcolor="Beige" |[[1,2-Dichloroethene]], [[1,3-Dichloropropene]], [[2C-E]], [[2C-I]], [[2C-T-7]], [[abrin]], [[alcoholism]], [[alcohol withdrawal]], [[beleric]], [[cinchonism]], [[ethanol abuse]], [[hangover]], [[heavy metal ingestion]], [[heroin]], [[orellanine]], [[Reye's syndrome]], [[marine toxins]], [[PMA]]
|- bgcolor="LightSteelBlue"
|'''Psychiatric'''
| bgcolor="Beige" |[[Alcohol Withdrawal]], [[alcoholism]], [[anorexia nervosa]], [[anxiety]], [[anxiety disorders]], [[bulimia nervosa]], [[chronic fatigue syndrome]], [[combat stress reaction]], [[depression]], [[ethanol abuse]], [[hangover]], [[sexual fetish]] ([[emetophilia]]), [[SSRI discontinuation syndrome]] [[Hypochondriasis]]<ref name="pmid1263596">{{cite journal |vauthors=Swanson DW, Swenson WM, Huizenga KA, Melson SJ |title=Persistent Nausea without organic cause |journal=Mayo Clin Proc |volume=51 |issue=5 |pages=257–62 |date=May 1976 |pmid=1263596 |doi= |url=}}</ref>
|-
|- bgcolor="LightSteelBlue"
|'''Pulmonary'''
| bgcolor="Beige" |[[Acute viral nasopharyngitis (common cold)]], [[altitude sickness]], [[anaphylaxis]], [[aortic arch anomalies]], [[community acquired pneumonia]], [[croup]], [[decompression sickness]], [[Hantavirus pulmonary syndrome]], [[lower respiratory tract infection]], [[pulmonary embolism]], [[ pharyngitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Renal / Electrolyte'''
| bgcolor="Beige" |[[Dehydration]], [[diabetic ketoacidosis]], [[hypercalcemia]], [[hypermagnesemia]], [[hypocalcemia]], [[hypocholermia]], [[hypokalemia]], [[hyponatraemia]], [[Interstitial nephritis]], [[nutcracker syndrome]], [[pyelonephritis]], [[renal colic]], [[renal failure]], [[renal stones]], [[ urinary tract infections]]
|-
|- bgcolor="LightSteelBlue"
|'''Rheum / Immune / Allergy'''
| bgcolor="Beige" |[[Amyloidosis]], [[anaphylaxis]], [[chronic fatigue syndrome]], [[Crohn's disease]], [[food allergies]], [[food intolerance]], [[Graft-versus-host disease]], [[scleroderma]], [[Tetanus, Diphtheria, and Pertussis (Tdap) Vaccine|tetanus, diphtheria, and pertussis (Tdap) vaccine]], [[typhoid Vaccine]], [[HIV]]
|-
|- bgcolor="LightSteelBlue"
|'''Sexual'''
| bgcolor="Beige" |[[HIV]]
|-
|- bgcolor="LightSteelBlue"
|'''Trauma'''
| bgcolor="Beige" |[[Head trauma]], [[hemorrhage]], [[post-concussion syndrome]]
|-
|- bgcolor="LightSteelBlue"
|'''Urologic'''
| bgcolor="Beige" |[[Acute prostatitis]], [[testicular rupture]], [[testicular torsion]], [[urinary tract infections]], [[urolithiasis]]
|-
|- bgcolor="LightSteelBlue"
|'''Miscellaneous'''
| bgcolor="Beige" |[[Anadenanthera peregrina]], [[exercise induced nausea]], [[extreme pain]], [[foreign bodies]], [[sleep deprivation]], [[soapwort]], [[ulcers]], [[water intoxication]], [[cyclic vomiting syndrome]], [[DTPA]], [[ginkgo]]
|-
|}

{{columns-list||
* [[1,2-Dichloroethene]]
* [[1,3-Dichloropropene]]
* [[2C-E]]
* [[2C-I]]
* [[2C-T-7]]
* [[2-Ethylhexanol]]
* [[5-Hydroxytryptophan]]
* [[5-MeO-AMT]]
* [[Abrin]]
* [[Abscess]]
* [[ABVD]]
* [[Acamprosate calcium]]
* [[Accessory pancreas]]
* [[Acetaminophen]]
* [[Acetoxyketobemidone]]
* [[Acetylcysteine]]
* [[Achalasia]]
* [[Aclarubicin]]
* [[Acyclovir]]
* [[Aconitine]]
* [[Acoustic neuroma]]
* [[Acromegaly]]
* [[Actinomycin|Actinomycin D]]
* [[Acute angle-closure glaucoma]]
* [[Acute coronary syndromes]]
* [[Acute fatty liver of pregnancy]]
* [[Acute intermittent porphyria]]
* [[Acute pancreatitis]]
* [[Acute prostatitis]]
* [[Acute viral nasopharyngitis (common cold)]]
* [[Adamsite]]
* [[Adenovirus]]
* [[Addison's Disease]]
* [[Adjustable gastric band]]
* [[Adrenal insufficiency]]
* [[Afferent loop syndrome]]
* [[Airsickness]]
* [[Alatrofloxacin Injection]]
* [[Albuterol Inhalation]]
* [[Alcohol withdrawal]]
* [[Alcoholism]]
* [[Aldesleukin]]
* [[Alemtuzumab]]
* [[Allylprodine]]
* [[Alpha-Methyltryptamine]]
* [[Alprazolam]]
* [[Altitude sickness]]
* [[Altretamine]]
* [[Amantadine]]
* [[Amifostine]]
* [[Amineptine]]
* [[Aminocaproic acid]]
* [[Aminophylline]]
* [[Aminopterin]]
* [[Aminosalicylic acid]]
* [[Amitriptyline]]
* [[Ammonium chloride]]
* [[Amnesic shellfish poisoning]]
* [[Amoxicillin]]
* [[Amphotericin B]]
* [[Amrinone]]
* [[Amyl nitrite]]
* [[Amyloidosis]]
* [[Anadenanthera peregrina]]
* [[Anaphylaxis]]
* [[Anastrozole]]
* [[Anesthesia]]
* [[Angina pectoris]]
* [[Anorexia nervosa]]
* [[Antiarrhythmics]]
* [[Antibiotics]]
* [[Anticonvulsants]]
* [[Antihistamine]]
* [[Antihypertensives]]
* [[Antiretroviral drug]]
* [[Anxiety]]
* [[Aortic arch anomalies]]
* [[Apomorphine hydrochloride]]
* [[Appendicitis]]
* [[Aprepitant]]
* [[Arachnoid cyst]]
* [[Aripiprazole]]
* [[Arsenicals]]
* [[Arsenic Poisoning]]
* [[Arsenic trioxide]]
* [[Ascariasis]]
* [[Aseptic meningitis]]
* [[Asparaginase]]
* [[Aspirin]]
* [[Astrovirus]]
* [[Atomoxetine]]
* [[Atosiban]]
* [[Atripala]] ([[Efavirenz, emtricitabine and tenofovir disoproxil fumarate]])
* [[Auranofin]]
* [[Autonomic neuropathy]]
* [[Azathioprine]]
* [[Azithromycin]]
* [[Aztreonam]]
* [[Bacillus cereus]]
* [[Bacterial gastroenteritis]]
* [[Balance disorder]]
* [[Barbiturate]]
* [[Barcoo Fever|Barcoo fever]]
* [[Barium oxalate]]
* [[Barium sulfate]]
* [[BCG vaccine]]
* [[Beef tapeworm]]
* [[Beleric]]
* [[Belladonna Alkaloid Combinations and Phenobarbital|Belladonna alkaloid combinations]]
* [[Benign intracranial hypertension]]
* [[Benzodiazepine]]
* [[Benzylpiperazine]]
* [[Beta blockers]]
* [[Beta-lactam antibiotic]]
* [[Bevacizumab Injection (patient information)|Bevacizumab Injection]]
* [[Bezafibrate]]
* [[Bicalutamide]]
* [[Biliary colic]]
* [[Blastocystosis]]
* [[Bleomycin ]]
* [[Bortezomib]]
* [[Botulinum toxin]]
* [[Bowel obstruction]]
* [[Brain Stem Gliomas|Brain stem gliomas]]
* [[Brain tumor]]
* [[Breastfeeding complications]]
* [[Bromelain]]
* [[Bromomethane]]
* [[Bronchodilator]]
* [[Brucella]]
* [[Buprenorphine Hydrochloride, Naloxone Hydrochloride|Buprenorphine,naloxone]]
* [[Bulimia nervosa]]
* [[Buprenorphine]]
* [[Bupropion]]
* [[Busulfan]]
* [[Butanethiol]]
* [[Butorphanol]]
* [[Cabergoline]]
* [[Caecitis]]
* [[Calcitonin]]
* [[Calcitriol]]
* [[Calcium carbamide]]
* [[Calcium channel antagonists]]
* [[Camphor|Camphor poisoning]]
* [[Cancer]]
* [[Capecitabine]]
* [[Capsaicin]]
* [[Carbon monoxide poisoning]]
* [[Carboplatin]]
* [[Carcinoid tumours and carcinoid syndrome]]
* [[Cardiac arrhythmia]]
* [[Carmustine]]
* [[Carprofen]]
* [[Carvedilol]]
* [[Caspofungin]]
* [[Cefaclor]]
* [[Cefixime]]
* [[Cefoperazone Sodium Injection (patient information)|Cefoperazone Sodium Injection]]
* [[Cefotetan disodium]]
* [[Cefprozil]]
* [[Ceftaroline fosamil]]
* [[Ceftibuten]]
* [[Cefuroxime]]
* [[Cephalosporin]]
* [[Cerebral aneurysm]]
* [[Cerebral arteriovenous malformation]]
* [[Cerebral edema]]
* [[Cerebral hemorrhage]]
* [[Cerebral shunt]]
* [[Cerebrovascular disease]]
* [[Cetuximab Injection]]
* [[Cevimeline]]
* [[Chelation therapy]]
* [[Chemotherapy]]
* [[Childbirth]]
* [[Chloral hydrate]]
* [[Chlordiazepoxide]]
* [[Chloromethane]]
* [[Chlorothiazide]]
* [[Chlorpropamide]]
* [[Cholecystitis]]
* [[Cholecystolithiasis]]
* [[CHOP]]
* [[Chronic fatigue syndrome]]
* [[Chronic intestinal pseudo-obstruction]]
* [[Cicuta]]
* [[Ciguatera]]
* [[Cimicifuga racemosa]]
* [[Cinchonism]]
* [[Ciprofloxacin]]
* [[Cisplatin]]
* [[Citalopram]]
* [[Cladribine]]
* [[Clarithromycin]]
* [[Clindamycin]]
* [[Clofarabine]]
* [[Clofibrate]]
* [[Clomifene]]
* [[Clorazepate]]
* [[Clostridium perfringens]]
* [[Cobicistat]]
* [[Co-codamol]]
* [[Codeine]]
* [[Colchicine]]
* [[Colestyramine]]
* [[Colorado tick fever]]
* [[Colorectal cancer]]
* [[Combat stress reaction]]
* [[Community-acquired pneumonia]]
* [[Concussion]]
* [[Congenital hypertrophic pyloric stenosis]]
* [[Congenital malformation]]
* [[Contraceptive patch]]
* [[Copper|Copper salts]]
* [[Coprinopsis atramentaria]]
* [[Craniopharyngioma]]
* [[Crohn's disease]]
* [[Croup]]
* [[Cryptosporidium parvum]]
* [[Cyanogen]]
* [[Cyclic vomiting syndrome]]
* [[Cyclobenzaprine]]
* [[Cyclophosphamide]]
* [[Cyclospora cayetanensis]]
* [[Cytarabine]]
* [[Cytisine]]
* [[Dacarbazine]]
* [[Dactinomycin]]
* [[Danazol]]
* [[Dantrolene]]
* [[Daptomycin]]
* [[Darbepoetin Alfa Injection (patient information)|Darbepoetin Alfa Injection]]
* [[Darunavir]]
* [[Daunorubicin]]
* [[Decompression sickness]]
* [[Deferasirox]]
* [[Deferiprone]]
* [[Defibrotide]]
* [[Dehydration]]
* [[Dengue fever]]
* [[Depression]]
* [[Desmopressin]]
* [[Dexamethasone]]
* [[Dextroamphetamine and Amphetamine (patient information)|Dextroamphetamine and Amphetamine]]
* [[Dextromethorphan]]
* [[Dextropropoxyphene]]
* [[Diabetes mellitus]]
* [[Diabetic gastroparesis]]
* [[Diabetic Ketoacidosis]]
* [[Diarrheal shellfish poisoning]]
* [[Diazepam]]
* [[Diazinon]]
* [[Dicofol]]
* [[Didanosine]]
* [[Dientamoebiasis]]
* [[Diethyl ether]]
* [[Diethylcathinone]]
* [[Diflunisal]]
* [[Digitalis purpurea]]
* [[Digitoxin]]
* [[Digoxin]]
* [[Dioxathion]]
* [[Dioxin]]
* [[Diphtheria]]
* [[Disulfiram]]
* [[Diuretic]]
* [[Diverticulitis]]
* [[Docetaxel]]
* [[Dofetilide]]
* [[Dolasetron]]
* [[Donepezil]]
* [[Doripenem]]
* [[Dosulepin hydrochloride]]
* [[Down syndrome]]
* [[Doxorubicin Hydrochloride]]
* [[DTPA]]
* [[Duke's disease]]
* [[Duloxetine]]
* [[Dumping syndrome]]
* [[Ear infection]]
* [[Ebola virus disease]]
* [[Eculizumab]]
* [[Efavirenz]]
* [[Elvitegravir]]
* [[Emergency contraception]]
* [[Emetine]]
* [[Encephalitis]]
* [[Endometriosis]]
* [[Endosulfan]]
* [[Enfuvirtide]]
* [[Entecavir]]
* [[Enteric Neuropathy]]
* [[Enterobiasis]]
* [[Eosinophilic gastroenteritis]]
* [[Epidural haemorrhage]]
* [[Ependymoma]]
* [[Epiploic appendagitis]]
* [[Epirubicin hydrochloride]]
* [[Episodic ataxia]]
* [[Epistaxis]]
* [[Epoetin Alfa Injection (patient information)|Epoetin Alfa Injection]]
* [[Ergotamine]]
* [[Ergotism]]
* [[Eribulin]]
* [[Erlotinib]]
* [[Erythromycin]]
* [[Esophageal achalasia]]
* [[Esophageal cancer]]
* [[Esophageal diverticulum]]
* [[Esophageal stenosis]]
* [[Esophagitis]]
* [[Essure]]
* [[Estradiol]]
* [[Estrogen and Progestin (Oral Contraceptives) (patient information)|Estrogen and Progestin ]]
* [[Ethanol abuse]]
* [[Ethcathinone]]
* [[Ethchlorvynol]]
* [[Ethosuximide]]
* [[Ethyl carbamate]]
* [[Ethylmorphine]]
* [[Etidronate]]
* [[Etoposide]]
* [[Exemestane]]
* [[Exenatide]]
* [[Exercise induced nausea]]
* [[Exercise urticaria]]
* [[Extreme pain]]
* [[Familial hemiplegic migraine]]
* [[Felbamate]]
* [[Femoral hernia]]
* [[Fentanyl Oral Transmucosal (patient information)|Fentanyl Oral Transmucosal]]
* [[Fexofenadine]]
* [[Filgrastim]]
* [[Fioricet]]
* [[Fluorouracil]]
* [[Floxuridine]]
* [[Flu]]
* [[Fluconazole]]
* [[Flucytosine]]
* [[Fludarabine Phosphate]]
* [[Flunisolide]]
* [[Fluorescein sodium]]
* [[Fluoride poisoning]]
* [[Fluorouracil]]
* [[Flurazepam]]
* [[Flurbiprofen]]
* [[Flutamide]]
* [[Fluticasone]]
* [[Food allergies]]
* [[Food intolerance]]
* [[Food poisoning]]
* [[Foreign bodies]]
* [[Fructose intolerance]] [[hypoglycemia]]
* [[Fulvestrant Injection (patient information)|Fulvestrant Injection]]
* [[Functional dyspepsia]]
* [[Fundic gland polyposis]]
* [[Gabapentin]]
* [[Galactosemia]]
* [[Galantamine]]
* [[Gamma-Hydroxybutyric acid]]
* [[Gangrene]]
* [[Gastric carcinoma]]
* [[Gastric outlet obstruction]]
* [[Gastritis]]
* [[Gastrocolic fistula]]
* [[Gastroenteritis]]
* [[Gastroesophageal reflux disease]]
* [[Gastrointestinal perforation]]
* [[Gastroparesis]]
* [[Gatifloxacin]]
* [[Gefitinib]]
* [[Gemcitabine Hydrochloride (patient information)|Gemcitabine hydrochloride]]
* [[Gemeprost]]
* [[Gestational diabetes]]
* [[Gestrinone]]
* [[Giardia lamblia]]
* [[Giardiasis]]
* [[Ginger]]
* [[Ginkgo]]
* [[Glaucoma]]
* [[Glioblastoma multiforme]]
* [[Glioma]]
* [[Glucagon]]
* [[Glycylcycline]]
* [[Goserelin]]
* [[Graft-versus-host disease]]
* [[Granisetron]]
* [[Green Tobacco Sickness|Green tobacco sickness]]
* [[Grifulvin V]]
* [[Griseofulvin]]
* [[Guaifenesin]]
* [[Hangover]]
* [[Hantavirus pulmonary syndrome]]
* [[Head trauma]]
* [[Heart failure]]
* [[Heat stroke]]
* [[Heavy metal ingestion]]
* [[Helicobacter pylori infection]]
* [[HELLP syndrome]]
* [[Hematemesis]]
* [[Hemicrania continua]]
* [[Hemorrhage]]
* [[Henipavirus]]
* [[Hepatic coma]]
* [[Hepatic porphyria]]
* [[Hepatitis]]
* [[Hepatitis B]]
* [[Hepatitis D]]
* [[Hepatitis E]]
* [[Hepatobiliary disease]]
* [[Hereditary fructose intolerance]]
* [[Herkinorin]]
* [[Hernia]]
* [[Heroin]]
* [[Hirschsprung disease]]
* [[HIV]]
* [[Hookworm]]
* [[Hormone replacement therapy (trans)]]
* [[Human ehrlichiosis]]
* [[Hydralazine]]
* [[Hydrocephalus]]
* [[Hydrochlorothiazide]]
* [[Hydrocodone]]
* [[Hydromorphone]]
* [[Hydroxychloroquine]]
* [[Hydroxocobalamin]]
* [[Hydroxyurea]]
* [[Hydroxyzine]]
* [[Hypercalcemia]]
* [[Hyperemesis gravidarum]]
* [[Hypermagnesemia]]
* [[Hyperparathyroidism]]
* [[Hypertension]]
* [[Hyperthermia]]
* [[Hyperthyroidism]]
* [[Hypervitaminosis A]]
* [[Hypocalcemia]]
* [[Hypocholermia]]
* [[Hypoglycemia]]
* [[Hypokalemia]]
* [[Hyponatremia]]
* [[Hypoparathyroidism]]
* [[Hysterical contagion]]
* [[Iatrogenesis]]
* [[Ibogaine]]
* [[Ibuprofen]]
* [[Idarubicin]]
* [[Idiopathic]]
* [[Ifosfamide]]
* [[Ileus]]
* [[Imatinib]]
* [[Imipenem]]
* [[Inappetence]]
* [[Inborn errors of metabolism]]
* [[Incarcerated hernia]]
* [[Indinavir]]
* [[Indometacin]]
* [[Infarction]]
* [[Inflammatory bowel disease]]
* [[Infliximab]]
* [[Influenza]]
* [[Inguinal hernia]]
* [[Instillation abortion]]
* [[Insulin lispro]]
* [[Interferon gamma]]
* [[Interstitial nephritis]]
* [[Intracranial mass]]
* [[Intestinal atresia]]
* [[Intestinal parasite]]
* [[Intestinal volvulus]]
* [[Intracranial haemorrhage]]
* [[Intracranial hypertension]]
* [[Intussusception]]
* [[Ipecacuanha]]
* [[Iodomethane]]
* [[Irinotecan hydrochloride]]
* [[Iron(II) sulfate]]
* [[Irritable bowel syndrome]]
* [[Irukandji syndrome]]
* [[Ischemic bowel]]
* [[Isoniazid]]
* [[Isopropyl alcohol]]
* [[Isosorbide mononitrate]]
* [[Isotretinoin]]
* [[Itraconazole]]
* [[Ivacaftor]]
* [[Ixabepilone]]
* [[Jamaican vomiting sickness]]
* [[Janumet]] ([[sitagliptin]] and [[metformin]])
* [[Kaopectate]]
* [[Kaposi's sarcoma]]
* [[Ketoconazole]]
* [[Ketogenic diet]]
* [[Ketorolac]]
* [[Ketotic hypoglycemia]]
* [[La Crosse encephalitis]]
* [[Labyrinthitis]]
* [[Lactose intolerance]]
* [[Lanreotide]]
* [[Lansoprazole]]
* [[Large bowel obstruction]]
* [[Lassa fever]]
* [[Lead poisoning]]
* [[Letrozole]]
* [[Leuprolide]]
* [[Levodopa and Carbidopa]]
* [[Levofloxacin]]
* [[Levonorgestrel]]
* [[Lewisite]]
* [[Lindane]]
* [[Listeria monocytogenes]]
* [[Lithium]]
* [[Lithium nitrate]]
* [[Lobelia]]
* [[Lomefloxacin hydrochloride]]
* [[Lomotil]]
* [[Lopinavir]]
* [[Loprazolam]]
* [[Lorazepam]]
* [[Lower respiratory tract infection]]
* [[Lubiprostone]]
* [[Lysuride]]
* [[Malaria]]
* [[Malaria prophylaxis]]
* [[Malignancy]]
* [[Intestinal malrotation|Malrotation]]
* [[Marine toxins]]
* [[Mass effect (medicine)|Mass lesion]]
* [[Mastocytosis]]
* [[Mazindol]]
* [[Mechlorethamine]]
* [[Medazepam]]
* [[Medical cannabis]]
* [[Megestrol]]
* [[Melarsoprol]]
* [[Melphalan]]
* [[Ménière's disease]]
* [[Meningitis]]
* [[Meningococcemia]]
* [[Meningoencephalitis]]
* [[Mercaptopurine]]
* [[Mesoamerican nephropathy]]
* [[Meropenem]]
* [[Mesalamine]]
* [[Mescaline]]
* [[Mesenteric infarction]]
* [[Mesna]]
* [[Metabolic acidosis]]
* [[Metal fume fever]]
* [[Metformin]]
* [[Methadone]]
* [[Methotrexate]]
* [[Methylergonovine]]
* [[Methylketobemidone]]
* [[Methylphenidate]]
* [[Methyprylon]]
* [[Metronidazole]]
* [[Micafungin sodium]]
* [[Mifepristone]]
* [[Migraine]]
* [[Milk of Magnesia]]
* [[Milnacipran hydrochloride]]
* [[Miltefosine]]
* [[Minimally Invasive Thorasic Spinal Fusion]]
* [[Mirtazapine]]
* [[Misoprostol]]
* [[Mitomycin]]
* [[Mitotane]]
* [[Mitoxantrone]]
* [[Moclobemide]]
* [[Monocrotophos]]
* [[Mood stabilizer]]
* [[MOPP (medicine)|MOPP]]
* [[Morning sickness]]
* [[Morphine]]
* [[Motion sickness]]
* [[Motofen]]
* [[Moxifloxacin]]
* [[Multiple chemical sensitivity]]
* [[Multiple endocrine neoplasia type 1]]
* [[Munchausen syndrome by proxy]]
* [[Murray Valley encephalitis virus]]
* [[Mushroom poisoning]]
* [[Mycophenolic acid]]
* [[Mycoplasma pneumoniae]]
* [[Myocardial infarction]]
* [[Nabilone]]
* [[Naegleria fowleri]]
* [[Nafcillin]]
* [[Nalbuphine]]
* [[Nalidixic acid]]
* [[Nalmefene]]
* [[Naloxone]]
* [[Naphthalene]]
* [[Naproxen sodium]]
* [[Narcotics]]
* [[Natamycin]]
* [[Necrotizing enterocolitis]]
* [[Nerve agent]]
* [[Nervousness]]
* [[N-Ethyl-3-piperidyl benzilate]]
* [[Nicorandil]]
* [[Nicotine poisoning]]
* [[Nilutamide]]
* [[Nintedanib]]
* [[Nitrazepam]]
* [[Nitrogen mustard]]
* [[N-Nitroso-N-Methylurea]]
* [[Non-Hodgkin lymphoma]]
* [[Non steroidal anti-inflammatory drugs]]
* [[Nootropic]]
* [[Norfloxacin]]
* [[Norgestimate and Ethinyl estradiol]]
* [[Norgestrel and Ethinyl estradiol]]
* [[Norovirus]]
* [[Norplant]]
* [[Nortriptyline]]
* [[Norwalk Virus]]
* [[Nutcracker syndrome]]
* [[Nystatin]]
* [[Obidoxime]]
* [[Obstructive uropathy]]
* [[Obturator hernia]]
* [[Oesophageal cancer]]
* [[Ofloxacin]]
* [[Olanzapine]]
* [[Omeprazole]]
* [[Ondansetron]]
* [[Opioid]]
* [[Oprelvekin]]
* [[Oral contraceptives]]
* [[Orellanine]]
* [[Organic acidemia]]
* [[Organophosphates]]
* [[Oritavancin]]
* [[Oseltamivir]]
* [[Osteosarcoma]]
* [[Otitis interna]]
* [[Otitis media]]
* [[Ovarian cancer]]
* [[Ovarian cyst]]
* [[Ovarian hyperstimulation syndrome]]
* [[Ovarian torsion]]
* [[Oxaliplatin]]
* [[Oxamniquine]]
* [[Oxazepam]]
* [[Oxcarbazepine]]
* [[Oxybutynin]]
* [[Oxycodone and aspirin]]
* [[Paclitaxel]]
* [[Pain]]
* [[Palbociclib]]
* [[Pancreatic adenocarcinoma]]
* [[Pancreatitis]]
* [[Panitumumab]]
* [[Pantoprazole]]
* [[Palbociclib]]
* [[Paliperidone]]
* [[Palonosetron]]
* [[Panic attack]]
* [[Paralytic ileus]]
* [[Paraneoplastic syndrome]]
* [[Paraquat]]
* [[Paroxetine]]
* [[Pegaspargase]]
* [[Pemetrexed injection]]
* [[Penicillin]]
* [[Pentamidine]]
* [[Pentavalent antimonial]]
* [[Pentetic acid]]
* [[Pentostatin]]
* [[Peptic ulcer]]
* [[Pergolide]]
* [[Perhexiline]]
* [[Peritonitis]]
* [[Pesticide]]
* [[Pethidine]]
* [[Pfiesteria piscicida]]
* [[PFPP]]
* [[Pharyngeal pouch]]
* [[Pharyngitis]]
* [[Phenelzine]]
* [[Phenoxymethylpenicillin]]
* [[Phentermine]]
* [[Phentolamine]]
* [[Pholcodine]]
* [[Physostigmine]]
* [[Phytohaemagglutinin]]
* [[Pioglitazone]]
* [[Pirfenidone]]
* [[Piribedil]]
* [[Plerixafor]]
* [[Plicamycin]]
* [[Piroxicam]]
* [[PMA]]
* [[Pneumonia]]
* [[Polio]]
* [[Poliomyelitis]]
* [[Porphyria]]
* [[Posaconazole]]
* [[Post-concussion syndrome]]
* [[Post-exposure prophylaxis]]
* [[Ileus|Postoperative ileus]]
* [[Postoperative nausea and vomiting]]
* [[Pain|Postoperative pain]]
* [[Potassium bromide]]
* [[Potassium chloride]]
* [[Potassium citrate]]
* [[Praziquantel]]
* [[Pregabalin]]
* [[Pregnancy]]
* [[Primaquine]]
* [[Procainamide]]
* [[Procarbazine]]
* [[Prochlorperazine]]
* [[Progesterone]]
* [[Prolactinoma]]
* [[Propiram]]
* [[Propylketobemidone]]
* [[Prosidol]]
* [[Protriptyline]]
* [[Pseudotumor cerebri]]
* [[Psychogenic]]
* [[Pulmonary embolism]]
* [[Pyelonephritis]]
* [[Pyloric stenosis]]
* [[Pyrazinamide]]
* [[Pyrantel pamoate]]
* [[Pyridostigmine]]
* [[Pyridoxine deficiency]]
* [[Q fever]]
* [[Quetiapine]]
* [[Quinidine]]
* [[Quinupristin/dalfopristin]]
* [[Radiation poisoning]]
* [[Radiation therapy]]
* [[Raised intracranial pressure]]
* [[Radium chloride]]
* [[Ramelteon]]
* [[Ranolazine]]
* [[Rasagiline]]
* [[Refractive error]]
* [[Renal colic]]
* [[Renal failure]]
* [[Renal insufficiency]]
* [[Reserpine]]
* [[Retroperitoneal fibrosis]]
* [[Reversible cerebral vasoconstriction syndrome]]
* [[Reye's syndrome]]
* [[Ribavirin]]
* [[Rifabutin]]
* [[Riluzole]]
* [[Risedronate]]
* [[Rituximab injection]]
* [[Rivastigmine]]
* [[Rizatriptan]]
* [[Rocky mountain spotted fever]]
* [[Ropinirole]]
* [[Rotavirus]]
* [[Rotigotine]]
* [[Roxithromycin]]
* [[Rubbing alcohol]]
* [[Rumination disorder]]
* [[Salicylate poisoning]]
* [[Salmonella]]
* [[Salpingitis]]
* [[Salsalate]]
* [[Saquinavir mesylate]]
* [[Sargramostim]]
* [[Sarin]]
* [[Sativex]]
* [[Scarlet fever]]
* [[Scleroderma]]
* [[Seasickness]]
* [[Secobarbital]]
* [[second-hand smoke]]
* [[Secretin human]]
* [[Seizure disorders]]
* [[Selective serotonin reuptake inhibitor]]
* [[Selegiline]]
* [[Seliciclib]]
* [[Sepsis]]
* [[Sexual fetish]]
* [[Shigella]]
* [[Sibutramine]]
* [[Sipuleucel-T]]
* [[Ski sickness]]
* [[Sleep deprivation]]
* [[Slone's disease]]
* [[Small bowel bacterial overgrowth syndrome]]
* [[Small bowel lymphoma]]
* [[Small bowel obstruction]]
* [[Small intestine cancer]]
* [[Smoke inhalation]]
* [[Snakebites]]
* [[Soapwort]]
* [[Sodium oxybate]]
* [[Sodium polystyrene sulfonate]]
* [[Sodium stibogluconate]]
* [[Sofosbuvir]]
* [[Solanine]]
* [[Somatization]]
* [[Spider bite]]
* [[Spironolactone]]
* [[Splenic infarction]]
* [[Sporotrichosis]]
* [[Spotted fever]]
* [[SSRI discontinuation syndrome]]
* [[Staphylococcal enteritis]]
* [[Starvation]]
* [[Stavudine]]
* [[Stomach cancer]]
* [[Streptococcal pharyngitis]]
* [[Stribild]] ([[Elvitegravir, Cobicistat, Emtricitabine, And Tenofovir Disoproxil Fumarate]])
* [[Strongyloidiasis]]
* [[Stiripentol]]
* [[Strep throat]]
* [[Streptozocin]]
* [[Subdural hematoma]]
* [[Sufentanil]]
* [[Sulfasalazine]]
* [[Sulfonamides]]
* [[Sulprostone]]
* [[Suicide attempt]]
* [[Sultiame]]
* [[Sumatriptan injection]]
* [[Sunitinib]]
* [[Suramin]]
* [[Syndrome of inappropriate antidiuretic hormone]] [[SIADH]]
* [[Tabes dorsalis]]
* [[Tacrine]]
* [[Tacrolimus]]
* [[Tamoxifen]]
* [[Tapentadol]]
* [[Telavancin hydrochloride]]
* [[Telbivudine]]
* [[Telithromycin]]
* [[Tetracycline]]
* [[Temik]]
* [[Temozolomide]]
* [[Teniposide]]
* [[Testicular rupture]]
* [[Testicular torsion]]
* [[Tetanus, Diphtheria, and Pertussis (Tdap) Vaccine]]
* [[Tetracaine]]
* [[Tetrahydrocannabinol]]
* [[Tetrahydrozoline]]
* [[Tetramethylsuccinonitrile]]
* [[Tetrodotoxin]]
* [[Thallium]]
* [[Theobromine]]
* [[Theophylline]]
* [[Thiabendazole]]
* [[Thiethylperazine]]
* [[Thioguanine]]
* [[Thiotepa]]
* [[Thrombotic thrombocytopenic purpura]]
* [[Thyroid Medication (patient information)|Thyroid medication]]
* [[Thyrotoxicosis]]
* [[Tigecycline]]
* [[smoking|Tobacco smoking]]
* [[Tocopherol]]
* [[Tolmetin]]
* [[Topiramate]]
* [[Topotecan Hydrochloride|Topotecan Hydrochloride]]
* [[Toxic ingestion]]
* [[Toxidrome]]
* [[Tralomethrin]]
* [[Tramadol]]
* [[Trametinib dimethyl sulfoxide]]
* [[Trandolapril]]
* [[Tranexamic acid]]
* [[Trastuzumab]]
* [[Traumatic brain injury]]
* [[Traveler's diarrhea]]
* [[Trazodone]]
* [[Tretinoin]]
* [[Triamterene]]
* [[Triazolam]]
* [[Trichuriasis]]
* [[Triclofos]]
* [[Tricyclic antidepressant]]
* [[Trifluoperazine]]
* [[Trifluoromethylphenylpiperazine]]
* [[Trimeperidine]]
* [[Trimethobenzamide]]
* [[Trimetrexate glucuronate]]
* [[Tropisetron]]
* [[Trovafloxacin mesylate]]
* [[Tularemia]]
* [[Tumors]]
* [[Twisted ovarian cyst]]
* [[Typhoid Vaccine (patient information)|Typhoid Vaccine]]
* [[Typhus]]
* [[Ulcers]]
* [[Urea cycle disorders]]
* [[Uremia]]
* [[Urinary tract infection]]
* [[Urofollitropin]]
* [[Urolithiasis]]
* [[Vagotomy]]
* [[Valaciclovir]]
* [[Valganciclovir hydrochloride]]
* [[Valproic Acid]]
* [[Varenicline]]
* [[Vasovagal syncope]]
* [[Venlafaxine]]
* [[Verapamil]]
* [[Vertebro-basilar syndrome]]
* [[Vertigo]]
* [[Vestibular balance disorder]]
* [[Vestibular neuronitis]]
* [[Vibrio parahaemolyticus]]
* [[Vicodin]]
* [[Vidarabine]]
* [[Vigabatrin]]
* [[Vilazodone]]
* [[Viloxazine]]
* [[Vinblastine]]
* [[Vinorelbine Tartrate]]
* [[Viral gastroenteritis]]
* [[emotion|Violent emotions]]
* [[Cough|Violent fits of coughing]]
* [[hiccups|Violent fits of coughing]]
* [[Vitamin A]]
* [[Vitamin C]]
* [[Vitamin D]]
* [[Volvulus]]
* [[Von Willebrand factor]]
* [[Voriconazole]]
* [[Vorinostat]]
* [[Vortioxetine]]
* [[Water intoxication]]
* [[Waterborne diseases]]
* [[West Nile virus]]
* [[Yellow fever]]
* [[Zanamivir Inhalation]]
* [[Zidovudine]]
* [[Ziprasidone]]
* [[Zollinger-Ellison Syndrome]]
* [[Zolpidem]]
* [[Zopiclone]]

}}

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Emergency medicine]]
[[Category:Gastroenterology]]
[[Category:Obstetrics]]
[[Category:Crowdiagnosis]]

Nausea and vomiting causes

2021-02-01T20:26:54Z

Shaik Aisha sultana: references

__NOTOC__
{{Nausea and vomiting}}
{{CMG}}; {{AE}} {{VVS}} {{KS}}

==Overview==
Life threatening causes of nausea and vomiting include [[acute coronary syndrome]], [[anaphylaxis]], and [[heart failure]]. Other common causes of nausea and vomiting are [[food allergies]], [[food poisoning]], [[gastroenteritis]], and [[gastroesophageal reflux]].

==Causes==
===Life Threatening Causes===

*[[Acute Coronary Syndromes]]<ref name="pmid637006">{{cite journal |vauthors=Ahmed SS, Gupta RC, Brancato RR |title=Significance of nausea and vomiting during acute myocardial infarction |journal=Am Heart J |volume=95 |issue=5 |pages=671–2 |date=May 1978 |pmid=637006 |doi=10.1016/0002-8703(78)90311-3 |url=}}</ref>
*[[Anaphylaxis]]
*[[Angina pectoris]]
*[[Heart failure]]

===Common Causes===

*[[Chemotherapy]]<ref>{{cite journal|doi=10.1002/j.1875-9114.1990.tb02560.x}}</ref>

*[[Food allergies]]
*[[Food poisoning]]
*[[Migraine]]
*[[Morning sickness]]
*[[Rotavirus]]
*[[Viral gastroenteritis]]

===Causes by Organ System===

{| style="width: 80%; height: 100px; text-align: justify; text-justify: distribute;" border="1"
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" |'''Cardiovascular'''
| style="width:75%" bgcolor="Beige" ; border="1" |[[Acute Coronary Syndromes]], [[amyloidosis]], [[anaphylaxis]], [[angina pectoris]], [[aortic arch anomalies]], [[cardiac arrhythmia]], [[cerebral aneurysm]], [[cerebral arteriovenous malformation]], [[cerebrovascular disease]], [[myocardial infarction]], [[heart failure]], [[hypercalcemia]], [[hypertension]], [[hypercalcemia]], [[hypocalcemia]], [[hypokalemia]]
|- bgcolor="LightSteelBlue"
|'''Chemical / poisoning'''
| bgcolor="Beige" |[[1,2-Dichloroethene]], [[2-Ethylhexanol]], [[1,3-Dichloropropene]], [[abrin]], [[aconitine]], [[adamsite]], [[ammonium chloride]], [[amnesic shellfish poisoning]], [[arsenic Poisoning]], [[barium oxalate]], [[barium sulfate]], [[butanethiol]], [[camphor|camphor poisoning]], [[capsaicin]], [[carbon monoxide poisoning]], [[chloromethane]], [[cicuta]], [[ciguatera]], [[cinchonism]], [[coprinopsis atramentaria]], [[cyanogen]], [[daunorubicin]], [[diethyl ether]], [[digitalis purpurea]], [[dioxathion]], [[dioxin]], [[endosulfan]], [[ergotism]], [[fluoride poisoning]], [[fluoxymesterone]], [[ginkgo]], [[Green Tobacco Sickness|green tobacco sickness]], [[heavy metal ingestion]], [[Iodomethane]], [[Iron poisoning]], [[Iron(II) sulfate]], [[lead poisoning]], [[lenvatinib]], [[lewisite]], [[lindane]], [[lithium]], [[lobelia]], [[metal fume fever]], [[mushroom poisoning]], [[N-Ethyl-3-piperidyl benzilate]], [[nerve agent]], [[nicotine poisoning]], [[N-Nitroso-N-methylurea]], [[PFPP]], [[pesticide]], [[potassium bromide]], [[phytohaemagglutinin]], [[smoke inhalation]], [[snakebites]], [[temik]], [[theobromine]]
|- bgcolor="LightSteelBlue"
|'''Dermatologic'''
| bgcolor="Beige" |[[Abscess]], [[decompression sickness]], [[exercise urticaria]]
|-
|- bgcolor="LightSteelBlue"
|'''Drug Side Effect'''<ref name="pmid17668843">{{cite journal |vauthors=Scorza K, Williams A, Phillips JD, Shaw J |title=Evaluation of nausea and vomiting |journal=Am Fam Physician |volume=76 |issue=1 |pages=76–84 |date=July 2007 |pmid=17668843 |doi= |url=}}</ref>
| bgcolor="Beige" |[[2C-E]], [[2C-I]], [[2C-T-7]], [[5-Hydroxytryptophan]], [[5-MeO-AMT]], [[ABVD]], [[acamprosate calcium]], [[acetaminophen]], [[acetoxyketobemidone]], [[acetylcysteine]], [[acetylsalicylic acid]],[[acyclovir]], [[aclarubicin]], [[actinomycin D]], [[alatrofloxacin Injection (patient information)|alatrofloxacin]], [[albuterol]], [[aldesleukin]], [[alemtuzumab]], [[allylprodine]], [[alpha-Methyltryptamine]], [[alprazolam]], [[altretamine]], [[amifostine]], [[amineptine]], [[aminocaproic acid]], [[aminoglutethimide]], [[aminopterin]], [[aminosalicylic acid]], [[amitriptyline (patient information)|amitriptyline]], [[amoxicillin]], [[amphotericin B]], [[amrinone]], [[amyl nitrite]], [[anadenanthera peregrina]], [[analgesic]], [[anastrozole]], [[anesthesia]], [[anticonvulsants]], [[antigout]], [[antihistamine]], [[antihypertensives]],[[antiretroviral drug]], [[apremilast]], [[apomorphine hydrochloride]], [[aprepitant]], [[aripiprazole]], [[armodafinil]], [[asparaginase (patient information)|asparaginase]], [[aspirin]], [[atomoxetine]], [[atosiban]], [[atropine]], [[auranofin]], [[axitinib]], [[azacitidine]], [[azathioprine]], [[azithromycin]], [[aztreonam]], [[barbiturate]], [[barium Sulfate]], [[basiliximab]], [[bCG vaccine]], [[Belladonna Alkaloid Combinations and Phenobarbital|belladonna alkaloid]] [[benzodiazepine]], [[benztropine]], [[benzphetamine]], [[benzylpiperazine]], [[betaine]], [[beta-lactam antibiotic]], [[Bevacizumab|bevacizumab]], [[beta blockers]], [[bezafibrate]], [[bicalutamide]], [[bleomycin]], [[blinatumomab]], [[botulinum antitoxin]], [[bortezomib]], [[bosutinib]], [[botulinum toxin]], [[bromelain]], [[bromocriptine]], [[bromomethane]], [[bronchodilator]], [[butalbital]], [[buprenorphine]], [[bupropion]], [[busulfan]], [[butanethiol]], [[butorphanol]], [[cabergoline]], [[calcitonin]], [[calcitriol]], [[calcium carbamide]], [[calcium channel antagonists]], [[capecitabine]], [[capsaicin]], [[carbamates]], [[Carbidopa and Levodopa|carbidopa and levodopa]], [[carboplatin]], [[carmustine]], [[carprofen]], [[carvedilol]], [[caspofungin]], [[cefaclor]], [[cefixime]], [[ceritinib]], [[cetrorelix]], [[cefoperazone Sodium Injection (patient information)|cefoperazone sodium]], [[cefotaxime sodium]], [[cefotetan disodium]], [[cefprozil]], [[ceftibuten]], [[cefuroxime]], [[ceftibuten]], [[ceftaroline fosamil]], [[cefuroxime]], [[cephalosporin]], [[cetuximab]], [[cetuximab injection ]] , [[cevimeline]], [[chelation therapy]], [[chemotherapy]], [[chloral hydrate]], [[chlordiazepoxide]], [[chloromethane]], [[chlorothiazide]], [[chlorpropamide]], [[CHOP]], [[cimicifuga racemosa]], [[ciprofloxacin]], [[cisplatin]], [[citalopram]], [[cladribine]], [[clarithromycin]], [[clindamycin]], [[clofarabine]], [[clofibrate]], [[clomifene]], [[clorazepate]], [[clozapine]], [[cobicistat]], [[co-codamol]], [[codeine]], [[colchicine]], [[colestyramine]], [[combined oral contraceptive pill]], [[conjugated estrogens/bazedoxifene]], [[contraceptive patch]], [[crizotinib]], [[cyclobenzaprine]], [[cyclophosphamide]], [[cytisine]], [[cytarabine]], [[cytarabine liposome]], [[cytisine]],[[capsaicin]], [[dacarbazine ]] , [[dactinomycin ]] , [[dalfampridine]], [[danazol]], [[dantrolene]], [[daptomycin]], [[Darbepoetin Alfa Injection|darbepoetin alfa Injection]] , [[darunavir ]] , [[daunorubicin ]] , [[deferasirox ]] , [[deferiprone]], [[defibrotide]], [[denileukin diftitox]], [[desmopressin]], [[dexamethasone]], [[dexchlorpheniramine]], [[dexrazoxane]], [[Dextroamphetamine and Amphetamine|dextroamphetamine and amphetamine]], [[dextromethorphan]], [[dextropropoxyphene]], [[diazepam]], [[diazinon]], [[dicofol]], [[didanosine]], [[diethyl ether]], [[diethylcathinone]], [[diflunisal]], [[digitoxin]], [[digoxin]], [[diethylcathinone]], [[diethyl ether]], [[dimercaprol]], [[dinoprostone]], [[dipyridamole]], [[disulfiram ]] , [[diuretic]], [[docetaxel ]] , [[dofetilide ]] , [[dolasetron ]] , [[donepezil ]] , [[doripenem]], [[dosulepin hydrochloride]], [[doxorubicin hydrochloride]], [[doxycycline]], [[Drospirenone and Ethinyl estradiol|drospirenone and ethinyl estradiol]], [[DTPA]], [[duloxetine]], [[ecallantide]], [[eculizumab]], [[efavirenz]], [[elvitegravir]], [[enfuvirtide]], [[entecavir]], [[epinephrine (aerosol)]], [[ergometrine]], [[ergotamine]], [[eribulin]], [[erlotinib]], [[erythromycin]], [[estradiol valerate and estradiol valerate/dienogest]], [[eslicarbazepine acetate]], [[ethcathinone]], [[ethchlorvynol]], [[ethosuximide]], [[ethynodiol diacetate and ethinyl estradiol]], [[ethyl carbamate]], [[emetine]], [[emtricitabine]], [[Emtricitabine, Rilpivirine Hydrochloride, And Tenofovir Disoproxil Fumarate|rilpivirine hydrochloride, and tenofovir disoproxil fumarate]], [[endosulfan]], [[entacapone]], [[efavirenz]], [[enfuvirtide]], [[entecavir ]] , [[elosulfase alfa]], [[epinephrine (aerosol)]], [[epirubicin hydrochloride]], [[epoetin Alfa ]] , [[eribulin]], [[eliglustat]], [[erlotinib ]] , [[erythromycin]], [[estradiol]], [[estrogen and Progestin (Oral Contraceptives) ]] , [[ethcathinone]], [[ethchlorvynol]], [[ethyl carbamate]], [[ethylmorphine]], [[etidronate ]] , [[etodolac]], [[etoposide]], [[exemestane]], [[exenatide]], [[felbamate]], [[fentanyl Oral Transmucosal ]] [[fexofenadine]], [[filgrastim]], [[fioricet]], [[flavoxate]], [[fludarabine phosphate]], [[fluorouracil]], [[flurazepam]],[[Flurbiprofen]], [[floxuridine]], [[fluconazole]], [[flucytosine]], [[fludarabine Phosphate]], [[flunisolide]], [[fluorescein sodium]], [[fluorouracil ]] , [[flurazepam]], [[flurbiprofen]], [[flutamide ]] , [[Fluticasone]], [[foscarnet sodium]], [[fulvestrant]], [[galantamine]], [[gallium nitrate]], [[gabapentin]], [[gamma-Hydroxybutyric acid]], [[gatifloxacin ]] , [[gefitinib ]] , [[gemcitabine]], [[gemeprost]], [[general anaesthesia]], [[gestrinone]], [[glimepiride]], [[glipizide]], [[glucagon]], [[glucarpidase]], [[glycylcycline]], [[glycopyrrolate]], [[glyburide]], [[glyburide and Metformin]], [[glycylcycline]], [[goserelin ]] , [[Graft-versus-host disease]], [[granisetron ]] , [[grifulvin V]], [[guaifenesin]], [[H1 antihistamine]], [[herkinorin]], [[heroin]], [[hydralazine]], [[hydrochlorothiazide]], [[hydrocodone]], [[Hydrocodone bitartrate and Homatropine methylbromide|hydrocodone bitartrate and homatropine methylbromide]], [[hydrocortisone]], [[hydromorphone]], [[hydroxycarbamide]], [[hydroxychloroquine]], [[hydroxocobalamin]], [[hydroxyurea]], [[hydroxyzine]], [[hydroxyprogesterone caproate]], [[Ibogaine]], [[Ibuprofen]], [[Ibrutinib]], [[Ibritumomab tiuxetan]], [[Idarubicin ]] , [[Idursulfase]], [[Ifosfamide ]] , [[Imatinib ]] , [[Imiglucerase]], [[Imipenem]], [[Indinavir]], [[Interferon gamma]], [[Interferon alfa-2b]], [[Iodomethane]], [[Irinotecan hydrochloride]], [[Isoniazid]], [[Isoproterenol (aerosol)]], [[Isopropyl alcohol]], [[Isosorbide mononitrate]], [[Isotretinoin]], [[Itraconazole]], [[Ivacaftor]], [[Ivermectin]], [[Ixabepilone]], [[kaopectate]], [[ketorolac]], [[lacosamide]], [[lactulose]], [[lamivudine]], [[lanreotide]], [[lansoprazole]], [[lanthanum carbonate]], [[lapatinib]], [[lenalidomide]], [[letrozole ]] , [[leuprolide ]] , [[Levodopa and Carbidopa|levodopa and carbidopa]] , [[levofloxacin]], [[levonorgestrel]], [[lidocaine (ointment)]], [[lithium nitrate]], [[lomefloxacin hydrochloride]], [[lorcaserin]], [[lopinavir]], [[loprazolam]], [[lorazepam]], [[lovaza]], [[malaria prophylaxis]], [[mazindol]], [[mechlorethamine ]] , [[medazepam]], [[megestrol ]] , [[melarsoprol]], [[melphalan ]] , [[mercaptopurine]], [[meropenem]], [[mesalamine ]] , [[mescaline]], [[mesna]], [[metformin]], [[methadone]], [[methenamine]], [[methotrexate]], [[methylergonovine]], [[methylketobemidone]], [[methylphenidate]], [[methyprylon]], [[metronidazole]], [[micafungin sodium]], [[mifepristone]], [[milk of magnesia]], [[milnacipran hydrochloride]], [[miltefosine]], [[mirtazapine]], [[misoprostol]], [[mitomycin ]] , [[mitotane]], [[mitoxantrone]], [[moclobemide]], [[monocrotophos]], [[morphine]], [[motofen]], [[moxifloxacin]], [[mycophenolic acid]], [[nabilone]], [[nafcillin]], [[nalbuphine]], [[nalmefene]], [[naloxone]], [[naphthalene]], [[naproxen sodium]], [[natamycin]], [[niacin/simvastatin]], [[nicorandil]], [[nilotinib]], [[nilutamide]], [[nintedanib]], [[nitrazepam]], [[nitrofurantoin]], [[nizatidine]], [[Norethindrone acetate and Ethinyl estradiol|norethindrone acetate and ethinyl estradiol]], [[Norgestimate and Ethinyl estradiol|norgestimate and ethinyl estradiol]], [[Norgestrel and Ethinyl estradiol|norgestrel and ethinyl estradiol]], [[olanzapine ]] , [[olsalazine]], [[omeprazole ]] , [[ondansetron]], [[opioid]], [[oprelvekin]], [[oritavancin]], [[oseltamivir ]] , [[oxaliplatin]], [[oxamniquine]], [[oxazepam]], [[oxcarbazepine]], [[oxybutynin ]] , [[oxycodone and aspirin ]] , [[oxytocin]], [[Paclitaxel]], [[palbociclib]], [[paliperidone ]] , [[palonosetron]], [[panitumumab]], [[pantoprazole]], [[papaverine]], [[paromomycin sulfate]], [[pazopanib hydrochloride]], [[paracetamol]], [[paroxetine]], [[pasireotide]], [[pegaspargase ]] , [[pemetrexed ]] , [[penicillin]], [[pentamidine]], [[pentavalent antimonial]], [[pentetic acid]], [[pentostatin ]] , [[pergolide ]] , [[perhexiline]], [[pertuzumab]], [[pirfenidone]], [[piroxicam]], [[phenelzine]], [[phenoxymethylpenicillin]], [[phentermine]], [[phenylephrine]], [[physostigmine]], [[pholcodine]], [[pilocarpine]], [[pioglitazone ]] , [[piribedil]], [[plerixafor]], [[plicamycin ]] ,[[posaconazole ]] , [[potassium chloride]], [[potassium citrate]], [[praziquantel]], [[pregabalin ]] , [[primaquine phosphate]], [[potassium iodide]], [[primaquine]][[procainamide ]] , [[procarbazine ]] , [[prochlorperazine]], [[progesterone]], [[propiram]], [[propylketobemidone]], [[prosidol]], [[protriptyline ]] , [[pyrantel pamoate]][[pyrazinamide]], [[pyridostigmine]], [[quetiapine ]] , [[quinupristin/dalfopristin]], [[radium chloride]], [[ramelteon]], [[ranolazine ]] , [[ranitidine]], [[rasburicase]], [[rasagiline ]] , [[reserpine]], [[ribavirin]], [[rifabutin]], [[rifaximin]], [[risedronate ]] , [[ritonavir]], [[rituximab ]] , [[rivastigmine ]] , [[rizatriptan ]] , [[ropinirole ]] , [[roflumilast]], [[rotigotine]], [[roxithromycin]], [[rubbing alcohol]], [[salsalate ]] , [[saquinavir mesylate]], [[sarin]], [[sargramostim]], [[stavudine]], [[sativex]], [[saxagliptin hydrochloride and Metformin hydrochloride]], [[secretin human]], [[secobarbital]], [[selegiline ]] , [[seliciclib]], [[serotonin]], [[sibutramine]], [[sipuleucel-T]], [[sodium oxybate]], [[sodium polystyrene sulfonate]], [[sodium stibogluconate]], [[sodium sulfate, potassium sulfate and magnesium sulfate]], [[solanine]], [[spironolactone]], [[Stiripentol]], [[streptozocin]], [[streptomycin]], [[streptozocin]], [[sufentanil]], [[Sulfamethoxazole/Trimethoprim (oral)]], [[sultiame]], [[sumatriptan]], [[sunitinib ]] , [[suramin]],[[tacrolimus]], [[tapentadol]], [[tedizolid]], [[telavancin hydrochloride]], [[telbivudine ]] , [[telithromycin ]] , [[taliglucerase alfa]][[temozolomide]], [[teniposide ]] , [[teriparatide]], [[tetracaine]], [[tetraferric tricitrate decahydrate]], [[tetrahydrocannabinol]], [[tetrahydrozoline]], [[tetramethylsuccinonitrile]], [[tetrodotoxin]], [[thallous Chloride Tl 201]], [[thiabendazole]], [[thiethylperazine]], [[thioguanine]], [[thiotepa ]] , [[Thyroid Medication|thyroid medication]], [[tigecycline]], [[tocopherol]], [[tolcapone ]] , [[tolmetin]], [[topiramate]], [[tolbutamide]], [[topotecan Hydrochloride|topotecan hydrochloride]], [[toremifene]], [[tralomethrin]], [[tramadol]], [[trametinib dimethyl sulfoxide]], [[trandolapril]], [[trastuzumab]], [[trazodone]], [[tretinoin]], [[triamterene]], [[triazolam]], [[triclofos]], [[tricyclic antidepressant]], [[trifluoperazine]], [[trifluoromethylphenylpiperazine]], [[trimeperidine]], [[trimethobenzamide]], [[trimetrexate Glucuronate]], [[tropisetron]], [[trovafloxacin mesylate]], [[valaciclovir]], [[valganciclovir hydrochloride]], [[valproic acid ]] , [[vancomycin]], [[varenicline]], [[venlafaxine]], [[vicodin]], [[vidarabine]], [[vigabatrin]], [[vilazodone]], [[viloxazine]], [[vinblastine ]] , [[vinorelbine Tartrate]], [[vismodegib]], [[von Willebrand factor]], [[voriconazole]], [[vorinostat]], [[vortioxetine]], [[zafirlukast]], [[zidovudine]], [[zolpidem ]] , [[zopiclone]], [[zoledronate]]
|-
|- bgcolor="LightSteelBlue"
|'''Ear Nose Throat'''
| bgcolor="Beige" |[[Balance disorder]], [[decompression sickness]], [[ear infection]], [[epistaxis]], [[glaucoma]], [[labyrinthitis]], [[Ménière's disease]], [[pharyngitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Endocrine'''
| bgcolor="Beige" |[[Acromegaly]], [[addison's disease]], [[adrenal failure]], [[adrenal insufficiency]], [[amyloidosis]], [[anorexia nervosa]], [[carcinoid tumours and carcinoid syndrome]], [[contraceptive patch]], [[diabetic gastroparesis]], [[diabetic ketoacidosis]], [[diabetes mellitus]],[[emergency contraception]], [[gangrene]], [[gestational diabetes]], [[hormone replacement therapy (trans)]],[[hypocalcemia]], [[hypoglycemia]], [[hyperparathyroidism]], [[hyperthyroidism]], [[prolactinoma]], [[syndrome of inappropriate antidiuretic hormone]]([[SIADH]]), [[thyrotoxicosis]], [[Estrogen and Progestin (Hormone Replacement Therapy) (patient information)|estrogen and progestin]], [[multiple endocrine neoplasia type 1]]
|- bgcolor="LightSteelBlue"
|'''Environmental'''
| bgcolor="Beige" |[[Bothrops|Bothrops bite]], [[bromomethane]], [[carbon monoxide poisoning]], [[dioxin]], [[heat stroke]], [[hyperthermia]]
|-
|- bgcolor="LightSteelBlue"
|'''Gastroenterologic'''
| bgcolor="Beige" |[[Achalasia]], [[acute abdomen]], [[accessory pancreas]] , [[acute fatty liver of pregnancy]], [[acute pancreatitis]], [[adjustable gastric band]], [[afferent loop syndrome]], [[alcoholic Hepatitis]], [[alcoholism]], [[anastomosis]] [[stenosis]], [[ anorexia nervosa]], [[appendicitis]], [[bacterial gastroenteritis]], [[beef tapeworm]], [[biliary colic]], [[blastocystosis]], [[bowel obstruction]], [[brucella]], [[bulimia nervosa]], [[caecitis]], [[carcinoid tumours and carcinoid syndrome]], [[chronic intestinal pseudo-obstruction]], [[cholecystitis]], [[cholecystolithiasis]], [[ciguatera]], [[colorectal cancer]], [[congenital hypertrophic pyloric stenosis]], [[Crohn's disease]], [[cryptosporidium parvum]], [[cyclic vomiting syndrome]], [[cyclospora cayetanensis]], [[diabetic gastroparesis]], [[dientamoebiasis]], [[diverticulitis]], [[dumping syndrome]], [[enteric Neuropathy]], [[eosinophilic esophagitis]], [[eosinophilic gastroenteritis]], [[epiploic appendagitis]], [[esophageal achalasia]], [[esophageal cancer]], [[esophageal diverticulum]], [[esophageal stenosis]], [[esophagitis]], [[femoral hernia]], [[food allergies]], [[food poisoning]], [[fundic gland polyposis]], [[functional dyspepsia]], [[gastric carcinoma]], [[gastric outlet obstruction]], [[gastritis]], [[gastrocolic fistula]], [[gastroenteritis]], [[gastroesophageal reflux disease]], [[gastrointestinal perforation]], [[gastroparesis]], [[giardiasis]], [[helicobacter pylori infection]], [[Hellp syndrome]], [[hematemesis]], [[hepatic coma]], [[hepatic porphyria]], [[hepatitis]], [[hepatitis A]], [[hepatitis B]], [[hepatitis D]], [[hepatitis E]], [[hepatobiliary disease]], [[hepatotoxicity ]] , [[hernia]], [[hirschsprung disease]], [[Ileus]], [[Intussusception (medical disorder)]], [[Irritable bowel syndrome]], [[Ischemic bowel]], [[Mesenteric ischemia]], [[peptic ulcer]], [[peritonitis]], [[pyloric stenosis]], [[Reye's syndrome]], [[Small bowel bacterial overgrowth syndrome]], [[Small intestine cancer]], [[traveler's diarrhea]]
|- bgcolor="LightSteelBlue"
|'''Genetic'''
| bgcolor="Beige" |[[Acute intermittent porphyria]], [[congenital malformation]], [[Down syndrome]], [[episodic ataxia]], [[familial hemiplegic migraine]], [[fundic gland polyposis]], [[galactosemia]], [[hereditary fructose intolerance]], [[slone's disease]]
|-
|- bgcolor="LightSteelBlue"
|'''Hematologic'''
| bgcolor="Beige" |[[HELLP syndrome]], [[hemorrhage]], [[mastocytosis]], [[porphyria]], [[splenic infarction]], [[thrombotic thrombocytopenic purpura]]
|-
|- bgcolor="LightSteelBlue"
|'''Iatrogenic'''
| bgcolor="Beige" |[[Essure]], [[dumping syndrome]], [[high doses of ionizing radiation]], [[Instillation abortion]], [[Minimally Invasive Thorasic Spinal Fusion|minimally Invasive thorasic spinal fusion]]
|-
|- bgcolor="LightSteelBlue"
|'''Infectious Disease'''
| bgcolor="Beige" |[[Infections|Acute infections]], [[acute viral nasopharyngitis (common cold)]], [[AIDS]], [[aseptic meningitis]], [[astrovirus]], [[bacillus cereus|bacillus cereus infection]], [[bacterial gastroenteritis]], [[Barcoo Fever|barcoo fever]], [[beef tapeworm]], [[blastocystosis]], [[brucella]], [[colorado tick fever]], [[community-acquired pneumonia]], [[croup]], [[cryptosporidium parvum|cryptosporidium parvum infection]], [[cyclospora cayetanensis|cyclospora cayetanensis infection]], [[dengue fever]], [[diarrheal shellfish poisoning]], [[dientamoebiasis]], [[diphtheria]], [[Duke's disease]], [[ebola]], [[giardia lamblia]], [[Hantavirus pulmonary syndrome]], [[helicobacter pylori infection]], [[henipavirus]], [[hepatitis B]], [[hepatitis D]], [[hepatitis E]], [[hookworm]], [[human ehrlichiosis]], [[Influenza]], [[Intestinal parasite]], [[lassa fever]], [[listeria monocytogenes]], [[malaria]], [[meningococcemia]], [[Naegleria fowleri]], [[norovirus]], [[norwalk Virus]], [[pfiesteria piscicida]], [[poliomyelitis]], [[Q fever]], [[Rocky Mountain spotted fever]], [[Scarlet fever]], [[shigella]], [[Sporotrichosis]], [[staphylococcal enteritis]], [[tularemia]], [[vibrio parahaemolyticus]], [[West Nile virus]], [[waterborne diseases]], [[Yellow fever]]
|-
|- bgcolor="LightSteelBlue"
|'''Musculoskeletal / Ortho'''
| bgcolor="Beige" |[[Decompression sickness]]
|-
|- bgcolor="LightSteelBlue"
|'''Neurologic'''
| bgcolor="Beige" |[[Acoustic neuroma]], [[airsickness]], [[altitude sickness]], [[arachnoid cyst]], [[Aseptic meningitis|aseptic meningitis]], [[autonomic neuropathy]], [[balance disorder]], [[benign intracranial hypertension]] ,[[Brain Stem Gliomas|brain stem gliomas]], [[brain tumor]], [[stroke|cerebellar stroke]], [[cerebral aneurysm]], [[cerebral arteriovenous malformation]], [[cerebral hemorrhage]], [[cerebrovascular disease]], [[cerebral oedema]],[[cerebral shunt ]] , [[cerebrovascular disease]], [[ciguatera]], [[concussion]], [[craniopharyngioma]], [[cyclic vomiting syndrome]], [[decompression sickness]], [[encephalitis]], [[enteric Neuropathy|enteric neuropathy]], [[ependymoma]], [[epidural haemorrhage]], [[episodic ataxia]], [[familial hemiplegic migraine]], [[glioblastoma multiforme]], [[glioma]], [[heavy metal ingestion]], [[hemicrania continua]], [[hepatic coma]], [[hydrocephalus]], [[La Crosse encephalitis]], [[Sea sickness]], [[subdural hematoma]], [[Tabes dorsalis]], [[vagal episode]], [[vertebrobasilar insufficiency]], [[vestibular neuritis]]
|-
|- bgcolor="LightSteelBlue"
|'''Nutritional / Metabolic'''
| bgcolor="Beige" |[[5-hydroxytryptophan]], [[acute intermittent porphyria]], [[amnesic shellfish poisoning]], [[amyloidosis]], [[bromelain]], [[cicuta]], [[cimicifuga racemosa]],[[coprinopsis atramentaria]], [[food allergies]], [[food intolerance]], [[food poisoning]], [[galactosemia]], [[ginger]], [[hereditary fructose intolerance]], [[hypercalcemia]], [[hypermagnesemia]], [[hypervitaminosis A]], [[hypervitaminosis]], [[hypocalcemia]], [[hypocholermia]], [[hypoglycemia]], [[hypokalemia]], [[hyponatremia]], [[ketogenic diet]], [[lactose intolerance]], [[metabolic acidosis]], [[pyridoxine deficiency]]
|-
|- bgcolor="LightSteelBlue"
|'''Obstetric/Gynecologic'''
| bgcolor="Beige" |[[Acute fatty liver of pregnancy]], [[breastfeeding complications]], [[childbirth]], [[contraceptive patch]], [[endometriosis]], [[emergency contraception]],[[Estrogen and Progestin (Oral Contraceptives)|estrogen and progestin]], [[essure]], [[gestational diabetes]], [[HELLP syndrome]], [[hydatidiform mole]], [[hyperemesis gravidarum]], [[ovarian cyst]], [[ovarian hyperstimulation syndrome]], [[ovarian torsion]], [[pregnancy]], [[salpingitis]], [[twisted ovarian cyst]]
|-
|- bgcolor="LightSteelBlue"
|'''Oncologic'''
| bgcolor="Beige" |[[Acoustic neuroma]], [[Brain Stem Gliomas|brain stem gliomas]], [[brain tumor]], [[cancer]], [[carcinoid tumours and carcinoid syndrome]], [[colorectal cancer]][[craniopharyngioma]], [[ependymoma]], [[esophageal cancer]], [[gastric carcinoma]], [[glioblastoma multiforme]], [[glioma]], [[Kaposi's sarcoma]], [[Non-Hodgkin lymphoma]], [[osteosarcoma]], [[prolactinoma]], [[Zollinger-Ellison Syndrome]]
|-
|- bgcolor="LightSteelBlue"
|'''Opthalmologic'''
| bgcolor="Beige" |[[Acute angle-closure glaucoma]], [[glaucoma]], [[refractive error]]
|-
|- bgcolor="LightSteelBlue"
|'''Overdose / Toxicity'''
| bgcolor="Beige" |[[1,2-Dichloroethene]], [[1,3-Dichloropropene]], [[2C-E]], [[2C-I]], [[2C-T-7]], [[abrin]], [[alcoholism]], [[alcohol withdrawal]], [[beleric]], [[cinchonism]], [[ethanol abuse]], [[hangover]], [[heavy metal ingestion]], [[heroin]], [[orellanine]], [[Reye's syndrome]], [[marine toxins]], [[PMA]]
|- bgcolor="LightSteelBlue"
|'''Psychiatric'''
| bgcolor="Beige" |[[Alcohol Withdrawal]], [[alcoholism]], [[anorexia nervosa]], [[anxiety]], [[anxiety disorders]], [[bulimia nervosa]], [[chronic fatigue syndrome]], [[combat stress reaction]], [[depression]], [[ethanol abuse]], [[hangover]], [[sexual fetish]] ([[emetophilia]]), [[SSRI discontinuation syndrome]] [[Hypochondriasis]]<ref name="pmid1263596">{{cite journal |vauthors=Swanson DW, Swenson WM, Huizenga KA, Melson SJ |title=Persistent Nausea without organic cause |journal=Mayo Clin Proc |volume=51 |issue=5 |pages=257–62 |date=May 1976 |pmid=1263596 |doi= |url=}}</ref>
|-
|- bgcolor="LightSteelBlue"
|'''Pulmonary'''
| bgcolor="Beige" |[[Acute viral nasopharyngitis (common cold)]], [[altitude sickness]], [[anaphylaxis]], [[aortic arch anomalies]], [[community acquired pneumonia]], [[croup]], [[decompression sickness]], [[Hantavirus pulmonary syndrome]], [[lower respiratory tract infection]], [[pulmonary embolism]], [[ pharyngitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Renal / Electrolyte'''
| bgcolor="Beige" |[[Dehydration]], [[diabetic ketoacidosis]], [[hypercalcemia]], [[hypermagnesemia]], [[hypocalcemia]], [[hypocholermia]], [[hypokalemia]], [[hyponatraemia]], [[Interstitial nephritis]], [[nutcracker syndrome]], [[pyelonephritis]], [[renal colic]], [[renal failure]], [[renal stones]], [[ urinary tract infections]]
|-
|- bgcolor="LightSteelBlue"
|'''Rheum / Immune / Allergy'''
| bgcolor="Beige" |[[Amyloidosis]], [[anaphylaxis]], [[chronic fatigue syndrome]], [[Crohn's disease]], [[food allergies]], [[food intolerance]], [[Graft-versus-host disease]], [[scleroderma]], [[Tetanus, Diphtheria, and Pertussis (Tdap) Vaccine|tetanus, diphtheria, and pertussis (Tdap) vaccine]], [[typhoid Vaccine]], [[HIV]]
|-
|- bgcolor="LightSteelBlue"
|'''Sexual'''
| bgcolor="Beige" |[[HIV]]
|-
|- bgcolor="LightSteelBlue"
|'''Trauma'''
| bgcolor="Beige" |[[Head trauma]], [[hemorrhage]], [[post-concussion syndrome]]
|-
|- bgcolor="LightSteelBlue"
|'''Urologic'''
| bgcolor="Beige" |[[Acute prostatitis]], [[testicular rupture]], [[testicular torsion]], [[urinary tract infections]], [[urolithiasis]]
|-
|- bgcolor="LightSteelBlue"
|'''Miscellaneous'''
| bgcolor="Beige" |[[Anadenanthera peregrina]], [[exercise induced nausea]], [[extreme pain]], [[foreign bodies]], [[sleep deprivation]], [[soapwort]], [[ulcers]], [[water intoxication]], [[cyclic vomiting syndrome]], [[DTPA]], [[ginkgo]]
|-
|}

{{columns-list||
* [[1,2-Dichloroethene]]
* [[1,3-Dichloropropene]]
* [[2C-E]]
* [[2C-I]]
* [[2C-T-7]]
* [[2-Ethylhexanol]]
* [[5-Hydroxytryptophan]]
* [[5-MeO-AMT]]
* [[Abrin]]
* [[Abscess]]
* [[ABVD]]
* [[Acamprosate calcium]]
* [[Accessory pancreas]]
* [[Acetaminophen]]
* [[Acetoxyketobemidone]]
* [[Acetylcysteine]]
* [[Achalasia]]
* [[Aclarubicin]]
* [[Acyclovir]]
* [[Aconitine]]
* [[Acoustic neuroma]]
* [[Acromegaly]]
* [[Actinomycin|Actinomycin D]]
* [[Acute angle-closure glaucoma]]
* [[Acute coronary syndromes]]
* [[Acute fatty liver of pregnancy]]
* [[Acute intermittent porphyria]]
* [[Acute pancreatitis]]
* [[Acute prostatitis]]
* [[Acute viral nasopharyngitis (common cold)]]
* [[Adamsite]]
* [[Adenovirus]]
* [[Addison's Disease]]
* [[Adjustable gastric band]]
* [[Adrenal insufficiency]]
* [[Afferent loop syndrome]]
* [[Airsickness]]
* [[Alatrofloxacin Injection]]
* [[Albuterol Inhalation]]
* [[Alcohol withdrawal]]
* [[Alcoholism]]
* [[Aldesleukin]]
* [[Alemtuzumab]]
* [[Allylprodine]]
* [[Alpha-Methyltryptamine]]
* [[Alprazolam]]
* [[Altitude sickness]]
* [[Altretamine]]
* [[Amantadine]]
* [[Amifostine]]
* [[Amineptine]]
* [[Aminocaproic acid]]
* [[Aminophylline]]
* [[Aminopterin]]
* [[Aminosalicylic acid]]
* [[Amitriptyline]]
* [[Ammonium chloride]]
* [[Amnesic shellfish poisoning]]
* [[Amoxicillin]]
* [[Amphotericin B]]
* [[Amrinone]]
* [[Amyl nitrite]]
* [[Amyloidosis]]
* [[Anadenanthera peregrina]]
* [[Anaphylaxis]]
* [[Anastrozole]]
* [[Anesthesia]]
* [[Angina pectoris]]
* [[Anorexia nervosa]]
* [[Antiarrhythmics]]
* [[Antibiotics]]
* [[Anticonvulsants]]
* [[Antihistamine]]
* [[Antihypertensives]]
* [[Antiretroviral drug]]
* [[Anxiety]]
* [[Aortic arch anomalies]]
* [[Apomorphine hydrochloride]]
* [[Appendicitis]]
* [[Aprepitant]]
* [[Arachnoid cyst]]
* [[Aripiprazole]]
* [[Arsenicals]]
* [[Arsenic Poisoning]]
* [[Arsenic trioxide]]
* [[Ascariasis]]
* [[Aseptic meningitis]]
* [[Asparaginase]]
* [[Aspirin]]
* [[Astrovirus]]
* [[Atomoxetine]]
* [[Atosiban]]
* [[Atripala]] ([[Efavirenz, emtricitabine and tenofovir disoproxil fumarate]])
* [[Auranofin]]
* [[Autonomic neuropathy]]
* [[Azathioprine]]
* [[Azithromycin]]
* [[Aztreonam]]
* [[Bacillus cereus]]
* [[Bacterial gastroenteritis]]
* [[Balance disorder]]
* [[Barbiturate]]
* [[Barcoo Fever|Barcoo fever]]
* [[Barium oxalate]]
* [[Barium sulfate]]
* [[BCG vaccine]]
* [[Beef tapeworm]]
* [[Beleric]]
* [[Belladonna Alkaloid Combinations and Phenobarbital|Belladonna alkaloid combinations]]
* [[Benign intracranial hypertension]]
* [[Benzodiazepine]]
* [[Benzylpiperazine]]
* [[Beta blockers]]
* [[Beta-lactam antibiotic]]
* [[Bevacizumab Injection (patient information)|Bevacizumab Injection]]
* [[Bezafibrate]]
* [[Bicalutamide]]
* [[Biliary colic]]
* [[Blastocystosis]]
* [[Bleomycin ]]
* [[Bortezomib]]
* [[Botulinum toxin]]
* [[Bowel obstruction]]
* [[Brain Stem Gliomas|Brain stem gliomas]]
* [[Brain tumor]]
* [[Breastfeeding complications]]
* [[Bromelain]]
* [[Bromomethane]]
* [[Bronchodilator]]
* [[Brucella]]
* [[Buprenorphine Hydrochloride, Naloxone Hydrochloride|Buprenorphine,naloxone]]
* [[Bulimia nervosa]]
* [[Buprenorphine]]
* [[Bupropion]]
* [[Busulfan]]
* [[Butanethiol]]
* [[Butorphanol]]
* [[Cabergoline]]
* [[Caecitis]]
* [[Calcitonin]]
* [[Calcitriol]]
* [[Calcium carbamide]]
* [[Calcium channel antagonists]]
* [[Camphor|Camphor poisoning]]
* [[Cancer]]
* [[Capecitabine]]
* [[Capsaicin]]
* [[Carbon monoxide poisoning]]
* [[Carboplatin]]
* [[Carcinoid tumours and carcinoid syndrome]]
* [[Cardiac arrhythmia]]
* [[Carmustine]]
* [[Carprofen]]
* [[Carvedilol]]
* [[Caspofungin]]
* [[Cefaclor]]
* [[Cefixime]]
* [[Cefoperazone Sodium Injection (patient information)|Cefoperazone Sodium Injection]]
* [[Cefotetan disodium]]
* [[Cefprozil]]
* [[Ceftaroline fosamil]]
* [[Ceftibuten]]
* [[Cefuroxime]]
* [[Cephalosporin]]
* [[Cerebral aneurysm]]
* [[Cerebral arteriovenous malformation]]
* [[Cerebral edema]]
* [[Cerebral hemorrhage]]
* [[Cerebral shunt]]
* [[Cerebrovascular disease]]
* [[Cetuximab Injection]]
* [[Cevimeline]]
* [[Chelation therapy]]
* [[Chemotherapy]]
* [[Childbirth]]
* [[Chloral hydrate]]
* [[Chlordiazepoxide]]
* [[Chloromethane]]
* [[Chlorothiazide]]
* [[Chlorpropamide]]
* [[Cholecystitis]]
* [[Cholecystolithiasis]]
* [[CHOP]]
* [[Chronic fatigue syndrome]]
* [[Chronic intestinal pseudo-obstruction]]
* [[Cicuta]]
* [[Ciguatera]]
* [[Cimicifuga racemosa]]
* [[Cinchonism]]
* [[Ciprofloxacin]]
* [[Cisplatin]]
* [[Citalopram]]
* [[Cladribine]]
* [[Clarithromycin]]
* [[Clindamycin]]
* [[Clofarabine]]
* [[Clofibrate]]
* [[Clomifene]]
* [[Clorazepate]]
* [[Clostridium perfringens]]
* [[Cobicistat]]
* [[Co-codamol]]
* [[Codeine]]
* [[Colchicine]]
* [[Colestyramine]]
* [[Colorado tick fever]]
* [[Colorectal cancer]]
* [[Combat stress reaction]]
* [[Community-acquired pneumonia]]
* [[Concussion]]
* [[Congenital hypertrophic pyloric stenosis]]
* [[Congenital malformation]]
* [[Contraceptive patch]]
* [[Copper|Copper salts]]
* [[Coprinopsis atramentaria]]
* [[Craniopharyngioma]]
* [[Crohn's disease]]
* [[Croup]]
* [[Cryptosporidium parvum]]
* [[Cyanogen]]
* [[Cyclic vomiting syndrome]]
* [[Cyclobenzaprine]]
* [[Cyclophosphamide]]
* [[Cyclospora cayetanensis]]
* [[Cytarabine]]
* [[Cytisine]]
* [[Dacarbazine]]
* [[Dactinomycin]]
* [[Danazol]]
* [[Dantrolene]]
* [[Daptomycin]]
* [[Darbepoetin Alfa Injection (patient information)|Darbepoetin Alfa Injection]]
* [[Darunavir]]
* [[Daunorubicin]]
* [[Decompression sickness]]
* [[Deferasirox]]
* [[Deferiprone]]
* [[Defibrotide]]
* [[Dehydration]]
* [[Dengue fever]]
* [[Depression]]
* [[Desmopressin]]
* [[Dexamethasone]]
* [[Dextroamphetamine and Amphetamine (patient information)|Dextroamphetamine and Amphetamine]]
* [[Dextromethorphan]]
* [[Dextropropoxyphene]]
* [[Diabetes mellitus]]
* [[Diabetic gastroparesis]]
* [[Diabetic Ketoacidosis]]
* [[Diarrheal shellfish poisoning]]
* [[Diazepam]]
* [[Diazinon]]
* [[Dicofol]]
* [[Didanosine]]
* [[Dientamoebiasis]]
* [[Diethyl ether]]
* [[Diethylcathinone]]
* [[Diflunisal]]
* [[Digitalis purpurea]]
* [[Digitoxin]]
* [[Digoxin]]
* [[Dioxathion]]
* [[Dioxin]]
* [[Diphtheria]]
* [[Disulfiram]]
* [[Diuretic]]
* [[Diverticulitis]]
* [[Docetaxel]]
* [[Dofetilide]]
* [[Dolasetron]]
* [[Donepezil]]
* [[Doripenem]]
* [[Dosulepin hydrochloride]]
* [[Down syndrome]]
* [[Doxorubicin Hydrochloride]]
* [[DTPA]]
* [[Duke's disease]]
* [[Duloxetine]]
* [[Dumping syndrome]]
* [[Ear infection]]
* [[Ebola virus disease]]
* [[Eculizumab]]
* [[Efavirenz]]
* [[Elvitegravir]]
* [[Emergency contraception]]
* [[Emetine]]
* [[Encephalitis]]
* [[Endometriosis]]
* [[Endosulfan]]
* [[Enfuvirtide]]
* [[Entecavir]]
* [[Enteric Neuropathy]]
* [[Enterobiasis]]
* [[Eosinophilic gastroenteritis]]
* [[Epidural haemorrhage]]
* [[Ependymoma]]
* [[Epiploic appendagitis]]
* [[Epirubicin hydrochloride]]
* [[Episodic ataxia]]
* [[Epistaxis]]
* [[Epoetin Alfa Injection (patient information)|Epoetin Alfa Injection]]
* [[Ergotamine]]
* [[Ergotism]]
* [[Eribulin]]
* [[Erlotinib]]
* [[Erythromycin]]
* [[Esophageal achalasia]]
* [[Esophageal cancer]]
* [[Esophageal diverticulum]]
* [[Esophageal stenosis]]
* [[Esophagitis]]
* [[Essure]]
* [[Estradiol]]
* [[Estrogen and Progestin (Oral Contraceptives) (patient information)|Estrogen and Progestin ]]
* [[Ethanol abuse]]
* [[Ethcathinone]]
* [[Ethchlorvynol]]
* [[Ethosuximide]]
* [[Ethyl carbamate]]
* [[Ethylmorphine]]
* [[Etidronate]]
* [[Etoposide]]
* [[Exemestane]]
* [[Exenatide]]
* [[Exercise induced nausea]]
* [[Exercise urticaria]]
* [[Extreme pain]]
* [[Familial hemiplegic migraine]]
* [[Felbamate]]
* [[Femoral hernia]]
* [[Fentanyl Oral Transmucosal (patient information)|Fentanyl Oral Transmucosal]]
* [[Fexofenadine]]
* [[Filgrastim]]
* [[Fioricet]]
* [[Fluorouracil]]
* [[Floxuridine]]
* [[Flu]]
* [[Fluconazole]]
* [[Flucytosine]]
* [[Fludarabine Phosphate]]
* [[Flunisolide]]
* [[Fluorescein sodium]]
* [[Fluoride poisoning]]
* [[Fluorouracil]]
* [[Flurazepam]]
* [[Flurbiprofen]]
* [[Flutamide]]
* [[Fluticasone]]
* [[Food allergies]]
* [[Food intolerance]]
* [[Food poisoning]]
* [[Foreign bodies]]
* [[Fructose intolerance]] [[hypoglycemia]]
* [[Fulvestrant Injection (patient information)|Fulvestrant Injection]]
* [[Functional dyspepsia]]
* [[Fundic gland polyposis]]
* [[Gabapentin]]
* [[Galactosemia]]
* [[Galantamine]]
* [[Gamma-Hydroxybutyric acid]]
* [[Gangrene]]
* [[Gastric carcinoma]]
* [[Gastric outlet obstruction]]
* [[Gastritis]]
* [[Gastrocolic fistula]]
* [[Gastroenteritis]]
* [[Gastroesophageal reflux disease]]
* [[Gastrointestinal perforation]]
* [[Gastroparesis]]
* [[Gatifloxacin]]
* [[Gefitinib]]
* [[Gemcitabine Hydrochloride (patient information)|Gemcitabine hydrochloride]]
* [[Gemeprost]]
* [[Gestational diabetes]]
* [[Gestrinone]]
* [[Giardia lamblia]]
* [[Giardiasis]]
* [[Ginger]]
* [[Ginkgo]]
* [[Glaucoma]]
* [[Glioblastoma multiforme]]
* [[Glioma]]
* [[Glucagon]]
* [[Glycylcycline]]
* [[Goserelin]]
* [[Graft-versus-host disease]]
* [[Granisetron]]
* [[Green Tobacco Sickness|Green tobacco sickness]]
* [[Grifulvin V]]
* [[Griseofulvin]]
* [[Guaifenesin]]
* [[Hangover]]
* [[Hantavirus pulmonary syndrome]]
* [[Head trauma]]
* [[Heart failure]]
* [[Heat stroke]]
* [[Heavy metal ingestion]]
* [[Helicobacter pylori infection]]
* [[HELLP syndrome]]
* [[Hematemesis]]
* [[Hemicrania continua]]
* [[Hemorrhage]]
* [[Henipavirus]]
* [[Hepatic coma]]
* [[Hepatic porphyria]]
* [[Hepatitis]]
* [[Hepatitis B]]
* [[Hepatitis D]]
* [[Hepatitis E]]
* [[Hepatobiliary disease]]
* [[Hereditary fructose intolerance]]
* [[Herkinorin]]
* [[Hernia]]
* [[Heroin]]
* [[Hirschsprung disease]]
* [[HIV]]
* [[Hookworm]]
* [[Hormone replacement therapy (trans)]]
* [[Human ehrlichiosis]]
* [[Hydralazine]]
* [[Hydrocephalus]]
* [[Hydrochlorothiazide]]
* [[Hydrocodone]]
* [[Hydromorphone]]
* [[Hydroxychloroquine]]
* [[Hydroxocobalamin]]
* [[Hydroxyurea]]
* [[Hydroxyzine]]
* [[Hypercalcemia]]
* [[Hyperemesis gravidarum]]
* [[Hypermagnesemia]]
* [[Hyperparathyroidism]]
* [[Hypertension]]
* [[Hyperthermia]]
* [[Hyperthyroidism]]
* [[Hypervitaminosis A]]
* [[Hypocalcemia]]
* [[Hypocholermia]]
* [[Hypoglycemia]]
* [[Hypokalemia]]
* [[Hyponatremia]]
* [[Hypoparathyroidism]]
* [[Hysterical contagion]]
* [[Iatrogenesis]]
* [[Ibogaine]]
* [[Ibuprofen]]
* [[Idarubicin]]
* [[Idiopathic]]
* [[Ifosfamide]]
* [[Ileus]]
* [[Imatinib]]
* [[Imipenem]]
* [[Inappetence]]
* [[Inborn errors of metabolism]]
* [[Incarcerated hernia]]
* [[Indinavir]]
* [[Indometacin]]
* [[Infarction]]
* [[Inflammatory bowel disease]]
* [[Infliximab]]
* [[Influenza]]
* [[Inguinal hernia]]
* [[Instillation abortion]]
* [[Insulin lispro]]
* [[Interferon gamma]]
* [[Interstitial nephritis]]
* [[Intracranial mass]]
* [[Intestinal atresia]]
* [[Intestinal parasite]]
* [[Intestinal volvulus]]
* [[Intracranial haemorrhage]]
* [[Intracranial hypertension]]
* [[Intussusception]]
* [[Ipecacuanha]]
* [[Iodomethane]]
* [[Irinotecan hydrochloride]]
* [[Iron(II) sulfate]]
* [[Irritable bowel syndrome]]
* [[Irukandji syndrome]]
* [[Ischemic bowel]]
* [[Isoniazid]]
* [[Isopropyl alcohol]]
* [[Isosorbide mononitrate]]
* [[Isotretinoin]]
* [[Itraconazole]]
* [[Ivacaftor]]
* [[Ixabepilone]]
* [[Jamaican vomiting sickness]]
* [[Janumet]] ([[sitagliptin]] and [[metformin]])
* [[Kaopectate]]
* [[Kaposi's sarcoma]]
* [[Ketoconazole]]
* [[Ketogenic diet]]
* [[Ketorolac]]
* [[Ketotic hypoglycemia]]
* [[La Crosse encephalitis]]
* [[Labyrinthitis]]
* [[Lactose intolerance]]
* [[Lanreotide]]
* [[Lansoprazole]]
* [[Large bowel obstruction]]
* [[Lassa fever]]
* [[Lead poisoning]]
* [[Letrozole]]
* [[Leuprolide]]
* [[Levodopa and Carbidopa]]
* [[Levofloxacin]]
* [[Levonorgestrel]]
* [[Lewisite]]
* [[Lindane]]
* [[Listeria monocytogenes]]
* [[Lithium]]
* [[Lithium nitrate]]
* [[Lobelia]]
* [[Lomefloxacin hydrochloride]]
* [[Lomotil]]
* [[Lopinavir]]
* [[Loprazolam]]
* [[Lorazepam]]
* [[Lower respiratory tract infection]]
* [[Lubiprostone]]
* [[Lysuride]]
* [[Malaria]]
* [[Malaria prophylaxis]]
* [[Malignancy]]
* [[Intestinal malrotation|Malrotation]]
* [[Marine toxins]]
* [[Mass effect (medicine)|Mass lesion]]
* [[Mastocytosis]]
* [[Mazindol]]
* [[Mechlorethamine]]
* [[Medazepam]]
* [[Medical cannabis]]
* [[Megestrol]]
* [[Melarsoprol]]
* [[Melphalan]]
* [[Ménière's disease]]
* [[Meningitis]]
* [[Meningococcemia]]
* [[Meningoencephalitis]]
* [[Mercaptopurine]]
* [[Mesoamerican nephropathy]]
* [[Meropenem]]
* [[Mesalamine]]
* [[Mescaline]]
* [[Mesenteric infarction]]
* [[Mesna]]
* [[Metabolic acidosis]]
* [[Metal fume fever]]
* [[Metformin]]
* [[Methadone]]
* [[Methotrexate]]
* [[Methylergonovine]]
* [[Methylketobemidone]]
* [[Methylphenidate]]
* [[Methyprylon]]
* [[Metronidazole]]
* [[Micafungin sodium]]
* [[Mifepristone]]
* [[Migraine]]
* [[Milk of Magnesia]]
* [[Milnacipran hydrochloride]]
* [[Miltefosine]]
* [[Minimally Invasive Thorasic Spinal Fusion]]
* [[Mirtazapine]]
* [[Misoprostol]]
* [[Mitomycin]]
* [[Mitotane]]
* [[Mitoxantrone]]
* [[Moclobemide]]
* [[Monocrotophos]]
* [[Mood stabilizer]]
* [[MOPP (medicine)|MOPP]]
* [[Morning sickness]]
* [[Morphine]]
* [[Motion sickness]]
* [[Motofen]]
* [[Moxifloxacin]]
* [[Multiple chemical sensitivity]]
* [[Multiple endocrine neoplasia type 1]]
* [[Munchausen syndrome by proxy]]
* [[Murray Valley encephalitis virus]]
* [[Mushroom poisoning]]
* [[Mycophenolic acid]]
* [[Mycoplasma pneumoniae]]
* [[Myocardial infarction]]
* [[Nabilone]]
* [[Naegleria fowleri]]
* [[Nafcillin]]
* [[Nalbuphine]]
* [[Nalidixic acid]]
* [[Nalmefene]]
* [[Naloxone]]
* [[Naphthalene]]
* [[Naproxen sodium]]
* [[Narcotics]]
* [[Natamycin]]
* [[Necrotizing enterocolitis]]
* [[Nerve agent]]
* [[Nervousness]]
* [[N-Ethyl-3-piperidyl benzilate]]
* [[Nicorandil]]
* [[Nicotine poisoning]]
* [[Nilutamide]]
* [[Nintedanib]]
* [[Nitrazepam]]
* [[Nitrogen mustard]]
* [[N-Nitroso-N-Methylurea]]
* [[Non-Hodgkin lymphoma]]
* [[Non steroidal anti-inflammatory drugs]]
* [[Nootropic]]
* [[Norfloxacin]]
* [[Norgestimate and Ethinyl estradiol]]
* [[Norgestrel and Ethinyl estradiol]]
* [[Norovirus]]
* [[Norplant]]
* [[Nortriptyline]]
* [[Norwalk Virus]]
* [[Nutcracker syndrome]]
* [[Nystatin]]
* [[Obidoxime]]
* [[Obstructive uropathy]]
* [[Obturator hernia]]
* [[Oesophageal cancer]]
* [[Ofloxacin]]
* [[Olanzapine]]
* [[Omeprazole]]
* [[Ondansetron]]
* [[Opioid]]
* [[Oprelvekin]]
* [[Oral contraceptives]]
* [[Orellanine]]
* [[Organic acidemia]]
* [[Organophosphates]]
* [[Oritavancin]]
* [[Oseltamivir]]
* [[Osteosarcoma]]
* [[Otitis interna]]
* [[Otitis media]]
* [[Ovarian cancer]]
* [[Ovarian cyst]]
* [[Ovarian hyperstimulation syndrome]]
* [[Ovarian torsion]]
* [[Oxaliplatin]]
* [[Oxamniquine]]
* [[Oxazepam]]
* [[Oxcarbazepine]]
* [[Oxybutynin]]
* [[Oxycodone and aspirin]]
* [[Paclitaxel]]
* [[Pain]]
* [[Palbociclib]]
* [[Pancreatic adenocarcinoma]]
* [[Pancreatitis]]
* [[Panitumumab]]
* [[Pantoprazole]]
* [[Palbociclib]]
* [[Paliperidone]]
* [[Palonosetron]]
* [[Panic attack]]
* [[Paralytic ileus]]
* [[Paraneoplastic syndrome]]
* [[Paraquat]]
* [[Paroxetine]]
* [[Pegaspargase]]
* [[Pemetrexed injection]]
* [[Penicillin]]
* [[Pentamidine]]
* [[Pentavalent antimonial]]
* [[Pentetic acid]]
* [[Pentostatin]]
* [[Peptic ulcer]]
* [[Pergolide]]
* [[Perhexiline]]
* [[Peritonitis]]
* [[Pesticide]]
* [[Pethidine]]
* [[Pfiesteria piscicida]]
* [[PFPP]]
* [[Pharyngeal pouch]]
* [[Pharyngitis]]
* [[Phenelzine]]
* [[Phenoxymethylpenicillin]]
* [[Phentermine]]
* [[Phentolamine]]
* [[Pholcodine]]
* [[Physostigmine]]
* [[Phytohaemagglutinin]]
* [[Pioglitazone]]
* [[Pirfenidone]]
* [[Piribedil]]
* [[Plerixafor]]
* [[Plicamycin]]
* [[Piroxicam]]
* [[PMA]]
* [[Pneumonia]]
* [[Polio]]
* [[Poliomyelitis]]
* [[Porphyria]]
* [[Posaconazole]]
* [[Post-concussion syndrome]]
* [[Post-exposure prophylaxis]]
* [[Ileus|Postoperative ileus]]
* [[Postoperative nausea and vomiting]]
* [[Pain|Postoperative pain]]
* [[Potassium bromide]]
* [[Potassium chloride]]
* [[Potassium citrate]]
* [[Praziquantel]]
* [[Pregabalin]]
* [[Pregnancy]]
* [[Primaquine]]
* [[Procainamide]]
* [[Procarbazine]]
* [[Prochlorperazine]]
* [[Progesterone]]
* [[Prolactinoma]]
* [[Propiram]]
* [[Propylketobemidone]]
* [[Prosidol]]
* [[Protriptyline]]
* [[Pseudotumor cerebri]]
* [[Psychogenic]]
* [[Pulmonary embolism]]
* [[Pyelonephritis]]
* [[Pyloric stenosis]]
* [[Pyrazinamide]]
* [[Pyrantel pamoate]]
* [[Pyridostigmine]]
* [[Pyridoxine deficiency]]
* [[Q fever]]
* [[Quetiapine]]
* [[Quinidine]]
* [[Quinupristin/dalfopristin]]
* [[Radiation poisoning]]
* [[Radiation therapy]]
* [[Raised intracranial pressure]]
* [[Radium chloride]]
* [[Ramelteon]]
* [[Ranolazine]]
* [[Rasagiline]]
* [[Refractive error]]
* [[Renal colic]]
* [[Renal failure]]
* [[Renal insufficiency]]
* [[Reserpine]]
* [[Retroperitoneal fibrosis]]
* [[Reversible cerebral vasoconstriction syndrome]]
* [[Reye's syndrome]]
* [[Ribavirin]]
* [[Rifabutin]]
* [[Riluzole]]
* [[Risedronate]]
* [[Rituximab injection]]
* [[Rivastigmine]]
* [[Rizatriptan]]
* [[Rocky mountain spotted fever]]
* [[Ropinirole]]
* [[Rotavirus]]
* [[Rotigotine]]
* [[Roxithromycin]]
* [[Rubbing alcohol]]
* [[Rumination disorder]]
* [[Salicylate poisoning]]
* [[Salmonella]]
* [[Salpingitis]]
* [[Salsalate]]
* [[Saquinavir mesylate]]
* [[Sargramostim]]
* [[Sarin]]
* [[Sativex]]
* [[Scarlet fever]]
* [[Scleroderma]]
* [[Seasickness]]
* [[Secobarbital]]
* [[second-hand smoke]]
* [[Secretin human]]
* [[Seizure disorders]]
* [[Selective serotonin reuptake inhibitor]]
* [[Selegiline]]
* [[Seliciclib]]
* [[Sepsis]]
* [[Sexual fetish]]
* [[Shigella]]
* [[Sibutramine]]
* [[Sipuleucel-T]]
* [[Ski sickness]]
* [[Sleep deprivation]]
* [[Slone's disease]]
* [[Small bowel bacterial overgrowth syndrome]]
* [[Small bowel lymphoma]]
* [[Small bowel obstruction]]
* [[Small intestine cancer]]
* [[Smoke inhalation]]
* [[Snakebites]]
* [[Soapwort]]
* [[Sodium oxybate]]
* [[Sodium polystyrene sulfonate]]
* [[Sodium stibogluconate]]
* [[Sofosbuvir]]
* [[Solanine]]
* [[Somatization]]
* [[Spider bite]]
* [[Spironolactone]]
* [[Splenic infarction]]
* [[Sporotrichosis]]
* [[Spotted fever]]
* [[SSRI discontinuation syndrome]]
* [[Staphylococcal enteritis]]
* [[Starvation]]
* [[Stavudine]]
* [[Stomach cancer]]
* [[Streptococcal pharyngitis]]
* [[Stribild]] ([[Elvitegravir, Cobicistat, Emtricitabine, And Tenofovir Disoproxil Fumarate]])
* [[Strongyloidiasis]]
* [[Stiripentol]]
* [[Strep throat]]
* [[Streptozocin]]
* [[Subdural hematoma]]
* [[Sufentanil]]
* [[Sulfasalazine]]
* [[Sulfonamides]]
* [[Sulprostone]]
* [[Suicide attempt]]
* [[Sultiame]]
* [[Sumatriptan injection]]
* [[Sunitinib]]
* [[Suramin]]
* [[Syndrome of inappropriate antidiuretic hormone]] [[SIADH]]
* [[Tabes dorsalis]]
* [[Tacrine]]
* [[Tacrolimus]]
* [[Tamoxifen]]
* [[Tapentadol]]
* [[Telavancin hydrochloride]]
* [[Telbivudine]]
* [[Telithromycin]]
* [[Tetracycline]]
* [[Temik]]
* [[Temozolomide]]
* [[Teniposide]]
* [[Testicular rupture]]
* [[Testicular torsion]]
* [[Tetanus, Diphtheria, and Pertussis (Tdap) Vaccine]]
* [[Tetracaine]]
* [[Tetrahydrocannabinol]]
* [[Tetrahydrozoline]]
* [[Tetramethylsuccinonitrile]]
* [[Tetrodotoxin]]
* [[Thallium]]
* [[Theobromine]]
* [[Theophylline]]
* [[Thiabendazole]]
* [[Thiethylperazine]]
* [[Thioguanine]]
* [[Thiotepa]]
* [[Thrombotic thrombocytopenic purpura]]
* [[Thyroid Medication (patient information)|Thyroid medication]]
* [[Thyrotoxicosis]]
* [[Tigecycline]]
* [[smoking|Tobacco smoking]]
* [[Tocopherol]]
* [[Tolmetin]]
* [[Topiramate]]
* [[Topotecan Hydrochloride|Topotecan Hydrochloride]]
* [[Toxic ingestion]]
* [[Toxidrome]]
* [[Tralomethrin]]
* [[Tramadol]]
* [[Trametinib dimethyl sulfoxide]]
* [[Trandolapril]]
* [[Tranexamic acid]]
* [[Trastuzumab]]
* [[Traumatic brain injury]]
* [[Traveler's diarrhea]]
* [[Trazodone]]
* [[Tretinoin]]
* [[Triamterene]]
* [[Triazolam]]
* [[Trichuriasis]]
* [[Triclofos]]
* [[Tricyclic antidepressant]]
* [[Trifluoperazine]]
* [[Trifluoromethylphenylpiperazine]]
* [[Trimeperidine]]
* [[Trimethobenzamide]]
* [[Trimetrexate glucuronate]]
* [[Tropisetron]]
* [[Trovafloxacin mesylate]]
* [[Tularemia]]
* [[Tumors]]
* [[Twisted ovarian cyst]]
* [[Typhoid Vaccine (patient information)|Typhoid Vaccine]]
* [[Typhus]]
* [[Ulcers]]
* [[Urea cycle disorders]]
* [[Uremia]]
* [[Urinary tract infection]]
* [[Urofollitropin]]
* [[Urolithiasis]]
* [[Vagotomy]]
* [[Valaciclovir]]
* [[Valganciclovir hydrochloride]]
* [[Valproic Acid]]
* [[Varenicline]]
* [[Vasovagal syncope]]
* [[Venlafaxine]]
* [[Verapamil]]
* [[Vertebro-basilar syndrome]]
* [[Vertigo]]
* [[Vestibular balance disorder]]
* [[Vestibular neuronitis]]
* [[Vibrio parahaemolyticus]]
* [[Vicodin]]
* [[Vidarabine]]
* [[Vigabatrin]]
* [[Vilazodone]]
* [[Viloxazine]]
* [[Vinblastine]]
* [[Vinorelbine Tartrate]]
* [[Viral gastroenteritis]]
* [[emotion|Violent emotions]]
* [[Cough|Violent fits of coughing]]
* [[hiccups|Violent fits of coughing]]
* [[Vitamin A]]
* [[Vitamin C]]
* [[Vitamin D]]
* [[Volvulus]]
* [[Von Willebrand factor]]
* [[Voriconazole]]
* [[Vorinostat]]
* [[Vortioxetine]]
* [[Water intoxication]]
* [[Waterborne diseases]]
* [[West Nile virus]]
* [[Yellow fever]]
* [[Zanamivir Inhalation]]
* [[Zidovudine]]
* [[Ziprasidone]]
* [[Zollinger-Ellison Syndrome]]
* [[Zolpidem]]
* [[Zopiclone]]

}}

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Emergency medicine]]
[[Category:Gastroenterology]]
[[Category:Obstetrics]]
[[Category:Crowdiagnosis]]

Nausea and vomiting pathophysiology

2021-02-01T20:23:20Z

Shaik Aisha sultana: references

__NOTOC__
{{Nausea and vomiting}}
{{CMG}} {{AE}} {{VVS}}
==Overview==
The physiology of [[nausea and vomiting]] encompass [[psychological]] states, the central nervous system, the [[autonomic nervous system]], gastric [[dysrhythmias]], and the [[endocrine]] system. Each individual has a threshold for nausea that changes minute by minute. Stimuli giving rise to nausea and vomiting originate from visceral, vestibular, and chemoreceptor trigger zone inputs which are mediated by serotonin/dopamine, histamine/acetylcholine, and serotonin/dopamine, respectively.

==Pathophysiology==
The physiology of [[nausea and vomiting]] encompass [[psychological]] states, the central nervous system, the [[autonomic nervous system]], gastric [[dysrhythmias]], and the [[endocrine]] system. Each individual has a threshold for nausea that changes minute by minute. At any given moment, the threshold depends on the interaction of certain inherent factors of the individual with the more changeable psychological states of [[anxiety]], [[anticipation]], [[expectation]], and adaptation. Stimuli giving rise to nausea and vomiting originate from visceral, vestibular, and chemoreceptor trigger zone inputs which are mediated by serotonin/dopamine, histamine/acetylcholine, and serotonin/dopamine, respectively. These relationships between these areas are the basis of the pharmacotherapy.<ref name="pmid26770271">{{cite journal |vauthors=Singh P, Yoon SS, Kuo B |title=Nausea: a review of pathophysiology and therapeutics |journal=Therap Adv Gastroenterol |volume=9 |issue=1 |pages=98–112 |date=January 2016 |pmid=26770271 |pmc=4699282 |doi=10.1177/1756283X15618131 |url=}}</ref>
===Vomiting Center===
The vomiting center lies in the medulla oblongata and comprises the reticular formation and the nucleus of the tractus solitarius.

When there is stimulus, it activates motor pathways descend from this center and trigger vomiting.

These efferent pathways travel within the 5th, 7th, 9th, 10th, and 12th cranial nerves to the upper gastrointestinal tract, within vagal and sympathetic nerves to the lower tract, and within spinal nerves to the diaphragm and abdominal muscles.

The vomiting center can be activated directly by irritants or indirectly following input from gastrointestinal tract, cerebral cortex and thalamus, vestibular region, and chemoreceptor trigger zone (CRTZ). <ref name="urlwww.eshare-org.co.cc">{{cite web |url=http://www.eshare-org.co.cc/2010/02/textbook-of-medical-physiology-guyton.html |title=www.eshare-org.co.cc |format= |work= |accessdate=}}</ref>

The CRTZ is closest in proximity, lying between the medulla and the floor of the fourth ventricle, and it is not protected by the blood-brain barrier.

The chemoreceptor trigger zone at the base of the fourth ventricle has numerous [[Dopamine receptor D2|dopamine D2 receptors]], [[5-HT receptor|serotonin 5-HT3 receptors]], [[opioid receptor]]s, [[acetylcholine receptor]]s, and receptors for [[substance P]]. Stimulation of different receptors are involved in different pathways leading to emesis, in the final common pathway substance P appears to be involved.<ref>Hornby PJ. Central neurocircuitry associated with emesis. Am J Med 2001;111:106S-12S. PMID 11749934.</ref>

The vestibular system which sends information to the brain via [[cranial nerve VIII]] (vestibulocochlear nerve). It plays a major role in [[motion sickness]] and is rich in [[Muscarinic acetylcholine receptor|muscarinic receptors]] and [[histamine receptor|histamine H1 receptors]].

[[Vagus nerve|Cranial nerve X]] (vagus nerve), which is activated when the pharynx is irritated, leading to a gag reflex.

Vagal and [[enteric nervous system]] inputs that transmit information regarding the state of the [[gastrointestinal system]]. Irritation of the GI mucosa by chemotherapy, radiation, distention or acute infectious [[gastroenteritis]] activates the 5-HT3 receptors of these inputs.

The CNS mediates vomiting arising from psychiatric disorders and stress.

===Vomiting:===
The act of vomiting consists of 3 steps:<ref name="pmid2235641">{{cite journal |vauthors=Rhodes VA |title=Nausea, vomiting, and retching |journal=Nurs Clin North Am |volume=25 |issue=4 |pages=885–900 |date=December 1990 |pmid=2235641 |doi= |url=}}</ref>

* [['''Nausea''']] is an unpleasant and difficult to describe psychic experience. Physiologically,[[ nausea ]]is typically associated with decreased gastric motility and increased tone in the [[small intestine]]. Also, there is often [[retroperistalsis|reverse peristalsis]] in the proximal small intestine.
*[[ '''Retching''']] ("dry heaves") refers to spasmodic respiratory movements conducted with a closed[[ glottis]]. While this is occurring, the [[antrum of the stomach]] contracts and the [[fundus]] and [[cardia]] relax.
* [['''Emesis''' ]]is when gastric and often small intestinal contents are propelled up to and out of the mouth.

and is caused by three types of outputs initiated by the[[ medulla]]:[[ Motor]], [[parasympathetic nervous system]] (PNS) and [[sympathetic nervous system]] (SNS).

*Increased [[saliva]]tion to protect the [[tooth enamel|enamel]] of [[teeth]] from stomach acids (excessive vomiting leads to [[dental caries|caries]]). This is part of the PNS output.
*[[Retroperistalsis|Reverse peristalsis]], starting from the middle of the [[small intestine]], sweeping up the contents of the digestive tract into the stomach, through the relaxed pyloric sphincter.
*A lowering of intrathoracic pressure (by inspiration against a closed [[glottis]]), coupled with an increase in abdominal pressure as the [[abdomen|abdominal muscles]] contract, propels stomach contents into the [[esophagus]] without involvement of the reverse peristalsis. The [[cardia|lower esophageal sphincter]] relaxes.
*Vomiting also initiates a SNS response causing both sweating and increased heart rate.

The [[neurotransmitter]]s that regulate vomiting are poorly understood, but inhibitors of [[dopamine]], [[histamine]] and [[serotonin]] are all used to suppress vomiting, suggesting that these play a role in the initiation or maintenance of a vomiting cycle. [[Vasopressin]] and neurokinin may also be involved.

===Content===
As the stomach secretes acid, vomit contains a high concentration of [[hydronium|hydronium ion]]s and is thus strongly acidic. Recent food intake will be reflected in the gastric vomit.

The content of the vomitus (vomit) may be of medical interest.

Fresh [[blood]] in the vomit is called [[hematemesis]] ("blood vomiting").

Old blood bears resemblance to coffee grounds (as the [[iron]] in the blood is [[oxidation|oxidized]]), and is termed "coffee ground vomiting".

[[Bile]] can enter the vomit during subsequent heaves due to [[duodenum|duodenal]] contraction if the vomiting is severe.

[[Fecal vomiting]] is often a consequence of [[intestinal obstruction]], and is treated as a warning sign of this potentially serious problem ("signum mali ominis"); such vomiting is sometimes called "miserere". If food has recently been consumed, then partly digested food may show up in the vomit.

 

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Emergency medicine]]
[[Category:Gastroenterology]]
[[Category:Obstetrics]]
[[Category:Needs overview]]

Nausea and vomiting pathophysiology

2021-02-01T20:06:56Z

Shaik Aisha sultana: /* Vomiting: */ reference

__NOTOC__
{{Nausea and vomiting}}
{{CMG}} {{AE}} {{VVS}}
==Overview==
The physiology of [[nausea and vomiting]] encompass [[psychological]] states, the central nervous system, the [[autonomic nervous system]], gastric [[dysrhythmias]], and the [[endocrine]] system. Each individual has a threshold for nausea that changes minute by minute. Stimuli giving rise to nausea and vomiting originate from visceral, vestibular, and chemoreceptor trigger zone inputs which are mediated by serotonin/dopamine, histamine/acetylcholine, and serotonin/dopamine, respectively.

==Pathophysiology==
The physiology of [[nausea and vomiting]] encompass [[psychological]] states, the central nervous system, the [[autonomic nervous system]], gastric [[dysrhythmias]], and the [[endocrine]] system. Each individual has a threshold for nausea that changes minute by minute. At any given moment, the threshold depends on the interaction of certain inherent factors of the individual with the more changeable psychological states of [[anxiety]], [[anticipation]], [[expectation]], and adaptation. Stimuli giving rise to nausea and vomiting originate from visceral, vestibular, and chemoreceptor trigger zone inputs which are mediated by serotonin/dopamine, histamine/acetylcholine, and serotonin/dopamine, respectively. These relationships between these areas are the basis of the pharmacotherapy.<ref name="pmid26770271">{{cite journal |vauthors=Singh P, Yoon SS, Kuo B |title=Nausea: a review of pathophysiology and therapeutics |journal=Therap Adv Gastroenterol |volume=9 |issue=1 |pages=98–112 |date=January 2016 |pmid=26770271 |pmc=4699282 |doi=10.1177/1756283X15618131 |url=}}</ref>
===Vomiting Center===
The vomiting center lies in the medulla oblongata and comprises the reticular formation and the nucleus of the tractus solitarius.

When there is stimulus, it activates motor pathways descend from this center and trigger vomiting.

These efferent pathways travel within the 5th, 7th, 9th, 10th, and 12th cranial nerves to the upper gastrointestinal tract, within vagal and sympathetic nerves to the lower tract, and within spinal nerves to the diaphragm and abdominal muscles.

The vomiting center can be activated directly by irritants or indirectly following input from gastrointestinal tract, cerebral cortex and thalamus, vestibular region, and chemoreceptor trigger zone (CRTZ).

The CRTZ is closest in proximity, lying between the medulla and the floor of the fourth ventricle, and it is not protected by the blood-brain barrier.

The chemoreceptor trigger zone at the base of the fourth ventricle has numerous [[Dopamine receptor D2|dopamine D2 receptors]], [[5-HT receptor|serotonin 5-HT3 receptors]], [[opioid receptor]]s, [[acetylcholine receptor]]s, and receptors for [[substance P]]. Stimulation of different receptors are involved in different pathways leading to emesis, in the final common pathway substance P appears to be involved.<ref>Hornby PJ. Central neurocircuitry associated with emesis. Am J Med 2001;111:106S-12S. PMID 11749934.</ref>

The vestibular system which sends information to the brain via [[cranial nerve VIII]] (vestibulocochlear nerve). It plays a major role in [[motion sickness]] and is rich in [[Muscarinic acetylcholine receptor|muscarinic receptors]] and [[histamine receptor|histamine H1 receptors]].

[[Vagus nerve|Cranial nerve X]] (vagus nerve), which is activated when the pharynx is irritated, leading to a gag reflex.

Vagal and [[enteric nervous system]] inputs that transmit information regarding the state of the [[gastrointestinal system]]. Irritation of the GI mucosa by chemotherapy, radiation, distention or acute infectious [[gastroenteritis]] activates the 5-HT3 receptors of these inputs.

The CNS mediates vomiting arising from psychiatric disorders and stress.

===Vomiting:===
The act of vomiting consists of 3 steps:<ref name="pmid2235641">{{cite journal |vauthors=Rhodes VA |title=Nausea, vomiting, and retching |journal=Nurs Clin North Am |volume=25 |issue=4 |pages=885–900 |date=December 1990 |pmid=2235641 |doi= |url=}}</ref>

* [['''Nausea''']] is an unpleasant and difficult to describe psychic experience. Physiologically,[[ nausea ]]is typically associated with decreased gastric motility and increased tone in the [[small intestine]]. Also, there is often [[retroperistalsis|reverse peristalsis]] in the proximal small intestine.
*[[ '''Retching''']] ("dry heaves") refers to spasmodic respiratory movements conducted with a closed[[ glottis]]. While this is occurring, the [[antrum of the stomach]] contracts and the [[fundus]] and [[cardia]] relax.
* [['''Emesis''' ]]is when gastric and often small intestinal contents are propelled up to and out of the mouth.

and is caused by three types of outputs initiated by the[[ medulla]]:[[ Motor]], [[parasympathetic nervous system]] (PNS) and [[sympathetic nervous system]] (SNS).

*Increased [[saliva]]tion to protect the [[tooth enamel|enamel]] of [[teeth]] from stomach acids (excessive vomiting leads to [[dental caries|caries]]). This is part of the PNS output.
*[[Retroperistalsis|Reverse peristalsis]], starting from the middle of the [[small intestine]], sweeping up the contents of the digestive tract into the stomach, through the relaxed pyloric sphincter.
*A lowering of intrathoracic pressure (by inspiration against a closed [[glottis]]), coupled with an increase in abdominal pressure as the [[abdomen|abdominal muscles]] contract, propels stomach contents into the [[esophagus]] without involvement of the reverse peristalsis. The [[cardia|lower esophageal sphincter]] relaxes.
*Vomiting also initiates a SNS response causing both sweating and increased heart rate.

The [[neurotransmitter]]s that regulate vomiting are poorly understood, but inhibitors of [[dopamine]], [[histamine]] and [[serotonin]] are all used to suppress vomiting, suggesting that these play a role in the initiation or maintenance of a vomiting cycle. [[Vasopressin]] and neurokinin may also be involved.

===Content===
As the stomach secretes acid, vomit contains a high concentration of [[hydronium|hydronium ion]]s and is thus strongly acidic. Recent food intake will be reflected in the gastric vomit.

The content of the vomitus (vomit) may be of medical interest.

Fresh [[blood]] in the vomit is called [[hematemesis]] ("blood vomiting").

Old blood bears resemblance to coffee grounds (as the [[iron]] in the blood is [[oxidation|oxidized]]), and is termed "coffee ground vomiting".

[[Bile]] can enter the vomit during subsequent heaves due to [[duodenum|duodenal]] contraction if the vomiting is severe.

[[Fecal vomiting]] is often a consequence of [[intestinal obstruction]], and is treated as a warning sign of this potentially serious problem ("signum mali ominis"); such vomiting is sometimes called "miserere". If food has recently been consumed, then partly digested food may show up in the vomit.

 

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Emergency medicine]]
[[Category:Gastroenterology]]
[[Category:Obstetrics]]
[[Category:Needs overview]]

Nausea and vomiting pathophysiology

2021-02-01T20:03:30Z

Shaik Aisha sultana: /* Vomiting Act */

__NOTOC__
{{Nausea and vomiting}}
{{CMG}} {{AE}} {{VVS}}
==Overview==
The physiology of [[nausea and vomiting]] encompass [[psychological]] states, the central nervous system, the [[autonomic nervous system]], gastric [[dysrhythmias]], and the [[endocrine]] system. Each individual has a threshold for nausea that changes minute by minute. Stimuli giving rise to nausea and vomiting originate from visceral, vestibular, and chemoreceptor trigger zone inputs which are mediated by serotonin/dopamine, histamine/acetylcholine, and serotonin/dopamine, respectively.

==Pathophysiology==
The physiology of [[nausea and vomiting]] encompass [[psychological]] states, the central nervous system, the [[autonomic nervous system]], gastric [[dysrhythmias]], and the [[endocrine]] system. Each individual has a threshold for nausea that changes minute by minute. At any given moment, the threshold depends on the interaction of certain inherent factors of the individual with the more changeable psychological states of [[anxiety]], [[anticipation]], [[expectation]], and adaptation. Stimuli giving rise to nausea and vomiting originate from visceral, vestibular, and chemoreceptor trigger zone inputs which are mediated by serotonin/dopamine, histamine/acetylcholine, and serotonin/dopamine, respectively. These relationships between these areas are the basis of the pharmacotherapy.<ref name="pmid26770271">{{cite journal |vauthors=Singh P, Yoon SS, Kuo B |title=Nausea: a review of pathophysiology and therapeutics |journal=Therap Adv Gastroenterol |volume=9 |issue=1 |pages=98–112 |date=January 2016 |pmid=26770271 |pmc=4699282 |doi=10.1177/1756283X15618131 |url=}}</ref>
===Vomiting Center===
The vomiting center lies in the medulla oblongata and comprises the reticular formation and the nucleus of the tractus solitarius.

When there is stimulus, it activates motor pathways descend from this center and trigger vomiting.

These efferent pathways travel within the 5th, 7th, 9th, 10th, and 12th cranial nerves to the upper gastrointestinal tract, within vagal and sympathetic nerves to the lower tract, and within spinal nerves to the diaphragm and abdominal muscles.

The vomiting center can be activated directly by irritants or indirectly following input from gastrointestinal tract, cerebral cortex and thalamus, vestibular region, and chemoreceptor trigger zone (CRTZ).

The CRTZ is closest in proximity, lying between the medulla and the floor of the fourth ventricle, and it is not protected by the blood-brain barrier.

The chemoreceptor trigger zone at the base of the fourth ventricle has numerous [[Dopamine receptor D2|dopamine D2 receptors]], [[5-HT receptor|serotonin 5-HT3 receptors]], [[opioid receptor]]s, [[acetylcholine receptor]]s, and receptors for [[substance P]]. Stimulation of different receptors are involved in different pathways leading to emesis, in the final common pathway substance P appears to be involved.<ref>Hornby PJ. Central neurocircuitry associated with emesis. Am J Med 2001;111:106S-12S. PMID 11749934.</ref>

The vestibular system which sends information to the brain via [[cranial nerve VIII]] (vestibulocochlear nerve). It plays a major role in [[motion sickness]] and is rich in [[Muscarinic acetylcholine receptor|muscarinic receptors]] and [[histamine receptor|histamine H1 receptors]].

[[Vagus nerve|Cranial nerve X]] (vagus nerve), which is activated when the pharynx is irritated, leading to a gag reflex.

Vagal and [[enteric nervous system]] inputs that transmit information regarding the state of the [[gastrointestinal system]]. Irritation of the GI mucosa by chemotherapy, radiation, distention or acute infectious [[gastroenteritis]] activates the 5-HT3 receptors of these inputs.

The CNS mediates vomiting arising from psychiatric disorders and stress.

===Vomiting:===
The act of vomiting consists of 3 steps:

* '''Nausea''' is an unpleasant and difficult to describe psychic experience. Physiologically, nausea is typically associated with decreased gastric motility and increased tone in the small intestine. Also, there is often reverse peristalsis in the proximal small intestine.
* '''Retching''' ("dry heaves") refers to spasmodic respiratory movements conducted with a closed glottis. While this is occurring, the antrum of the stomach contracts and the fundus and cardia relax.
* '''Emesis''' is when gastric and often small intestinal contents are propelled up to and out of the mouth.

and is caused by three types of outputs initiated by the medulla: Motor, [[parasympathetic nervous system]] (PNS) and [[sympathetic nervous system]] (SNS).

*Increased [[saliva]]tion to protect the [[tooth enamel|enamel]] of [[teeth]] from stomach acids (excessive vomiting leads to [[dental caries|caries]]). This is part of the PNS output.
*[[Retroperistalsis|Reverse peristalsis]], starting from the middle of the [[small intestine]], sweeping up the contents of the digestive tract into the stomach, through the relaxed pyloric sphincter.
*A lowering of intrathoracic pressure (by inspiration against a closed [[glottis]]), coupled with an increase in abdominal pressure as the [[abdomen|abdominal muscles]] contract, propels stomach contents into the [[esophagus]] without involvement of the reverse peristalsis. The [[cardia|lower esophageal sphincter]] relaxes.
*Vomiting also initiates a SNS response causing both sweating and increased heart rate.

The [[neurotransmitter]]s that regulate vomiting are poorly understood, but inhibitors of [[dopamine]], [[histamine]] and [[serotonin]] are all used to suppress vomiting, suggesting that these play a role in the initiation or maintenance of a vomiting cycle. [[Vasopressin]] and neurokinin may also be involved.

===Content===
As the stomach secretes acid, vomit contains a high concentration of [[hydronium|hydronium ion]]s and is thus strongly acidic. Recent food intake will be reflected in the gastric vomit.

The content of the vomitus (vomit) may be of medical interest.

Fresh [[blood]] in the vomit is called [[hematemesis]] ("blood vomiting").

Old blood bears resemblance to coffee grounds (as the [[iron]] in the blood is [[oxidation|oxidized]]), and is termed "coffee ground vomiting".

[[Bile]] can enter the vomit during subsequent heaves due to [[duodenum|duodenal]] contraction if the vomiting is severe.

[[Fecal vomiting]] is often a consequence of [[intestinal obstruction]], and is treated as a warning sign of this potentially serious problem ("signum mali ominis"); such vomiting is sometimes called "miserere". If food has recently been consumed, then partly digested food may show up in the vomit.

 

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Emergency medicine]]
[[Category:Gastroenterology]]
[[Category:Obstetrics]]
[[Category:Needs overview]]

Nausea and vomiting pathophysiology

2021-02-01T19:21:08Z

Shaik Aisha sultana: /* Pathophysiology */

__NOTOC__
{{Nausea and vomiting}}
{{CMG}} {{AE}} {{VVS}}
==Overview==
The physiology of [[nausea and vomiting]] encompass [[psychological]] states, the central nervous system, the [[autonomic nervous system]], gastric [[dysrhythmias]], and the [[endocrine]] system. Each individual has a threshold for nausea that changes minute by minute. Stimuli giving rise to nausea and vomiting originate from visceral, vestibular, and chemoreceptor trigger zone inputs which are mediated by serotonin/dopamine, histamine/acetylcholine, and serotonin/dopamine, respectively.

==Pathophysiology==
The physiology of [[nausea and vomiting]] encompass [[psychological]] states, the central nervous system, the [[autonomic nervous system]], gastric [[dysrhythmias]], and the [[endocrine]] system. Each individual has a threshold for nausea that changes minute by minute. At any given moment, the threshold depends on the interaction of certain inherent factors of the individual with the more changeable psychological states of [[anxiety]], [[anticipation]], [[expectation]], and adaptation. Stimuli giving rise to nausea and vomiting originate from visceral, vestibular, and chemoreceptor trigger zone inputs which are mediated by serotonin/dopamine, histamine/acetylcholine, and serotonin/dopamine, respectively. These relationships between these areas are the basis of the pharmacotherapy.<ref name="pmid26770271">{{cite journal |vauthors=Singh P, Yoon SS, Kuo B |title=Nausea: a review of pathophysiology and therapeutics |journal=Therap Adv Gastroenterol |volume=9 |issue=1 |pages=98–112 |date=January 2016 |pmid=26770271 |pmc=4699282 |doi=10.1177/1756283X15618131 |url=}}</ref>
===Vomiting Center===
The vomiting center lies in the medulla oblongata and comprises the reticular formation and the nucleus of the tractus solitarius.

When there is stimulus, it activates motor pathways descend from this center and trigger vomiting.

These efferent pathways travel within the 5th, 7th, 9th, 10th, and 12th cranial nerves to the upper gastrointestinal tract, within vagal and sympathetic nerves to the lower tract, and within spinal nerves to the diaphragm and abdominal muscles.

The vomiting center can be activated directly by irritants or indirectly following input from gastrointestinal tract, cerebral cortex and thalamus, vestibular region, and chemoreceptor trigger zone (CRTZ).

The CRTZ is closest in proximity, lying between the medulla and the floor of the fourth ventricle, and it is not protected by the blood-brain barrier.

The chemoreceptor trigger zone at the base of the fourth ventricle has numerous [[Dopamine receptor D2|dopamine D2 receptors]], [[5-HT receptor|serotonin 5-HT3 receptors]], [[opioid receptor]]s, [[acetylcholine receptor]]s, and receptors for [[substance P]]. Stimulation of different receptors are involved in different pathways leading to emesis, in the final common pathway substance P appears to be involved.<ref>Hornby PJ. Central neurocircuitry associated with emesis. Am J Med 2001;111:106S-12S. PMID 11749934.</ref>

The vestibular system which sends information to the brain via [[cranial nerve VIII]] (vestibulocochlear nerve). It plays a major role in [[motion sickness]] and is rich in [[Muscarinic acetylcholine receptor|muscarinic receptors]] and [[histamine receptor|histamine H1 receptors]].

[[Vagus nerve|Cranial nerve X]] (vagus nerve), which is activated when the pharynx is irritated, leading to a gag reflex.

Vagal and [[enteric nervous system]] inputs that transmit information regarding the state of the [[gastrointestinal system]]. Irritation of the GI mucosa by chemotherapy, radiation, distention or acute infectious [[gastroenteritis]] activates the 5-HT3 receptors of these inputs.

The CNS mediates vomiting arising from psychiatric disorders and stress.

===Vomiting Act===
The vomiting act encompasses three types of outputs initiated by the medulla: Motor, [[parasympathetic nervous system]] (PNS) and [[sympathetic nervous system]] (SNS). Collectively, they are as follows:

*Increased [[saliva]]tion to protect the [[tooth enamel|enamel]] of [[teeth]] from stomach acids (excessive vomiting leads to [[dental caries|caries]]). This is part of the PNS output.
*[[Retroperistalsis]], starting from the middle of the [[small intestine]], sweeping up the contents of the digestive tract into the stomach, through the relaxed pyloric sphincter.
*A lowering of intrathoracic pressure (by inspiration against a closed [[glottis]]), coupled with an increase in abdominal pressure as the [[abdomen|abdominal muscles]] contract, propels stomach contents into the [[esophagus]] without involvement of retroperistalsis. The [[cardia|lower esophageal sphincter]] relaxes. This is part of the motor output, and it is also important to note that the stomach itself does not contract in the process of vomiting.
*Vomiting is ordinarily preceded by [[retching]].
*Vomiting also initiates a SNS response causing both sweating and increased heart rate.

The [[neurotransmitter]]s that regulate vomiting are poorly understood, but inhibitors of [[dopamine]], [[histamine]] and [[serotonin]] are all used to suppress vomiting, suggesting that these play a role in the initiation or maintenance of a vomiting cycle. [[Vasopressin]] and neurokinin may also be involved.

===Content===
Since the stomach secretes acid, vomit contains a high concentration of [[hydronium|hydronium ion]]s and is thus strongly acidic. Recent food intake will be reflected in the gastric vomit.

The content of the vomitus (vomit) may be of medical interest. Fresh [[blood]] in the vomit is termed [[hematemesis]] ("blood vomiting"). Old blood bears resemblance to coffee grounds (as the [[iron]] in the blood is [[oxidation|oxidized]]), and when this matter is identified the term "coffee ground vomiting" is used. [[Bile]] can enter the vomit during subsequent heaves due to [[duodenum|duodenal]] contraction if the vomiting is severe. [[Fecal vomiting]] is often a consequence of [[intestinal obstruction]], and is treated as a warning sign of this potentially serious problem ("signum mali ominis"); such vomiting is sometimes called "miserere". If food has recently been consumed, then partly digested food may show up in the vomit.

If the vomiting reflex continues for an extended period of time with no appreciable vomitus, the condition is known as non-productive emesis or dry heaves, which can become both extremely painful and debilitating.

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Emergency medicine]]
[[Category:Gastroenterology]]
[[Category:Obstetrics]]
[[Category:Needs overview]]

Nausea and vomiting pathophysiology

2021-02-01T19:18:47Z

Shaik Aisha sultana: /* Overview */ Pathophysiology

__NOTOC__
{{Nausea and vomiting}}
{{CMG}} {{AE}} {{VVS}}
==Overview==
The physiology of [[nausea and vomiting]] encompass [[psychological]] states, the central nervous system, the [[autonomic nervous system]], gastric [[dysrhythmias]], and the [[endocrine]] system. Each individual has a threshold for nausea that changes minute by minute. Stimuli giving rise to nausea and vomiting originate from visceral, vestibular, and chemoreceptor trigger zone inputs which are mediated by serotonin/dopamine, histamine/acetylcholine, and serotonin/dopamine, respectively.

==Pathophysiology==
The physiology of [[nausea and vomiting]] encompass [[psychological]] states, the central nervous system, the [[autonomic nervous system]], gastric [[dysrhythmias]], and the [[endocrine]] system. Each individual has a threshold for nausea that changes minute by minute. At any given moment, the threshold depends on the interaction of certain inherent factors of the individual with the more changeable psychological states of [[anxiety]], [[anticipation]], [[expectation]], and adaptation. Stimuli giving rise to nausea and vomiting originate from visceral, vestibular, and chemoreceptor trigger zone inputs which are mediated by serotonin/dopamine, histamine/acetylcholine, and serotonin/dopamine, respectively. These relationships between these areas are the basis of the pharmacotherapy.<ref name="pmid26770271">{{cite journal |vauthors=Singh P, Yoon SS, Kuo B |title=Nausea: a review of pathophysiology and therapeutics |journal=Therap Adv Gastroenterol |volume=9 |issue=1 |pages=98–112 |date=January 2016 |pmid=26770271 |pmc=4699282 |doi=10.1177/1756283X15618131 |url=}}</ref>
===Vomiting Center===
The vomiting center lies in the medulla oblongata and comprises the reticular formation and the nucleus of the tractus solitarius.

When there is stimulus, it activates motor pathways descend from this center and trigger vomiting.

These efferent pathways travel within the 5th, 7th, 9th, 10th, and 12th cranial nerves to the upper gastrointestinal tract, within vagal and sympathetic nerves to the lower tract, and within spinal nerves to the diaphragm and abdominal muscles.

The vomiting center can be activated directly by irritants or indirectly following input from gastrointestinal tract, cerebral cortex and thalamus, vestibular region, and chemoreceptor trigger zone (CRTZ).

The CRTZ is closest in proximity, lying between the medulla and the floor of the fourth ventricle, and it is not protected by the blood-brain barrier.

The chemoreceptor trigger zone at the base of the fourth ventricle has numerous [[Dopamine receptor D2|dopamine D2 receptors]], [[5-HT receptor|serotonin 5-HT3 receptors]], [[opioid receptor]]s, [[acetylcholine receptor]]s, and receptors for [[substance P]]. Stimulation of different receptors are involved in different pathways leading to emesis, in the final common pathway substance P appears to be involved.<ref>Hornby PJ. Central neurocircuitry associated with emesis. Am J Med 2001;111:106S-12S. PMID 11749934.</ref>

The vestibular system which sends information to the brain via [[cranial nerve VIII]] (vestibulocochlear nerve). It plays a major role in [[motion sickness]] and is rich in [[Muscarinic acetylcholine receptor|muscarinic receptors]] and [[histamine receptor|histamine H1 receptors]].

[[Vagus nerve|Cranial nerve X]] (vagus nerve), which is activated when the pharynx is irritated, leading to a gag reflex.

Vagal and [[enteric nervous system]] inputs that transmit information regarding the state of the [[gastrointestinal system]]. Irritation of the GI mucosa by chemotherapy, radiation, distention or acute infectious [[gastroenteritis]] activates the 5-HT3 receptors of these inputs.

The CNS mediates vomiting arising from psychiatric disorders and stress.

===Vomiting Act===
The vomiting act encompasses three types of outputs initiated by the medulla: Motor, [[parasympathetic nervous system]] (PNS) and [[sympathetic nervous system]] (SNS). Collectively, they are as follows:

*Increased [[saliva]]tion to protect the [[tooth enamel|enamel]] of [[teeth]] from stomach acids (excessive vomiting leads to [[dental caries|caries]]). This is part of the PNS output.
*[[Retroperistalsis]], starting from the middle of the [[small intestine]], sweeping up the contents of the digestive tract into the stomach, through the relaxed pyloric sphincter.
*A lowering of intrathoracic pressure (by inspiration against a closed [[glottis]]), coupled with an increase in abdominal pressure as the [[abdomen|abdominal muscles]] contract, propels stomach contents into the [[esophagus]] without involvement of retroperistalsis. The [[cardia|lower esophageal sphincter]] relaxes. This is part of the motor output, and it is also important to note that the stomach itself does not contract in the process of vomiting.
*Vomiting is ordinarily preceded by [[retching]].
*Vomiting also initiates a SNS response causing both sweating and increased heart rate.

The [[neurotransmitter]]s that regulate vomiting are poorly understood, but inhibitors of [[dopamine]], [[histamine]] and [[serotonin]] are all used to suppress vomiting, suggesting that these play a role in the initiation or maintenance of a vomiting cycle. [[Vasopressin]] and neurokinin may also participate.

===Content===
Since the stomach secretes acid, vomit contains a high concentration of [[hydronium|hydronium ion]]s and is thus strongly acidic. Recent food intake will be reflected in the gastric vomit.

The content of the vomitus (vomit) may be of medical interest. Fresh [[blood]] in the vomit is termed [[hematemesis]] ("blood vomiting"). Old blood bears resemblance to coffee grounds (as the [[iron]] in the blood is [[oxidation|oxidized]]), and when this matter is identified the term "coffee ground vomiting" is used. [[Bile]] can enter the vomit during subsequent heaves due to [[duodenum|duodenal]] contraction if the vomiting is severe. [[Fecal vomiting]] is often a consequence of [[intestinal obstruction]], and is treated as a warning sign of this potentially serious problem ("signum mali ominis"); such vomiting is sometimes called "miserere". If food has recently been consumed, then partly digested food may show up in the vomit.

If the vomiting reflex continues for an extended period of time with no appreciable vomitus, the condition is known as non-productive emesis or dry heaves, which can become both extremely painful and debilitating.

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Emergency medicine]]
[[Category:Gastroenterology]]
[[Category:Obstetrics]]
[[Category:Needs overview]]

Nausea and vomiting differential diagnosis

2021-01-28T03:17:11Z

Shaik Aisha sultana: /* Others: */

__NOTOC__
{{Nausea and vomiting}}
==Overview==
Differential diagnosis of vomiting may be a result of a range of causes, including GI (obstructive and inflammatory) etiologies, CNS disease, pulmonary problems, renal disease, endocrine/metabolic disorders, drugs (either as side effects or in over dosages), psychiatric disorders, strep throat, pregnancy or stress.

==Differential diagnosis==
The causes of nausea and vomiting can be differentiated as GI and Non GI causes:

===GI causes===

====[[Inflammatory]]:====
[[Esophagitis]]

[[Gastritis]]

[[Hepatitis]]

[[Enteritis]]

[[Pancreatitis]]

====[[Obstructive]]:====
Esophageal [[malignancies]]

[[Gastric outlet obstruction ]] , may be due to[[ malignancy]]

[[Pyloric stenosis]]

Strangulated [[hernia]]s

Small bowel obstruction due to[[ adhesion]],[[ intussusception]] or[[ volvulus]]

[[Diverticulitis]]

====Functional:====
[[Esophageal dysmotility]]

[[Achalasia Cardia]]

[[Gastroparesis]] due to [[autonomic dysfunction]]

[[Ileus]]-[[ Hypokalemia]]

[[Ogilvie Syndrome]]

===Non GI causes can be===

====CNS causes:====
[[Migraine]]

[[Pseudotumor cerebri]]

[[Meningitis]]

Space occupying lesions

[[Labrynthitis]]

====Metabolic:====
Acidosis- [[DK]]A, [[Lactic acidosis]]

====Others:====
[[Alcoholism]]

[[Chemotherapy]]<ref>{{cite journal|doi=10.1002/j.1875-9114.1990.tb02560.x}}</ref>

[[Opiate]] therapy

[[Antibiotics]]

[[Pregnancy]]

[[Sea sickness]]

 

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Emergency medicine]]
[[Category:Gastroenterology]]
[[Category:Obstetrics]]
[[Category:Needs content]]

Nausea and vomiting differential diagnosis

2021-01-28T03:04:29Z

Shaik Aisha sultana: references

__NOTOC__
{{Nausea and vomiting}}
==Overview==
Differential diagnosis of vomiting may be a result of a range of causes, including GI (obstructive and inflammatory) etiologies, CNS disease, pulmonary problems, renal disease, endocrine/metabolic disorders, drugs (either as side effects or in over dosages), psychiatric disorders, strep throat, pregnancy or stress.

==Differential diagnosis==
The causes of nausea and vomiting can be differentiated as GI and Non GI causes:

===GI causes===

====[[Inflammatory]]:====
[[Esophagitis]]

[[Gastritis]]

[[Hepatitis]]

[[Enteritis]]

[[Pancreatitis]]

====[[Obstructive]]:====
Esophageal [[malignancies]]

[[Gastric outlet obstruction ]] , may be due to[[ malignancy]]

[[Pyloric stenosis]]

Strangulated [[hernia]]s

Small bowel obstruction due to[[ adhesion]],[[ intussusception]] or[[ volvulus]]

[[Diverticulitis]]

====Functional:====
[[Esophageal dysmotility]]

[[Achalasia Cardia]]

[[Gastroparesis]] due to [[autonomic dysfunction]]

[[Ileus]]-[[ Hypokalemia]]

[[Ogilvie Syndrome]]

===Non GI causes can be===

====CNS causes:====
[[Migraine]]

[[Pseudotumor cerebri]]

[[Meningitis]]

Space occupying lesions

[[Labrynthitis]]

====Metabolic:====
Acidosis- [[DK]]A, [[Lactic acidosis]]

====Others:====
[[Alcoholism]]

[[Chemotherapy]]<ref>{{cite journal|doi=10.1002/j.1875-9114.1990.tb02560.x}}</ref>

[[Opiate]] therapy

[[Antibiotics]]

[[Pregnancy]]

[[Sea sickness]]

 

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Emergency medicine]]
[[Category:Gastroenterology]]
[[Category:Obstetrics]]
[[Category:Needs content]]

Nausea and vomiting causes

2021-01-28T03:02:32Z

Shaik Aisha sultana: /* Causes in Alphabetical Order */

__NOTOC__
{{Nausea and vomiting}}
{{CMG}}; {{AE}} {{VVS}} {{KS}}

==Overview==
Life threatening causes of nausea and vomiting include [[acute coronary syndrome]], [[anaphylaxis]], and [[heart failure]]. Other common causes of nausea and vomiting are [[food allergies]], [[food poisoning]], [[gastroenteritis]], and [[gastroesophageal reflux]].

==Causes==
===Life Threatening Causes===

*[[Acute Coronary Syndromes]]<ref name="pmid637006">{{cite journal |vauthors=Ahmed SS, Gupta RC, Brancato RR |title=Significance of nausea and vomiting during acute myocardial infarction |journal=Am Heart J |volume=95 |issue=5 |pages=671–2 |date=May 1978 |pmid=637006 |doi=10.1016/0002-8703(78)90311-3 |url=}}</ref>
*[[Anaphylaxis]]
*[[Angina pectoris]]
*[[Heart failure]]

===Common Causes===

*[[Chemotherapy]]<ref>{{cite journal|doi=10.1002/j.1875-9114.1990.tb02560.x}}</ref>

*[[Food allergies]]
*[[Food poisoning]]
*[[Migraine]]
*[[Morning sickness]]
*[[Rotavirus]]
*[[Viral gastroenteritis]]

===Causes by Organ System===

{| style="width: 80%; height: 100px; text-align: justify; text-justify: distribute;" border="1"
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" |'''Cardiovascular'''
| style="width:75%" bgcolor="Beige" ; border="1" |[[Acute Coronary Syndromes]], [[amyloidosis]], [[anaphylaxis]], [[angina pectoris]], [[aortic arch anomalies]], [[cardiac arrhythmia]], [[cerebral aneurysm]], [[cerebral arteriovenous malformation]], [[cerebrovascular disease]], [[myocardial infarction]], [[heart failure]], [[hypercalcemia]], [[hypertension]], [[hypercalcemia]], [[hypocalcemia]], [[hypokalemia]]
|- bgcolor="LightSteelBlue"
|'''Chemical / poisoning'''
| bgcolor="Beige" |[[1,2-Dichloroethene]], [[2-Ethylhexanol]], [[1,3-Dichloropropene]], [[abrin]], [[aconitine]], [[adamsite]], [[ammonium chloride]], [[amnesic shellfish poisoning]], [[arsenic Poisoning]], [[barium oxalate]], [[barium sulfate]], [[butanethiol]], [[camphor|camphor poisoning]], [[capsaicin]], [[carbon monoxide poisoning]], [[chloromethane]], [[cicuta]], [[ciguatera]], [[cinchonism]], [[coprinopsis atramentaria]], [[cyanogen]], [[daunorubicin]], [[diethyl ether]], [[digitalis purpurea]], [[dioxathion]], [[dioxin]], [[endosulfan]], [[ergotism]], [[fluoride poisoning]], [[fluoxymesterone]], [[ginkgo]], [[Green Tobacco Sickness|green tobacco sickness]], [[heavy metal ingestion]], [[Iodomethane]], [[Iron poisoning]], [[Iron(II) sulfate]], [[lead poisoning]], [[lenvatinib]], [[lewisite]], [[lindane]], [[lithium]], [[lobelia]], [[metal fume fever]], [[mushroom poisoning]], [[N-Ethyl-3-piperidyl benzilate]], [[nerve agent]], [[nicotine poisoning]], [[N-Nitroso-N-methylurea]], [[PFPP]], [[pesticide]], [[potassium bromide]], [[phytohaemagglutinin]], [[smoke inhalation]], [[snakebites]], [[temik]], [[theobromine]]
|- bgcolor="LightSteelBlue"
|'''Dermatologic'''
| bgcolor="Beige" |[[Abscess]], [[decompression sickness]], [[exercise urticaria]]
|-
|- bgcolor="LightSteelBlue"
|'''Drug Side Effect'''
| bgcolor="Beige" |[[2C-E]], [[2C-I]], [[2C-T-7]], [[5-Hydroxytryptophan]], [[5-MeO-AMT]], [[ABVD]], [[acamprosate calcium]], [[acetaminophen]], [[acetoxyketobemidone]], [[acetylcysteine]], [[acetylsalicylic acid]],[[acyclovir]], [[aclarubicin]], [[actinomycin D]], [[alatrofloxacin Injection (patient information)|alatrofloxacin]], [[albuterol]], [[aldesleukin]], [[alemtuzumab]], [[allylprodine]], [[alpha-Methyltryptamine]], [[alprazolam]], [[altretamine]], [[amifostine]], [[amineptine]], [[aminocaproic acid]], [[aminoglutethimide]], [[aminopterin]], [[aminosalicylic acid]], [[amitriptyline (patient information)|amitriptyline]], [[amoxicillin]], [[amphotericin B]], [[amrinone]], [[amyl nitrite]], [[anadenanthera peregrina]], [[analgesic]], [[anastrozole]], [[anesthesia]], [[anticonvulsants]], [[antigout]], [[antihistamine]], [[antihypertensives]],[[antiretroviral drug]], [[apremilast]], [[apomorphine hydrochloride]], [[aprepitant]], [[aripiprazole]], [[armodafinil]], [[asparaginase (patient information)|asparaginase]], [[aspirin]], [[atomoxetine]], [[atosiban]], [[atropine]], [[auranofin]], [[axitinib]], [[azacitidine]], [[azathioprine]], [[azithromycin]], [[aztreonam]], [[barbiturate]], [[barium Sulfate]], [[basiliximab]], [[bCG vaccine]], [[Belladonna Alkaloid Combinations and Phenobarbital|belladonna alkaloid]] [[benzodiazepine]], [[benztropine]], [[benzphetamine]], [[benzylpiperazine]], [[betaine]], [[beta-lactam antibiotic]], [[Bevacizumab|bevacizumab]], [[beta blockers]], [[bezafibrate]], [[bicalutamide]], [[bleomycin]], [[blinatumomab]], [[botulinum antitoxin]], [[bortezomib]], [[bosutinib]], [[botulinum toxin]], [[bromelain]], [[bromocriptine]], [[bromomethane]], [[bronchodilator]], [[butalbital]], [[buprenorphine]], [[bupropion]], [[busulfan]], [[butanethiol]], [[butorphanol]], [[cabergoline]], [[calcitonin]], [[calcitriol]], [[calcium carbamide]], [[calcium channel antagonists]], [[capecitabine]], [[capsaicin]], [[carbamates]], [[Carbidopa and Levodopa|carbidopa and levodopa]], [[carboplatin]], [[carmustine]], [[carprofen]], [[carvedilol]], [[caspofungin]], [[cefaclor]], [[cefixime]], [[ceritinib]], [[cetrorelix]], [[cefoperazone Sodium Injection (patient information)|cefoperazone sodium]], [[cefotaxime sodium]], [[cefotetan disodium]], [[cefprozil]], [[ceftibuten]], [[cefuroxime]], [[ceftibuten]], [[ceftaroline fosamil]], [[cefuroxime]], [[cephalosporin]], [[cetuximab]], [[cetuximab injection ]] , [[cevimeline]], [[chelation therapy]], [[chemotherapy]], [[chloral hydrate]], [[chlordiazepoxide]], [[chloromethane]], [[chlorothiazide]], [[chlorpropamide]], [[CHOP]], [[cimicifuga racemosa]], [[ciprofloxacin]], [[cisplatin]], [[citalopram]], [[cladribine]], [[clarithromycin]], [[clindamycin]], [[clofarabine]], [[clofibrate]], [[clomifene]], [[clorazepate]], [[clozapine]], [[cobicistat]], [[co-codamol]], [[codeine]], [[colchicine]], [[colestyramine]], [[combined oral contraceptive pill]], [[conjugated estrogens/bazedoxifene]], [[contraceptive patch]], [[crizotinib]], [[cyclobenzaprine]], [[cyclophosphamide]], [[cytisine]], [[cytarabine]], [[cytarabine liposome]], [[cytisine]],[[capsaicin]], [[dacarbazine ]] , [[dactinomycin ]] , [[dalfampridine]], [[danazol]], [[dantrolene]], [[daptomycin]], [[Darbepoetin Alfa Injection|darbepoetin alfa Injection]] , [[darunavir ]] , [[daunorubicin ]] , [[deferasirox ]] , [[deferiprone]], [[defibrotide]], [[denileukin diftitox]], [[desmopressin]], [[dexamethasone]], [[dexchlorpheniramine]], [[dexrazoxane]], [[Dextroamphetamine and Amphetamine|dextroamphetamine and amphetamine]], [[dextromethorphan]], [[dextropropoxyphene]], [[diazepam]], [[diazinon]], [[dicofol]], [[didanosine]], [[diethyl ether]], [[diethylcathinone]], [[diflunisal]], [[digitoxin]], [[digoxin]], [[diethylcathinone]], [[diethyl ether]], [[dimercaprol]], [[dinoprostone]], [[dipyridamole]], [[disulfiram ]] , [[diuretic]], [[docetaxel ]] , [[dofetilide ]] , [[dolasetron ]] , [[donepezil ]] , [[doripenem]], [[dosulepin hydrochloride]], [[doxorubicin hydrochloride]], [[doxycycline]], [[Drospirenone and Ethinyl estradiol|drospirenone and ethinyl estradiol]], [[DTPA]], [[duloxetine]], [[ecallantide]], [[eculizumab]], [[efavirenz]], [[elvitegravir]], [[enfuvirtide]], [[entecavir]], [[epinephrine (aerosol)]], [[ergometrine]], [[ergotamine]], [[eribulin]], [[erlotinib]], [[erythromycin]], [[estradiol valerate and estradiol valerate/dienogest]], [[eslicarbazepine acetate]], [[ethcathinone]], [[ethchlorvynol]], [[ethosuximide]], [[ethynodiol diacetate and ethinyl estradiol]], [[ethyl carbamate]], [[emetine]], [[emtricitabine]], [[Emtricitabine, Rilpivirine Hydrochloride, And Tenofovir Disoproxil Fumarate|rilpivirine hydrochloride, and tenofovir disoproxil fumarate]], [[endosulfan]], [[entacapone]], [[efavirenz]], [[enfuvirtide]], [[entecavir ]] , [[elosulfase alfa]], [[epinephrine (aerosol)]], [[epirubicin hydrochloride]], [[epoetin Alfa ]] , [[eribulin]], [[eliglustat]], [[erlotinib ]] , [[erythromycin]], [[estradiol]], [[estrogen and Progestin (Oral Contraceptives) ]] , [[ethcathinone]], [[ethchlorvynol]], [[ethyl carbamate]], [[ethylmorphine]], [[etidronate ]] , [[etodolac]], [[etoposide]], [[exemestane]], [[exenatide]], [[felbamate]], [[fentanyl Oral Transmucosal ]] [[fexofenadine]], [[filgrastim]], [[fioricet]], [[flavoxate]], [[fludarabine phosphate]], [[fluorouracil]], [[flurazepam]],[[Flurbiprofen]], [[floxuridine]], [[fluconazole]], [[flucytosine]], [[fludarabine Phosphate]], [[flunisolide]], [[fluorescein sodium]], [[fluorouracil ]] , [[flurazepam]], [[flurbiprofen]], [[flutamide ]] , [[Fluticasone]], [[foscarnet sodium]], [[fulvestrant]], [[galantamine]], [[gallium nitrate]], [[gabapentin]], [[gamma-Hydroxybutyric acid]], [[gatifloxacin ]] , [[gefitinib ]] , [[gemcitabine]], [[gemeprost]], [[general anaesthesia]], [[gestrinone]], [[glimepiride]], [[glipizide]], [[glucagon]], [[glucarpidase]], [[glycylcycline]], [[glycopyrrolate]], [[glyburide]], [[glyburide and Metformin]], [[glycylcycline]], [[goserelin ]] , [[Graft-versus-host disease]], [[granisetron ]] , [[grifulvin V]], [[guaifenesin]], [[H1 antihistamine]], [[herkinorin]], [[heroin]], [[hydralazine]], [[hydrochlorothiazide]], [[hydrocodone]], [[Hydrocodone bitartrate and Homatropine methylbromide|hydrocodone bitartrate and homatropine methylbromide]], [[hydrocortisone]], [[hydromorphone]], [[hydroxycarbamide]], [[hydroxychloroquine]], [[hydroxocobalamin]], [[hydroxyurea]], [[hydroxyzine]], [[hydroxyprogesterone caproate]], [[Ibogaine]], [[Ibuprofen]], [[Ibrutinib]], [[Ibritumomab tiuxetan]], [[Idarubicin ]] , [[Idursulfase]], [[Ifosfamide ]] , [[Imatinib ]] , [[Imiglucerase]], [[Imipenem]], [[Indinavir]], [[Interferon gamma]], [[Interferon alfa-2b]], [[Iodomethane]], [[Irinotecan hydrochloride]], [[Isoniazid]], [[Isoproterenol (aerosol)]], [[Isopropyl alcohol]], [[Isosorbide mononitrate]], [[Isotretinoin]], [[Itraconazole]], [[Ivacaftor]], [[Ivermectin]], [[Ixabepilone]], [[kaopectate]], [[ketorolac]], [[lacosamide]], [[lactulose]], [[lamivudine]], [[lanreotide]], [[lansoprazole]], [[lanthanum carbonate]], [[lapatinib]], [[lenalidomide]], [[letrozole ]] , [[leuprolide ]] , [[Levodopa and Carbidopa|levodopa and carbidopa]] , [[levofloxacin]], [[levonorgestrel]], [[lidocaine (ointment)]], [[lithium nitrate]], [[lomefloxacin hydrochloride]], [[lorcaserin]], [[lopinavir]], [[loprazolam]], [[lorazepam]], [[lovaza]], [[malaria prophylaxis]], [[mazindol]], [[mechlorethamine ]] , [[medazepam]], [[megestrol ]] , [[melarsoprol]], [[melphalan ]] , [[mercaptopurine]], [[meropenem]], [[mesalamine ]] , [[mescaline]], [[mesna]], [[metformin]], [[methadone]], [[methenamine]], [[methotrexate]], [[methylergonovine]], [[methylketobemidone]], [[methylphenidate]], [[methyprylon]], [[metronidazole]], [[micafungin sodium]], [[mifepristone]], [[milk of magnesia]], [[milnacipran hydrochloride]], [[miltefosine]], [[mirtazapine]], [[misoprostol]], [[mitomycin ]] , [[mitotane]], [[mitoxantrone]], [[moclobemide]], [[monocrotophos]], [[morphine]], [[motofen]], [[moxifloxacin]], [[mycophenolic acid]], [[nabilone]], [[nafcillin]], [[nalbuphine]], [[nalmefene]], [[naloxone]], [[naphthalene]], [[naproxen sodium]], [[natamycin]], [[niacin/simvastatin]], [[nicorandil]], [[nilotinib]], [[nilutamide]], [[nintedanib]], [[nitrazepam]], [[nitrofurantoin]], [[nizatidine]], [[Norethindrone acetate and Ethinyl estradiol|norethindrone acetate and ethinyl estradiol]], [[Norgestimate and Ethinyl estradiol|norgestimate and ethinyl estradiol]], [[Norgestrel and Ethinyl estradiol|norgestrel and ethinyl estradiol]], [[olanzapine ]] , [[olsalazine]], [[omeprazole ]] , [[ondansetron]], [[opioid]], [[oprelvekin]], [[oritavancin]], [[oseltamivir ]] , [[oxaliplatin]], [[oxamniquine]], [[oxazepam]], [[oxcarbazepine]], [[oxybutynin ]] , [[oxycodone and aspirin ]] , [[oxytocin]], [[Paclitaxel]], [[palbociclib]], [[paliperidone ]] , [[palonosetron]], [[panitumumab]], [[pantoprazole]], [[papaverine]], [[paromomycin sulfate]], [[pazopanib hydrochloride]], [[paracetamol]], [[paroxetine]], [[pasireotide]], [[pegaspargase ]] , [[pemetrexed ]] , [[penicillin]], [[pentamidine]], [[pentavalent antimonial]], [[pentetic acid]], [[pentostatin ]] , [[pergolide ]] , [[perhexiline]], [[pertuzumab]], [[pirfenidone]], [[piroxicam]], [[phenelzine]], [[phenoxymethylpenicillin]], [[phentermine]], [[phenylephrine]], [[physostigmine]], [[pholcodine]], [[pilocarpine]], [[pioglitazone ]] , [[piribedil]], [[plerixafor]], [[plicamycin ]] ,[[posaconazole ]] , [[potassium chloride]], [[potassium citrate]], [[praziquantel]], [[pregabalin ]] , [[primaquine phosphate]], [[potassium iodide]], [[primaquine]][[procainamide ]] , [[procarbazine ]] , [[prochlorperazine]], [[progesterone]], [[propiram]], [[propylketobemidone]], [[prosidol]], [[protriptyline ]] , [[pyrantel pamoate]][[pyrazinamide]], [[pyridostigmine]], [[quetiapine ]] , [[quinupristin/dalfopristin]], [[radium chloride]], [[ramelteon]], [[ranolazine ]] , [[ranitidine]], [[rasburicase]], [[rasagiline ]] , [[reserpine]], [[ribavirin]], [[rifabutin]], [[rifaximin]], [[risedronate ]] , [[ritonavir]], [[rituximab ]] , [[rivastigmine ]] , [[rizatriptan ]] , [[ropinirole ]] , [[roflumilast]], [[rotigotine]], [[roxithromycin]], [[rubbing alcohol]], [[salsalate ]] , [[saquinavir mesylate]], [[sarin]], [[sargramostim]], [[stavudine]], [[sativex]], [[saxagliptin hydrochloride and Metformin hydrochloride]], [[secretin human]], [[secobarbital]], [[selegiline ]] , [[seliciclib]], [[serotonin]], [[sibutramine]], [[sipuleucel-T]], [[sodium oxybate]], [[sodium polystyrene sulfonate]], [[sodium stibogluconate]], [[sodium sulfate, potassium sulfate and magnesium sulfate]], [[solanine]], [[spironolactone]], [[Stiripentol]], [[streptozocin]], [[streptomycin]], [[streptozocin]], [[sufentanil]], [[Sulfamethoxazole/Trimethoprim (oral)]], [[sultiame]], [[sumatriptan]], [[sunitinib ]] , [[suramin]],[[tacrolimus]], [[tapentadol]], [[tedizolid]], [[telavancin hydrochloride]], [[telbivudine ]] , [[telithromycin ]] , [[taliglucerase alfa]][[temozolomide]], [[teniposide ]] , [[teriparatide]], [[tetracaine]], [[tetraferric tricitrate decahydrate]], [[tetrahydrocannabinol]], [[tetrahydrozoline]], [[tetramethylsuccinonitrile]], [[tetrodotoxin]], [[thallous Chloride Tl 201]], [[thiabendazole]], [[thiethylperazine]], [[thioguanine]], [[thiotepa ]] , [[Thyroid Medication|thyroid medication]], [[tigecycline]], [[tocopherol]], [[tolcapone ]] , [[tolmetin]], [[topiramate]], [[tolbutamide]], [[topotecan Hydrochloride|topotecan hydrochloride]], [[toremifene]], [[tralomethrin]], [[tramadol]], [[trametinib dimethyl sulfoxide]], [[trandolapril]], [[trastuzumab]], [[trazodone]], [[tretinoin]], [[triamterene]], [[triazolam]], [[triclofos]], [[tricyclic antidepressant]], [[trifluoperazine]], [[trifluoromethylphenylpiperazine]], [[trimeperidine]], [[trimethobenzamide]], [[trimetrexate Glucuronate]], [[tropisetron]], [[trovafloxacin mesylate]], [[valaciclovir]], [[valganciclovir hydrochloride]], [[valproic acid ]] , [[vancomycin]], [[varenicline]], [[venlafaxine]], [[vicodin]], [[vidarabine]], [[vigabatrin]], [[vilazodone]], [[viloxazine]], [[vinblastine ]] , [[vinorelbine Tartrate]], [[vismodegib]], [[von Willebrand factor]], [[voriconazole]], [[vorinostat]], [[vortioxetine]], [[zafirlukast]], [[zidovudine]], [[zolpidem ]] , [[zopiclone]], [[zoledronate]]
|-
|- bgcolor="LightSteelBlue"
|'''Ear Nose Throat'''
| bgcolor="Beige" |[[Balance disorder]], [[decompression sickness]], [[ear infection]], [[epistaxis]], [[glaucoma]], [[labyrinthitis]], [[Ménière's disease]], [[pharyngitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Endocrine'''
| bgcolor="Beige" |[[Acromegaly]], [[addison's disease]], [[adrenal failure]], [[adrenal insufficiency]], [[amyloidosis]], [[anorexia nervosa]], [[carcinoid tumours and carcinoid syndrome]], [[contraceptive patch]], [[diabetic gastroparesis]], [[diabetic ketoacidosis]], [[diabetes mellitus]],[[emergency contraception]], [[gangrene]], [[gestational diabetes]], [[hormone replacement therapy (trans)]],[[hypocalcemia]], [[hypoglycemia]], [[hyperparathyroidism]], [[hyperthyroidism]], [[prolactinoma]], [[syndrome of inappropriate antidiuretic hormone]]([[SIADH]]), [[thyrotoxicosis]], [[Estrogen and Progestin (Hormone Replacement Therapy) (patient information)|estrogen and progestin]], [[multiple endocrine neoplasia type 1]]
|- bgcolor="LightSteelBlue"
|'''Environmental'''
| bgcolor="Beige" |[[Bothrops|Bothrops bite]], [[bromomethane]], [[carbon monoxide poisoning]], [[dioxin]], [[heat stroke]], [[hyperthermia]]
|-
|- bgcolor="LightSteelBlue"
|'''Gastroenterologic'''
| bgcolor="Beige" |[[Achalasia]], [[acute abdomen]], [[accessory pancreas]] , [[acute fatty liver of pregnancy]], [[acute pancreatitis]], [[adjustable gastric band]], [[afferent loop syndrome]], [[alcoholic Hepatitis]], [[alcoholism]], [[anastomosis]] [[stenosis]], [[ anorexia nervosa]], [[appendicitis]], [[bacterial gastroenteritis]], [[beef tapeworm]], [[biliary colic]], [[blastocystosis]], [[bowel obstruction]], [[brucella]], [[bulimia nervosa]], [[caecitis]], [[carcinoid tumours and carcinoid syndrome]], [[chronic intestinal pseudo-obstruction]], [[cholecystitis]], [[cholecystolithiasis]], [[ciguatera]], [[colorectal cancer]], [[congenital hypertrophic pyloric stenosis]], [[Crohn's disease]], [[cryptosporidium parvum]], [[cyclic vomiting syndrome]], [[cyclospora cayetanensis]], [[diabetic gastroparesis]], [[dientamoebiasis]], [[diverticulitis]], [[dumping syndrome]], [[enteric Neuropathy]], [[eosinophilic esophagitis]], [[eosinophilic gastroenteritis]], [[epiploic appendagitis]], [[esophageal achalasia]], [[esophageal cancer]], [[esophageal diverticulum]], [[esophageal stenosis]], [[esophagitis]], [[femoral hernia]], [[food allergies]], [[food poisoning]], [[fundic gland polyposis]], [[functional dyspepsia]], [[gastric carcinoma]], [[gastric outlet obstruction]], [[gastritis]], [[gastrocolic fistula]], [[gastroenteritis]], [[gastroesophageal reflux disease]], [[gastrointestinal perforation]], [[gastroparesis]], [[giardiasis]], [[helicobacter pylori infection]], [[Hellp syndrome]], [[hematemesis]], [[hepatic coma]], [[hepatic porphyria]], [[hepatitis]], [[hepatitis A]], [[hepatitis B]], [[hepatitis D]], [[hepatitis E]], [[hepatobiliary disease]], [[hepatotoxicity ]] , [[hernia]], [[hirschsprung disease]], [[Ileus]], [[Intussusception (medical disorder)]], [[Irritable bowel syndrome]], [[Ischemic bowel]], [[Mesenteric ischemia]], [[peptic ulcer]], [[peritonitis]], [[pyloric stenosis]], [[Reye's syndrome]], [[Small bowel bacterial overgrowth syndrome]], [[Small intestine cancer]], [[traveler's diarrhea]]
|- bgcolor="LightSteelBlue"
|'''Genetic'''
| bgcolor="Beige" |[[Acute intermittent porphyria]], [[congenital malformation]], [[Down syndrome]], [[episodic ataxia]], [[familial hemiplegic migraine]], [[fundic gland polyposis]], [[galactosemia]], [[hereditary fructose intolerance]], [[slone's disease]]
|-
|- bgcolor="LightSteelBlue"
|'''Hematologic'''
| bgcolor="Beige" |[[HELLP syndrome]], [[hemorrhage]], [[mastocytosis]], [[porphyria]], [[splenic infarction]], [[thrombotic thrombocytopenic purpura]]
|-
|- bgcolor="LightSteelBlue"
|'''Iatrogenic'''
| bgcolor="Beige" |[[Essure]], [[dumping syndrome]], [[high doses of ionizing radiation]], [[Instillation abortion]], [[Minimally Invasive Thorasic Spinal Fusion|minimally Invasive thorasic spinal fusion]]
|-
|- bgcolor="LightSteelBlue"
|'''Infectious Disease'''
| bgcolor="Beige" |[[Infections|Acute infections]], [[acute viral nasopharyngitis (common cold)]], [[AIDS]], [[aseptic meningitis]], [[astrovirus]], [[bacillus cereus|bacillus cereus infection]], [[bacterial gastroenteritis]], [[Barcoo Fever|barcoo fever]], [[beef tapeworm]], [[blastocystosis]], [[brucella]], [[colorado tick fever]], [[community-acquired pneumonia]], [[croup]], [[cryptosporidium parvum|cryptosporidium parvum infection]], [[cyclospora cayetanensis|cyclospora cayetanensis infection]], [[dengue fever]], [[diarrheal shellfish poisoning]], [[dientamoebiasis]], [[diphtheria]], [[Duke's disease]], [[ebola]], [[giardia lamblia]], [[Hantavirus pulmonary syndrome]], [[helicobacter pylori infection]], [[henipavirus]], [[hepatitis B]], [[hepatitis D]], [[hepatitis E]], [[hookworm]], [[human ehrlichiosis]], [[Influenza]], [[Intestinal parasite]], [[lassa fever]], [[listeria monocytogenes]], [[malaria]], [[meningococcemia]], [[Naegleria fowleri]], [[norovirus]], [[norwalk Virus]], [[pfiesteria piscicida]], [[poliomyelitis]], [[Q fever]], [[Rocky Mountain spotted fever]], [[Scarlet fever]], [[shigella]], [[Sporotrichosis]], [[staphylococcal enteritis]], [[tularemia]], [[vibrio parahaemolyticus]], [[West Nile virus]], [[waterborne diseases]], [[Yellow fever]]
|-
|- bgcolor="LightSteelBlue"
|'''Musculoskeletal / Ortho'''
| bgcolor="Beige" |[[Decompression sickness]]
|-
|- bgcolor="LightSteelBlue"
|'''Neurologic'''
| bgcolor="Beige" |[[Acoustic neuroma]], [[airsickness]], [[altitude sickness]], [[arachnoid cyst]], [[Aseptic meningitis|aseptic meningitis]], [[autonomic neuropathy]], [[balance disorder]], [[benign intracranial hypertension]] ,[[Brain Stem Gliomas|brain stem gliomas]], [[brain tumor]], [[stroke|cerebellar stroke]], [[cerebral aneurysm]], [[cerebral arteriovenous malformation]], [[cerebral hemorrhage]], [[cerebrovascular disease]], [[cerebral oedema]],[[cerebral shunt ]] , [[cerebrovascular disease]], [[ciguatera]], [[concussion]], [[craniopharyngioma]], [[cyclic vomiting syndrome]], [[decompression sickness]], [[encephalitis]], [[enteric Neuropathy|enteric neuropathy]], [[ependymoma]], [[epidural haemorrhage]], [[episodic ataxia]], [[familial hemiplegic migraine]], [[glioblastoma multiforme]], [[glioma]], [[heavy metal ingestion]], [[hemicrania continua]], [[hepatic coma]], [[hydrocephalus]], [[La Crosse encephalitis]], [[Sea sickness]], [[subdural hematoma]], [[Tabes dorsalis]], [[vagal episode]], [[vertebrobasilar insufficiency]], [[vestibular neuritis]]
|-
|- bgcolor="LightSteelBlue"
|'''Nutritional / Metabolic'''
| bgcolor="Beige" |[[5-hydroxytryptophan]], [[acute intermittent porphyria]], [[amnesic shellfish poisoning]], [[amyloidosis]], [[bromelain]], [[cicuta]], [[cimicifuga racemosa]],[[coprinopsis atramentaria]], [[food allergies]], [[food intolerance]], [[food poisoning]], [[galactosemia]], [[ginger]], [[hereditary fructose intolerance]], [[hypercalcemia]], [[hypermagnesemia]], [[hypervitaminosis A]], [[hypervitaminosis]], [[hypocalcemia]], [[hypocholermia]], [[hypoglycemia]], [[hypokalemia]], [[hyponatremia]], [[ketogenic diet]], [[lactose intolerance]], [[metabolic acidosis]], [[pyridoxine deficiency]]
|-
|- bgcolor="LightSteelBlue"
|'''Obstetric/Gynecologic'''
| bgcolor="Beige" |[[Acute fatty liver of pregnancy]], [[breastfeeding complications]], [[childbirth]], [[contraceptive patch]], [[endometriosis]], [[emergency contraception]],[[Estrogen and Progestin (Oral Contraceptives)|estrogen and progestin]], [[essure]], [[gestational diabetes]], [[HELLP syndrome]], [[hydatidiform mole]], [[hyperemesis gravidarum]], [[ovarian cyst]], [[ovarian hyperstimulation syndrome]], [[ovarian torsion]], [[pregnancy]], [[salpingitis]], [[twisted ovarian cyst]]
|-
|- bgcolor="LightSteelBlue"
|'''Oncologic'''
| bgcolor="Beige" |[[Acoustic neuroma]], [[Brain Stem Gliomas|brain stem gliomas]], [[brain tumor]], [[cancer]], [[carcinoid tumours and carcinoid syndrome]], [[colorectal cancer]][[craniopharyngioma]], [[ependymoma]], [[esophageal cancer]], [[gastric carcinoma]], [[glioblastoma multiforme]], [[glioma]], [[Kaposi's sarcoma]], [[Non-Hodgkin lymphoma]], [[osteosarcoma]], [[prolactinoma]], [[Zollinger-Ellison Syndrome]]
|-
|- bgcolor="LightSteelBlue"
|'''Opthalmologic'''
| bgcolor="Beige" |[[Acute angle-closure glaucoma]], [[glaucoma]], [[refractive error]]
|-
|- bgcolor="LightSteelBlue"
|'''Overdose / Toxicity'''
| bgcolor="Beige" |[[1,2-Dichloroethene]], [[1,3-Dichloropropene]], [[2C-E]], [[2C-I]], [[2C-T-7]], [[abrin]], [[alcoholism]], [[alcohol withdrawal]], [[beleric]], [[cinchonism]], [[ethanol abuse]], [[hangover]], [[heavy metal ingestion]], [[heroin]], [[orellanine]], [[Reye's syndrome]], [[marine toxins]], [[PMA]]
|- bgcolor="LightSteelBlue"
|'''Psychiatric'''
| bgcolor="Beige" |[[Alcohol Withdrawal]], [[alcoholism]], [[anorexia nervosa]], [[anxiety]], [[anxiety disorders]], [[bulimia nervosa]], [[chronic fatigue syndrome]], [[combat stress reaction]], [[depression]], [[ethanol abuse]], [[hangover]], [[sexual fetish]] ([[emetophilia]]), [[SSRI discontinuation syndrome]] [[Hypochondriasis]]<ref name="pmid1263596">{{cite journal |vauthors=Swanson DW, Swenson WM, Huizenga KA, Melson SJ |title=Persistent Nausea without organic cause |journal=Mayo Clin Proc |volume=51 |issue=5 |pages=257–62 |date=May 1976 |pmid=1263596 |doi= |url=}}</ref>
|-
|- bgcolor="LightSteelBlue"
|'''Pulmonary'''
| bgcolor="Beige" |[[Acute viral nasopharyngitis (common cold)]], [[altitude sickness]], [[anaphylaxis]], [[aortic arch anomalies]], [[community acquired pneumonia]], [[croup]], [[decompression sickness]], [[Hantavirus pulmonary syndrome]], [[lower respiratory tract infection]], [[pulmonary embolism]], [[ pharyngitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Renal / Electrolyte'''
| bgcolor="Beige" |[[Dehydration]], [[diabetic ketoacidosis]], [[hypercalcemia]], [[hypermagnesemia]], [[hypocalcemia]], [[hypocholermia]], [[hypokalemia]], [[hyponatraemia]], [[Interstitial nephritis]], [[nutcracker syndrome]], [[pyelonephritis]], [[renal colic]], [[renal failure]], [[renal stones]], [[ urinary tract infections]]
|-
|- bgcolor="LightSteelBlue"
|'''Rheum / Immune / Allergy'''
| bgcolor="Beige" |[[Amyloidosis]], [[anaphylaxis]], [[chronic fatigue syndrome]], [[Crohn's disease]], [[food allergies]], [[food intolerance]], [[Graft-versus-host disease]], [[scleroderma]], [[Tetanus, Diphtheria, and Pertussis (Tdap) Vaccine|tetanus, diphtheria, and pertussis (Tdap) vaccine]], [[typhoid Vaccine]], [[HIV]]
|-
|- bgcolor="LightSteelBlue"
|'''Sexual'''
| bgcolor="Beige" |[[HIV]]
|-
|- bgcolor="LightSteelBlue"
|'''Trauma'''
| bgcolor="Beige" |[[Head trauma]], [[hemorrhage]], [[post-concussion syndrome]]
|-
|- bgcolor="LightSteelBlue"
|'''Urologic'''
| bgcolor="Beige" |[[Acute prostatitis]], [[testicular rupture]], [[testicular torsion]], [[urinary tract infections]], [[urolithiasis]]
|-
|- bgcolor="LightSteelBlue"
|'''Miscellaneous'''
| bgcolor="Beige" |[[Anadenanthera peregrina]], [[exercise induced nausea]], [[extreme pain]], [[foreign bodies]], [[sleep deprivation]], [[soapwort]], [[ulcers]], [[water intoxication]], [[cyclic vomiting syndrome]], [[DTPA]], [[ginkgo]]
|-
|}

{{columns-list||
* [[1,2-Dichloroethene]]
* [[1,3-Dichloropropene]]
* [[2C-E]]
* [[2C-I]]
* [[2C-T-7]]
* [[2-Ethylhexanol]]
* [[5-Hydroxytryptophan]]
* [[5-MeO-AMT]]
* [[Abrin]]
* [[Abscess]]
* [[ABVD]]
* [[Acamprosate calcium]]
* [[Accessory pancreas]]
* [[Acetaminophen]]
* [[Acetoxyketobemidone]]
* [[Acetylcysteine]]
* [[Achalasia]]
* [[Aclarubicin]]
* [[Acyclovir]]
* [[Aconitine]]
* [[Acoustic neuroma]]
* [[Acromegaly]]
* [[Actinomycin|Actinomycin D]]
* [[Acute angle-closure glaucoma]]
* [[Acute coronary syndromes]]
* [[Acute fatty liver of pregnancy]]
* [[Acute intermittent porphyria]]
* [[Acute pancreatitis]]
* [[Acute prostatitis]]
* [[Acute viral nasopharyngitis (common cold)]]
* [[Adamsite]]
* [[Adenovirus]]
* [[Addison's Disease]]
* [[Adjustable gastric band]]
* [[Adrenal insufficiency]]
* [[Afferent loop syndrome]]
* [[Airsickness]]
* [[Alatrofloxacin Injection]]
* [[Albuterol Inhalation]]
* [[Alcohol withdrawal]]
* [[Alcoholism]]
* [[Aldesleukin]]
* [[Alemtuzumab]]
* [[Allylprodine]]
* [[Alpha-Methyltryptamine]]
* [[Alprazolam]]
* [[Altitude sickness]]
* [[Altretamine]]
* [[Amantadine]]
* [[Amifostine]]
* [[Amineptine]]
* [[Aminocaproic acid]]
* [[Aminophylline]]
* [[Aminopterin]]
* [[Aminosalicylic acid]]
* [[Amitriptyline]]
* [[Ammonium chloride]]
* [[Amnesic shellfish poisoning]]
* [[Amoxicillin]]
* [[Amphotericin B]]
* [[Amrinone]]
* [[Amyl nitrite]]
* [[Amyloidosis]]
* [[Anadenanthera peregrina]]
* [[Anaphylaxis]]
* [[Anastrozole]]
* [[Anesthesia]]
* [[Angina pectoris]]
* [[Anorexia nervosa]]
* [[Antiarrhythmics]]
* [[Antibiotics]]
* [[Anticonvulsants]]
* [[Antihistamine]]
* [[Antihypertensives]]
* [[Antiretroviral drug]]
* [[Anxiety]]
* [[Aortic arch anomalies]]
* [[Apomorphine hydrochloride]]
* [[Appendicitis]]
* [[Aprepitant]]
* [[Arachnoid cyst]]
* [[Aripiprazole]]
* [[Arsenicals]]
* [[Arsenic Poisoning]]
* [[Arsenic trioxide]]
* [[Ascariasis]]
* [[Aseptic meningitis]]
* [[Asparaginase]]
* [[Aspirin]]
* [[Astrovirus]]
* [[Atomoxetine]]
* [[Atosiban]]
* [[Atripala]] ([[Efavirenz, emtricitabine and tenofovir disoproxil fumarate]])
* [[Auranofin]]
* [[Autonomic neuropathy]]
* [[Azathioprine]]
* [[Azithromycin]]
* [[Aztreonam]]
* [[Bacillus cereus]]
* [[Bacterial gastroenteritis]]
* [[Balance disorder]]
* [[Barbiturate]]
* [[Barcoo Fever|Barcoo fever]]
* [[Barium oxalate]]
* [[Barium sulfate]]
* [[BCG vaccine]]
* [[Beef tapeworm]]
* [[Beleric]]
* [[Belladonna Alkaloid Combinations and Phenobarbital|Belladonna alkaloid combinations]]
* [[Benign intracranial hypertension]]
* [[Benzodiazepine]]
* [[Benzylpiperazine]]
* [[Beta blockers]]
* [[Beta-lactam antibiotic]]
* [[Bevacizumab Injection (patient information)|Bevacizumab Injection]]
* [[Bezafibrate]]
* [[Bicalutamide]]
* [[Biliary colic]]
* [[Blastocystosis]]
* [[Bleomycin ]]
* [[Bortezomib]]
* [[Botulinum toxin]]
* [[Bowel obstruction]]
* [[Brain Stem Gliomas|Brain stem gliomas]]
* [[Brain tumor]]
* [[Breastfeeding complications]]
* [[Bromelain]]
* [[Bromomethane]]
* [[Bronchodilator]]
* [[Brucella]]
* [[Buprenorphine Hydrochloride, Naloxone Hydrochloride|Buprenorphine,naloxone]]
* [[Bulimia nervosa]]
* [[Buprenorphine]]
* [[Bupropion]]
* [[Busulfan]]
* [[Butanethiol]]
* [[Butorphanol]]
* [[Cabergoline]]
* [[Caecitis]]
* [[Calcitonin]]
* [[Calcitriol]]
* [[Calcium carbamide]]
* [[Calcium channel antagonists]]
* [[Camphor|Camphor poisoning]]
* [[Cancer]]
* [[Capecitabine]]
* [[Capsaicin]]
* [[Carbon monoxide poisoning]]
* [[Carboplatin]]
* [[Carcinoid tumours and carcinoid syndrome]]
* [[Cardiac arrhythmia]]
* [[Carmustine]]
* [[Carprofen]]
* [[Carvedilol]]
* [[Caspofungin]]
* [[Cefaclor]]
* [[Cefixime]]
* [[Cefoperazone Sodium Injection (patient information)|Cefoperazone Sodium Injection]]
* [[Cefotetan disodium]]
* [[Cefprozil]]
* [[Ceftaroline fosamil]]
* [[Ceftibuten]]
* [[Cefuroxime]]
* [[Cephalosporin]]
* [[Cerebral aneurysm]]
* [[Cerebral arteriovenous malformation]]
* [[Cerebral edema]]
* [[Cerebral hemorrhage]]
* [[Cerebral shunt]]
* [[Cerebrovascular disease]]
* [[Cetuximab Injection]]
* [[Cevimeline]]
* [[Chelation therapy]]
* [[Chemotherapy]]
* [[Childbirth]]
* [[Chloral hydrate]]
* [[Chlordiazepoxide]]
* [[Chloromethane]]
* [[Chlorothiazide]]
* [[Chlorpropamide]]
* [[Cholecystitis]]
* [[Cholecystolithiasis]]
* [[CHOP]]
* [[Chronic fatigue syndrome]]
* [[Chronic intestinal pseudo-obstruction]]
* [[Cicuta]]
* [[Ciguatera]]
* [[Cimicifuga racemosa]]
* [[Cinchonism]]
* [[Ciprofloxacin]]
* [[Cisplatin]]
* [[Citalopram]]
* [[Cladribine]]
* [[Clarithromycin]]
* [[Clindamycin]]
* [[Clofarabine]]
* [[Clofibrate]]
* [[Clomifene]]
* [[Clorazepate]]
* [[Clostridium perfringens]]
* [[Cobicistat]]
* [[Co-codamol]]
* [[Codeine]]
* [[Colchicine]]
* [[Colestyramine]]
* [[Colorado tick fever]]
* [[Colorectal cancer]]
* [[Combat stress reaction]]
* [[Community-acquired pneumonia]]
* [[Concussion]]
* [[Congenital hypertrophic pyloric stenosis]]
* [[Congenital malformation]]
* [[Contraceptive patch]]
* [[Copper|Copper salts]]
* [[Coprinopsis atramentaria]]
* [[Craniopharyngioma]]
* [[Crohn's disease]]
* [[Croup]]
* [[Cryptosporidium parvum]]
* [[Cyanogen]]
* [[Cyclic vomiting syndrome]]
* [[Cyclobenzaprine]]
* [[Cyclophosphamide]]
* [[Cyclospora cayetanensis]]
* [[Cytarabine]]
* [[Cytisine]]
* [[Dacarbazine]]
* [[Dactinomycin]]
* [[Danazol]]
* [[Dantrolene]]
* [[Daptomycin]]
* [[Darbepoetin Alfa Injection (patient information)|Darbepoetin Alfa Injection]]
* [[Darunavir]]
* [[Daunorubicin]]
* [[Decompression sickness]]
* [[Deferasirox]]
* [[Deferiprone]]
* [[Defibrotide]]
* [[Dehydration]]
* [[Dengue fever]]
* [[Depression]]
* [[Desmopressin]]
* [[Dexamethasone]]
* [[Dextroamphetamine and Amphetamine (patient information)|Dextroamphetamine and Amphetamine]]
* [[Dextromethorphan]]
* [[Dextropropoxyphene]]
* [[Diabetes mellitus]]
* [[Diabetic gastroparesis]]
* [[Diabetic Ketoacidosis]]
* [[Diarrheal shellfish poisoning]]
* [[Diazepam]]
* [[Diazinon]]
* [[Dicofol]]
* [[Didanosine]]
* [[Dientamoebiasis]]
* [[Diethyl ether]]
* [[Diethylcathinone]]
* [[Diflunisal]]
* [[Digitalis purpurea]]
* [[Digitoxin]]
* [[Digoxin]]
* [[Dioxathion]]
* [[Dioxin]]
* [[Diphtheria]]
* [[Disulfiram]]
* [[Diuretic]]
* [[Diverticulitis]]
* [[Docetaxel]]
* [[Dofetilide]]
* [[Dolasetron]]
* [[Donepezil]]
* [[Doripenem]]
* [[Dosulepin hydrochloride]]
* [[Down syndrome]]
* [[Doxorubicin Hydrochloride]]
* [[DTPA]]
* [[Duke's disease]]
* [[Duloxetine]]
* [[Dumping syndrome]]
* [[Ear infection]]
* [[Ebola virus disease]]
* [[Eculizumab]]
* [[Efavirenz]]
* [[Elvitegravir]]
* [[Emergency contraception]]
* [[Emetine]]
* [[Encephalitis]]
* [[Endometriosis]]
* [[Endosulfan]]
* [[Enfuvirtide]]
* [[Entecavir]]
* [[Enteric Neuropathy]]
* [[Enterobiasis]]
* [[Eosinophilic gastroenteritis]]
* [[Epidural haemorrhage]]
* [[Ependymoma]]
* [[Epiploic appendagitis]]
* [[Epirubicin hydrochloride]]
* [[Episodic ataxia]]
* [[Epistaxis]]
* [[Epoetin Alfa Injection (patient information)|Epoetin Alfa Injection]]
* [[Ergotamine]]
* [[Ergotism]]
* [[Eribulin]]
* [[Erlotinib]]
* [[Erythromycin]]
* [[Esophageal achalasia]]
* [[Esophageal cancer]]
* [[Esophageal diverticulum]]
* [[Esophageal stenosis]]
* [[Esophagitis]]
* [[Essure]]
* [[Estradiol]]
* [[Estrogen and Progestin (Oral Contraceptives) (patient information)|Estrogen and Progestin ]]
* [[Ethanol abuse]]
* [[Ethcathinone]]
* [[Ethchlorvynol]]
* [[Ethosuximide]]
* [[Ethyl carbamate]]
* [[Ethylmorphine]]
* [[Etidronate]]
* [[Etoposide]]
* [[Exemestane]]
* [[Exenatide]]
* [[Exercise induced nausea]]
* [[Exercise urticaria]]
* [[Extreme pain]]
* [[Familial hemiplegic migraine]]
* [[Felbamate]]
* [[Femoral hernia]]
* [[Fentanyl Oral Transmucosal (patient information)|Fentanyl Oral Transmucosal]]
* [[Fexofenadine]]
* [[Filgrastim]]
* [[Fioricet]]
* [[Fluorouracil]]
* [[Floxuridine]]
* [[Flu]]
* [[Fluconazole]]
* [[Flucytosine]]
* [[Fludarabine Phosphate]]
* [[Flunisolide]]
* [[Fluorescein sodium]]
* [[Fluoride poisoning]]
* [[Fluorouracil]]
* [[Flurazepam]]
* [[Flurbiprofen]]
* [[Flutamide]]
* [[Fluticasone]]
* [[Food allergies]]
* [[Food intolerance]]
* [[Food poisoning]]
* [[Foreign bodies]]
* [[Fructose intolerance]] [[hypoglycemia]]
* [[Fulvestrant Injection (patient information)|Fulvestrant Injection]]
* [[Functional dyspepsia]]
* [[Fundic gland polyposis]]
* [[Gabapentin]]
* [[Galactosemia]]
* [[Galantamine]]
* [[Gamma-Hydroxybutyric acid]]
* [[Gangrene]]
* [[Gastric carcinoma]]
* [[Gastric outlet obstruction]]
* [[Gastritis]]
* [[Gastrocolic fistula]]
* [[Gastroenteritis]]
* [[Gastroesophageal reflux disease]]
* [[Gastrointestinal perforation]]
* [[Gastroparesis]]
* [[Gatifloxacin]]
* [[Gefitinib]]
* [[Gemcitabine Hydrochloride (patient information)|Gemcitabine hydrochloride]]
* [[Gemeprost]]
* [[Gestational diabetes]]
* [[Gestrinone]]
* [[Giardia lamblia]]
* [[Giardiasis]]
* [[Ginger]]
* [[Ginkgo]]
* [[Glaucoma]]
* [[Glioblastoma multiforme]]
* [[Glioma]]
* [[Glucagon]]
* [[Glycylcycline]]
* [[Goserelin]]
* [[Graft-versus-host disease]]
* [[Granisetron]]
* [[Green Tobacco Sickness|Green tobacco sickness]]
* [[Grifulvin V]]
* [[Griseofulvin]]
* [[Guaifenesin]]
* [[Hangover]]
* [[Hantavirus pulmonary syndrome]]
* [[Head trauma]]
* [[Heart failure]]
* [[Heat stroke]]
* [[Heavy metal ingestion]]
* [[Helicobacter pylori infection]]
* [[HELLP syndrome]]
* [[Hematemesis]]
* [[Hemicrania continua]]
* [[Hemorrhage]]
* [[Henipavirus]]
* [[Hepatic coma]]
* [[Hepatic porphyria]]
* [[Hepatitis]]
* [[Hepatitis B]]
* [[Hepatitis D]]
* [[Hepatitis E]]
* [[Hepatobiliary disease]]
* [[Hereditary fructose intolerance]]
* [[Herkinorin]]
* [[Hernia]]
* [[Heroin]]
* [[Hirschsprung disease]]
* [[HIV]]
* [[Hookworm]]
* [[Hormone replacement therapy (trans)]]
* [[Human ehrlichiosis]]
* [[Hydralazine]]
* [[Hydrocephalus]]
* [[Hydrochlorothiazide]]
* [[Hydrocodone]]
* [[Hydromorphone]]
* [[Hydroxychloroquine]]
* [[Hydroxocobalamin]]
* [[Hydroxyurea]]
* [[Hydroxyzine]]
* [[Hypercalcemia]]
* [[Hyperemesis gravidarum]]
* [[Hypermagnesemia]]
* [[Hyperparathyroidism]]
* [[Hypertension]]
* [[Hyperthermia]]
* [[Hyperthyroidism]]
* [[Hypervitaminosis A]]
* [[Hypocalcemia]]
* [[Hypocholermia]]
* [[Hypoglycemia]]
* [[Hypokalemia]]
* [[Hyponatremia]]
* [[Hypoparathyroidism]]
* [[Hysterical contagion]]
* [[Iatrogenesis]]
* [[Ibogaine]]
* [[Ibuprofen]]
* [[Idarubicin]]
* [[Idiopathic]]
* [[Ifosfamide]]
* [[Ileus]]
* [[Imatinib]]
* [[Imipenem]]
* [[Inappetence]]
* [[Inborn errors of metabolism]]
* [[Incarcerated hernia]]
* [[Indinavir]]
* [[Indometacin]]
* [[Infarction]]
* [[Inflammatory bowel disease]]
* [[Infliximab]]
* [[Influenza]]
* [[Inguinal hernia]]
* [[Instillation abortion]]
* [[Insulin lispro]]
* [[Interferon gamma]]
* [[Interstitial nephritis]]
* [[Intracranial mass]]
* [[Intestinal atresia]]
* [[Intestinal parasite]]
* [[Intestinal volvulus]]
* [[Intracranial haemorrhage]]
* [[Intracranial hypertension]]
* [[Intussusception]]
* [[Ipecacuanha]]
* [[Iodomethane]]
* [[Irinotecan hydrochloride]]
* [[Iron(II) sulfate]]
* [[Irritable bowel syndrome]]
* [[Irukandji syndrome]]
* [[Ischemic bowel]]
* [[Isoniazid]]
* [[Isopropyl alcohol]]
* [[Isosorbide mononitrate]]
* [[Isotretinoin]]
* [[Itraconazole]]
* [[Ivacaftor]]
* [[Ixabepilone]]
* [[Jamaican vomiting sickness]]
* [[Janumet]] ([[sitagliptin]] and [[metformin]])
* [[Kaopectate]]
* [[Kaposi's sarcoma]]
* [[Ketoconazole]]
* [[Ketogenic diet]]
* [[Ketorolac]]
* [[Ketotic hypoglycemia]]
* [[La Crosse encephalitis]]
* [[Labyrinthitis]]
* [[Lactose intolerance]]
* [[Lanreotide]]
* [[Lansoprazole]]
* [[Large bowel obstruction]]
* [[Lassa fever]]
* [[Lead poisoning]]
* [[Letrozole]]
* [[Leuprolide]]
* [[Levodopa and Carbidopa]]
* [[Levofloxacin]]
* [[Levonorgestrel]]
* [[Lewisite]]
* [[Lindane]]
* [[Listeria monocytogenes]]
* [[Lithium]]
* [[Lithium nitrate]]
* [[Lobelia]]
* [[Lomefloxacin hydrochloride]]
* [[Lomotil]]
* [[Lopinavir]]
* [[Loprazolam]]
* [[Lorazepam]]
* [[Lower respiratory tract infection]]
* [[Lubiprostone]]
* [[Lysuride]]
* [[Malaria]]
* [[Malaria prophylaxis]]
* [[Malignancy]]
* [[Intestinal malrotation|Malrotation]]
* [[Marine toxins]]
* [[Mass effect (medicine)|Mass lesion]]
* [[Mastocytosis]]
* [[Mazindol]]
* [[Mechlorethamine]]
* [[Medazepam]]
* [[Medical cannabis]]
* [[Megestrol]]
* [[Melarsoprol]]
* [[Melphalan]]
* [[Ménière's disease]]
* [[Meningitis]]
* [[Meningococcemia]]
* [[Meningoencephalitis]]
* [[Mercaptopurine]]
* [[Mesoamerican nephropathy]]
* [[Meropenem]]
* [[Mesalamine]]
* [[Mescaline]]
* [[Mesenteric infarction]]
* [[Mesna]]
* [[Metabolic acidosis]]
* [[Metal fume fever]]
* [[Metformin]]
* [[Methadone]]
* [[Methotrexate]]
* [[Methylergonovine]]
* [[Methylketobemidone]]
* [[Methylphenidate]]
* [[Methyprylon]]
* [[Metronidazole]]
* [[Micafungin sodium]]
* [[Mifepristone]]
* [[Migraine]]
* [[Milk of Magnesia]]
* [[Milnacipran hydrochloride]]
* [[Miltefosine]]
* [[Minimally Invasive Thorasic Spinal Fusion]]
* [[Mirtazapine]]
* [[Misoprostol]]
* [[Mitomycin]]
* [[Mitotane]]
* [[Mitoxantrone]]
* [[Moclobemide]]
* [[Monocrotophos]]
* [[Mood stabilizer]]
* [[MOPP (medicine)|MOPP]]
* [[Morning sickness]]
* [[Morphine]]
* [[Motion sickness]]
* [[Motofen]]
* [[Moxifloxacin]]
* [[Multiple chemical sensitivity]]
* [[Multiple endocrine neoplasia type 1]]
* [[Munchausen syndrome by proxy]]
* [[Murray Valley encephalitis virus]]
* [[Mushroom poisoning]]
* [[Mycophenolic acid]]
* [[Mycoplasma pneumoniae]]
* [[Myocardial infarction]]
* [[Nabilone]]
* [[Naegleria fowleri]]
* [[Nafcillin]]
* [[Nalbuphine]]
* [[Nalidixic acid]]
* [[Nalmefene]]
* [[Naloxone]]
* [[Naphthalene]]
* [[Naproxen sodium]]
* [[Narcotics]]
* [[Natamycin]]
* [[Necrotizing enterocolitis]]
* [[Nerve agent]]
* [[Nervousness]]
* [[N-Ethyl-3-piperidyl benzilate]]
* [[Nicorandil]]
* [[Nicotine poisoning]]
* [[Nilutamide]]
* [[Nintedanib]]
* [[Nitrazepam]]
* [[Nitrogen mustard]]
* [[N-Nitroso-N-Methylurea]]
* [[Non-Hodgkin lymphoma]]
* [[Non steroidal anti-inflammatory drugs]]
* [[Nootropic]]
* [[Norfloxacin]]
* [[Norgestimate and Ethinyl estradiol]]
* [[Norgestrel and Ethinyl estradiol]]
* [[Norovirus]]
* [[Norplant]]
* [[Nortriptyline]]
* [[Norwalk Virus]]
* [[Nutcracker syndrome]]
* [[Nystatin]]
* [[Obidoxime]]
* [[Obstructive uropathy]]
* [[Obturator hernia]]
* [[Oesophageal cancer]]
* [[Ofloxacin]]
* [[Olanzapine]]
* [[Omeprazole]]
* [[Ondansetron]]
* [[Opioid]]
* [[Oprelvekin]]
* [[Oral contraceptives]]
* [[Orellanine]]
* [[Organic acidemia]]
* [[Organophosphates]]
* [[Oritavancin]]
* [[Oseltamivir]]
* [[Osteosarcoma]]
* [[Otitis interna]]
* [[Otitis media]]
* [[Ovarian cancer]]
* [[Ovarian cyst]]
* [[Ovarian hyperstimulation syndrome]]
* [[Ovarian torsion]]
* [[Oxaliplatin]]
* [[Oxamniquine]]
* [[Oxazepam]]
* [[Oxcarbazepine]]
* [[Oxybutynin]]
* [[Oxycodone and aspirin]]
* [[Paclitaxel]]
* [[Pain]]
* [[Palbociclib]]
* [[Pancreatic adenocarcinoma]]
* [[Pancreatitis]]
* [[Panitumumab]]
* [[Pantoprazole]]
* [[Palbociclib]]
* [[Paliperidone]]
* [[Palonosetron]]
* [[Panic attack]]
* [[Paralytic ileus]]
* [[Paraneoplastic syndrome]]
* [[Paraquat]]
* [[Paroxetine]]
* [[Pegaspargase]]
* [[Pemetrexed injection]]
* [[Penicillin]]
* [[Pentamidine]]
* [[Pentavalent antimonial]]
* [[Pentetic acid]]
* [[Pentostatin]]
* [[Peptic ulcer]]
* [[Pergolide]]
* [[Perhexiline]]
* [[Peritonitis]]
* [[Pesticide]]
* [[Pethidine]]
* [[Pfiesteria piscicida]]
* [[PFPP]]
* [[Pharyngeal pouch]]
* [[Pharyngitis]]
* [[Phenelzine]]
* [[Phenoxymethylpenicillin]]
* [[Phentermine]]
* [[Phentolamine]]
* [[Pholcodine]]
* [[Physostigmine]]
* [[Phytohaemagglutinin]]
* [[Pioglitazone]]
* [[Pirfenidone]]
* [[Piribedil]]
* [[Plerixafor]]
* [[Plicamycin]]
* [[Piroxicam]]
* [[PMA]]
* [[Pneumonia]]
* [[Polio]]
* [[Poliomyelitis]]
* [[Porphyria]]
* [[Posaconazole]]
* [[Post-concussion syndrome]]
* [[Post-exposure prophylaxis]]
* [[Ileus|Postoperative ileus]]
* [[Postoperative nausea and vomiting]]
* [[Pain|Postoperative pain]]
* [[Potassium bromide]]
* [[Potassium chloride]]
* [[Potassium citrate]]
* [[Praziquantel]]
* [[Pregabalin]]
* [[Pregnancy]]
* [[Primaquine]]
* [[Procainamide]]
* [[Procarbazine]]
* [[Prochlorperazine]]
* [[Progesterone]]
* [[Prolactinoma]]
* [[Propiram]]
* [[Propylketobemidone]]
* [[Prosidol]]
* [[Protriptyline]]
* [[Pseudotumor cerebri]]
* [[Psychogenic]]
* [[Pulmonary embolism]]
* [[Pyelonephritis]]
* [[Pyloric stenosis]]
* [[Pyrazinamide]]
* [[Pyrantel pamoate]]
* [[Pyridostigmine]]
* [[Pyridoxine deficiency]]
* [[Q fever]]
* [[Quetiapine]]
* [[Quinidine]]
* [[Quinupristin/dalfopristin]]
* [[Radiation poisoning]]
* [[Radiation therapy]]
* [[Raised intracranial pressure]]
* [[Radium chloride]]
* [[Ramelteon]]
* [[Ranolazine]]
* [[Rasagiline]]
* [[Refractive error]]
* [[Renal colic]]
* [[Renal failure]]
* [[Renal insufficiency]]
* [[Reserpine]]
* [[Retroperitoneal fibrosis]]
* [[Reversible cerebral vasoconstriction syndrome]]
* [[Reye's syndrome]]
* [[Ribavirin]]
* [[Rifabutin]]
* [[Riluzole]]
* [[Risedronate]]
* [[Rituximab injection]]
* [[Rivastigmine]]
* [[Rizatriptan]]
* [[Rocky mountain spotted fever]]
* [[Ropinirole]]
* [[Rotavirus]]
* [[Rotigotine]]
* [[Roxithromycin]]
* [[Rubbing alcohol]]
* [[Rumination disorder]]
* [[Salicylate poisoning]]
* [[Salmonella]]
* [[Salpingitis]]
* [[Salsalate]]
* [[Saquinavir mesylate]]
* [[Sargramostim]]
* [[Sarin]]
* [[Sativex]]
* [[Scarlet fever]]
* [[Scleroderma]]
* [[Seasickness]]
* [[Secobarbital]]
* [[second-hand smoke]]
* [[Secretin human]]
* [[Seizure disorders]]
* [[Selective serotonin reuptake inhibitor]]
* [[Selegiline]]
* [[Seliciclib]]
* [[Sepsis]]
* [[Sexual fetish]]
* [[Shigella]]
* [[Sibutramine]]
* [[Sipuleucel-T]]
* [[Ski sickness]]
* [[Sleep deprivation]]
* [[Slone's disease]]
* [[Small bowel bacterial overgrowth syndrome]]
* [[Small bowel lymphoma]]
* [[Small bowel obstruction]]
* [[Small intestine cancer]]
* [[Smoke inhalation]]
* [[Snakebites]]
* [[Soapwort]]
* [[Sodium oxybate]]
* [[Sodium polystyrene sulfonate]]
* [[Sodium stibogluconate]]
* [[Sofosbuvir]]
* [[Solanine]]
* [[Somatization]]
* [[Spider bite]]
* [[Spironolactone]]
* [[Splenic infarction]]
* [[Sporotrichosis]]
* [[Spotted fever]]
* [[SSRI discontinuation syndrome]]
* [[Staphylococcal enteritis]]
* [[Starvation]]
* [[Stavudine]]
* [[Stomach cancer]]
* [[Streptococcal pharyngitis]]
* [[Stribild]] ([[Elvitegravir, Cobicistat, Emtricitabine, And Tenofovir Disoproxil Fumarate]])
* [[Strongyloidiasis]]
* [[Stiripentol]]
* [[Strep throat]]
* [[Streptozocin]]
* [[Subdural hematoma]]
* [[Sufentanil]]
* [[Sulfasalazine]]
* [[Sulfonamides]]
* [[Sulprostone]]
* [[Suicide attempt]]
* [[Sultiame]]
* [[Sumatriptan injection]]
* [[Sunitinib]]
* [[Suramin]]
* [[Syndrome of inappropriate antidiuretic hormone]] [[SIADH]]
* [[Tabes dorsalis]]
* [[Tacrine]]
* [[Tacrolimus]]
* [[Tamoxifen]]
* [[Tapentadol]]
* [[Telavancin hydrochloride]]
* [[Telbivudine]]
* [[Telithromycin]]
* [[Tetracycline]]
* [[Temik]]
* [[Temozolomide]]
* [[Teniposide]]
* [[Testicular rupture]]
* [[Testicular torsion]]
* [[Tetanus, Diphtheria, and Pertussis (Tdap) Vaccine]]
* [[Tetracaine]]
* [[Tetrahydrocannabinol]]
* [[Tetrahydrozoline]]
* [[Tetramethylsuccinonitrile]]
* [[Tetrodotoxin]]
* [[Thallium]]
* [[Theobromine]]
* [[Theophylline]]
* [[Thiabendazole]]
* [[Thiethylperazine]]
* [[Thioguanine]]
* [[Thiotepa]]
* [[Thrombotic thrombocytopenic purpura]]
* [[Thyroid Medication (patient information)|Thyroid medication]]
* [[Thyrotoxicosis]]
* [[Tigecycline]]
* [[smoking|Tobacco smoking]]
* [[Tocopherol]]
* [[Tolmetin]]
* [[Topiramate]]
* [[Topotecan Hydrochloride|Topotecan Hydrochloride]]
* [[Toxic ingestion]]
* [[Toxidrome]]
* [[Tralomethrin]]
* [[Tramadol]]
* [[Trametinib dimethyl sulfoxide]]
* [[Trandolapril]]
* [[Tranexamic acid]]
* [[Trastuzumab]]
* [[Traumatic brain injury]]
* [[Traveler's diarrhea]]
* [[Trazodone]]
* [[Tretinoin]]
* [[Triamterene]]
* [[Triazolam]]
* [[Trichuriasis]]
* [[Triclofos]]
* [[Tricyclic antidepressant]]
* [[Trifluoperazine]]
* [[Trifluoromethylphenylpiperazine]]
* [[Trimeperidine]]
* [[Trimethobenzamide]]
* [[Trimetrexate glucuronate]]
* [[Tropisetron]]
* [[Trovafloxacin mesylate]]
* [[Tularemia]]
* [[Tumors]]
* [[Twisted ovarian cyst]]
* [[Typhoid Vaccine (patient information)|Typhoid Vaccine]]
* [[Typhus]]
* [[Ulcers]]
* [[Urea cycle disorders]]
* [[Uremia]]
* [[Urinary tract infection]]
* [[Urofollitropin]]
* [[Urolithiasis]]
* [[Vagotomy]]
* [[Valaciclovir]]
* [[Valganciclovir hydrochloride]]
* [[Valproic Acid]]
* [[Varenicline]]
* [[Vasovagal syncope]]
* [[Venlafaxine]]
* [[Verapamil]]
* [[Vertebro-basilar syndrome]]
* [[Vertigo]]
* [[Vestibular balance disorder]]
* [[Vestibular neuronitis]]
* [[Vibrio parahaemolyticus]]
* [[Vicodin]]
* [[Vidarabine]]
* [[Vigabatrin]]
* [[Vilazodone]]
* [[Viloxazine]]
* [[Vinblastine]]
* [[Vinorelbine Tartrate]]
* [[Viral gastroenteritis]]
* [[emotion|Violent emotions]]
* [[Cough|Violent fits of coughing]]
* [[hiccups|Violent fits of coughing]]
* [[Vitamin A]]
* [[Vitamin C]]
* [[Vitamin D]]
* [[Volvulus]]
* [[Von Willebrand factor]]
* [[Voriconazole]]
* [[Vorinostat]]
* [[Vortioxetine]]
* [[Water intoxication]]
* [[Waterborne diseases]]
* [[West Nile virus]]
* [[Yellow fever]]
* [[Zanamivir Inhalation]]
* [[Zidovudine]]
* [[Ziprasidone]]
* [[Zollinger-Ellison Syndrome]]
* [[Zolpidem]]
* [[Zopiclone]]

}}

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Emergency medicine]]
[[Category:Gastroenterology]]
[[Category:Obstetrics]]
[[Category:Crowdiagnosis]]

Nausea and vomiting causes

2021-01-28T03:01:01Z

Shaik Aisha sultana:

__NOTOC__
{{Nausea and vomiting}}
{{CMG}}; {{AE}} {{VVS}} {{KS}}

==Overview==
Life threatening causes of nausea and vomiting include [[acute coronary syndrome]], [[anaphylaxis]], and [[heart failure]]. Other common causes of nausea and vomiting are [[food allergies]], [[food poisoning]], [[gastroenteritis]], and [[gastroesophageal reflux]].

==Causes==
===Life Threatening Causes===
*[[Acute Coronary Syndromes]]<ref name="pmid637006">{{cite journal |vauthors=Ahmed SS, Gupta RC, Brancato RR |title=Significance of nausea and vomiting during acute myocardial infarction |journal=Am Heart J |volume=95 |issue=5 |pages=671–2 |date=May 1978 |pmid=637006 |doi=10.1016/0002-8703(78)90311-3 |url=}}</ref>
*[[Anaphylaxis]]
*[[Angina pectoris]]
*[[Heart failure]]

===Common Causes===
*[[Chemotherapy]]<ref>{{cite journal|doi=10.1002/j.1875-9114.1990.tb02560.x}}</ref>

*[[Food allergies]]
*[[Food poisoning]]
*[[Migraine]]
*[[Morning sickness]]
*[[Rotavirus]]
*[[Viral gastroenteritis]]

===Causes by Organ System===

{|style="width: 80%; height: 100px; text-align: justify; text-justify: distribute;" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |[[Acute Coronary Syndromes]], [[amyloidosis]], [[anaphylaxis]], [[angina pectoris]], [[aortic arch anomalies]], [[cardiac arrhythmia]], [[cerebral aneurysm]], [[cerebral arteriovenous malformation]], [[cerebrovascular disease]], [[myocardial infarction]], [[heart failure]], [[hypercalcemia]], [[hypertension]], [[hypercalcemia]], [[hypocalcemia]], [[hypokalemia]]
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"|[[1,2-Dichloroethene]], [[2-Ethylhexanol]], [[1,3-Dichloropropene]], [[abrin]], [[aconitine]], [[adamsite]], [[ammonium chloride]], [[amnesic shellfish poisoning]], [[arsenic Poisoning]], [[barium oxalate]], [[barium sulfate]], [[butanethiol]], [[camphor|camphor poisoning]], [[capsaicin]], [[carbon monoxide poisoning]], [[chloromethane]], [[cicuta]], [[ciguatera]], [[cinchonism]], [[coprinopsis atramentaria]], [[cyanogen]], [[daunorubicin]], [[diethyl ether]], [[digitalis purpurea]], [[dioxathion]], [[dioxin]], [[endosulfan]], [[ergotism]], [[fluoride poisoning]], [[fluoxymesterone]], [[ginkgo]], [[Green Tobacco Sickness|green tobacco sickness]], [[heavy metal ingestion]], [[Iodomethane]], [[Iron poisoning]], [[Iron(II) sulfate]], [[lead poisoning]], [[lenvatinib]], [[lewisite]], [[lindane]], [[lithium]], [[lobelia]], [[metal fume fever]], [[mushroom poisoning]], [[N-Ethyl-3-piperidyl benzilate]], [[nerve agent]], [[nicotine poisoning]], [[N-Nitroso-N-methylurea]], [[PFPP]], [[pesticide]], [[potassium bromide]], [[phytohaemagglutinin]], [[smoke inhalation]], [[snakebites]], [[temik]], [[theobromine]]
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"|[[Abscess]], [[decompression sickness]], [[exercise urticaria]]
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"|[[2C-E]], [[2C-I]], [[2C-T-7]], [[5-Hydroxytryptophan]], [[5-MeO-AMT]], [[ABVD]], [[acamprosate calcium]], [[acetaminophen]], [[acetoxyketobemidone]], [[acetylcysteine]], [[acetylsalicylic acid]],[[acyclovir]], [[aclarubicin]], [[actinomycin D]], [[alatrofloxacin Injection (patient information)|alatrofloxacin]], [[albuterol]], [[aldesleukin]], [[alemtuzumab]], [[allylprodine]], [[alpha-Methyltryptamine]], [[alprazolam]], [[altretamine]], [[amifostine]], [[amineptine]], [[aminocaproic acid]], [[aminoglutethimide]], [[aminopterin]], [[aminosalicylic acid]], [[amitriptyline (patient information)|amitriptyline]], [[amoxicillin]], [[amphotericin B]], [[amrinone]], [[amyl nitrite]], [[anadenanthera peregrina]], [[analgesic]], [[anastrozole]], [[anesthesia]], [[anticonvulsants]], [[antigout]], [[antihistamine]], [[antihypertensives]],[[antiretroviral drug]], [[apremilast]], [[apomorphine hydrochloride]], [[aprepitant]], [[aripiprazole]], [[armodafinil]], [[asparaginase (patient information)|asparaginase]], [[aspirin]], [[atomoxetine]], [[atosiban]], [[atropine]], [[auranofin]], [[axitinib]], [[azacitidine]], [[azathioprine]], [[azithromycin]], [[aztreonam]], [[barbiturate]], [[barium Sulfate]], [[basiliximab]], [[bCG vaccine]], [[Belladonna Alkaloid Combinations and Phenobarbital|belladonna alkaloid]] [[benzodiazepine]], [[benztropine]], [[benzphetamine]], [[benzylpiperazine]], [[betaine]], [[beta-lactam antibiotic]], [[Bevacizumab|bevacizumab]], [[beta blockers]], [[bezafibrate]], [[bicalutamide]], [[bleomycin]], [[blinatumomab]], [[botulinum antitoxin]], [[bortezomib]], [[bosutinib]], [[botulinum toxin]], [[bromelain]], [[bromocriptine]], [[bromomethane]], [[bronchodilator]], [[butalbital]], [[buprenorphine]], [[bupropion]], [[busulfan]], [[butanethiol]], [[butorphanol]], [[cabergoline]], [[calcitonin]], [[calcitriol]], [[calcium carbamide]], [[calcium channel antagonists]], [[capecitabine]], [[capsaicin]], [[carbamates]], [[Carbidopa and Levodopa|carbidopa and levodopa]], [[carboplatin]], [[carmustine]], [[carprofen]], [[carvedilol]], [[caspofungin]], [[cefaclor]], [[cefixime]], [[ceritinib]], [[cetrorelix]], [[cefoperazone Sodium Injection (patient information)|cefoperazone sodium]], [[cefotaxime sodium]], [[cefotetan disodium]], [[cefprozil]], [[ceftibuten]], [[cefuroxime]], [[ceftibuten]], [[ceftaroline fosamil]], [[cefuroxime]], [[cephalosporin]], [[cetuximab]], [[cetuximab injection ]], [[cevimeline]], [[chelation therapy]], [[chemotherapy]], [[chloral hydrate]], [[chlordiazepoxide]], [[chloromethane]], [[chlorothiazide]], [[chlorpropamide]], [[CHOP]], [[cimicifuga racemosa]], [[ciprofloxacin]], [[cisplatin]], [[citalopram]], [[cladribine]], [[clarithromycin]], [[clindamycin]], [[clofarabine]], [[clofibrate]], [[clomifene]], [[clorazepate]], [[clozapine]], [[cobicistat]], [[co-codamol]], [[codeine]], [[colchicine]], [[colestyramine]], [[combined oral contraceptive pill]], [[conjugated estrogens/bazedoxifene]], [[contraceptive patch]], [[crizotinib]], [[cyclobenzaprine]], [[cyclophosphamide]], [[cytisine]], [[cytarabine]], [[cytarabine liposome]], [[cytisine]],[[capsaicin]], [[dacarbazine ]], [[dactinomycin ]], [[dalfampridine]], [[danazol]], [[dantrolene]], [[daptomycin]], [[Darbepoetin Alfa Injection|darbepoetin alfa Injection ]], [[darunavir ]], [[daunorubicin ]], [[deferasirox ]], [[deferiprone]], [[defibrotide]], [[denileukin diftitox]], [[desmopressin]], [[dexamethasone]], [[dexchlorpheniramine]], [[dexrazoxane]], [[Dextroamphetamine and Amphetamine|dextroamphetamine and amphetamine]], [[dextromethorphan]], [[dextropropoxyphene]], [[diazepam]], [[diazinon]], [[dicofol]], [[didanosine]], [[diethyl ether]], [[diethylcathinone]], [[diflunisal]], [[digitoxin]], [[digoxin]], [[diethylcathinone]], [[diethyl ether]], [[dimercaprol]], [[dinoprostone]], [[dipyridamole]], [[disulfiram ]], [[diuretic]], [[docetaxel ]], [[dofetilide ]], [[dolasetron ]], [[donepezil ]], [[doripenem]], [[dosulepin hydrochloride]], [[doxorubicin hydrochloride]], [[doxycycline]], [[Drospirenone and Ethinyl estradiol|drospirenone and ethinyl estradiol]], [[DTPA]], [[duloxetine]], [[ecallantide]], [[eculizumab]], [[efavirenz]], [[elvitegravir]], [[enfuvirtide]], [[entecavir]], [[epinephrine (aerosol)]], [[ergometrine]], [[ergotamine]], [[eribulin]], [[erlotinib]], [[erythromycin]], [[estradiol valerate and estradiol valerate/dienogest]], [[eslicarbazepine acetate]], [[ethcathinone]], [[ethchlorvynol]], [[ethosuximide]], [[ethynodiol diacetate and ethinyl estradiol]], [[ethyl carbamate]], [[emetine]], [[emtricitabine]], [[Emtricitabine, Rilpivirine Hydrochloride, And Tenofovir Disoproxil Fumarate|rilpivirine hydrochloride, and tenofovir disoproxil fumarate]], [[endosulfan]], [[entacapone]], [[efavirenz]], [[enfuvirtide]], [[entecavir ]], [[elosulfase alfa]], [[epinephrine (aerosol)]], [[epirubicin hydrochloride]], [[epoetin Alfa ]], [[eribulin]], [[eliglustat]], [[erlotinib ]], [[erythromycin]], [[estradiol]], [[estrogen and Progestin (Oral Contraceptives) ]], [[ethcathinone]], [[ethchlorvynol]], [[ethyl carbamate]], [[ethylmorphine]], [[etidronate ]], [[etodolac]], [[etoposide]], [[exemestane]], [[exenatide]], [[felbamate]], [[fentanyl Oral Transmucosal ]][[fexofenadine]], [[filgrastim]], [[fioricet]], [[flavoxate]], [[fludarabine phosphate]], [[fluorouracil]], [[flurazepam]],[[Flurbiprofen]], [[floxuridine]], [[fluconazole]], [[flucytosine]], [[fludarabine Phosphate]], [[flunisolide]], [[fluorescein sodium]], [[fluorouracil ]], [[flurazepam]], [[flurbiprofen]], [[flutamide ]], [[Fluticasone]], [[foscarnet sodium]], [[fulvestrant]], [[galantamine]], [[gallium nitrate]], [[gabapentin]], [[gamma-Hydroxybutyric acid]], [[gatifloxacin ]], [[gefitinib ]], [[gemcitabine]], [[gemeprost]], [[general anaesthesia]], [[gestrinone]], [[glimepiride]], [[glipizide]], [[glucagon]], [[glucarpidase]], [[glycylcycline]], [[glycopyrrolate]], [[glyburide]], [[glyburide and Metformin]], [[glycylcycline]], [[goserelin ]], [[Graft-versus-host disease]], [[granisetron ]], [[grifulvin V]], [[guaifenesin]], [[H1 antihistamine]], [[herkinorin]], [[heroin]], [[hydralazine]], [[hydrochlorothiazide]], [[hydrocodone]], [[Hydrocodone bitartrate and Homatropine methylbromide|hydrocodone bitartrate and homatropine methylbromide]], [[hydrocortisone]], [[hydromorphone]], [[hydroxycarbamide]], [[hydroxychloroquine]], [[hydroxocobalamin]], [[hydroxyurea]], [[hydroxyzine]], [[hydroxyprogesterone caproate]], [[Ibogaine]], [[Ibuprofen]], [[Ibrutinib]], [[Ibritumomab tiuxetan]], [[Idarubicin ]], [[Idursulfase]], [[Ifosfamide ]], [[Imatinib ]], [[Imiglucerase]], [[Imipenem]], [[Indinavir]], [[Interferon gamma]], [[Interferon alfa-2b]], [[Iodomethane]], [[Irinotecan hydrochloride]], [[Isoniazid]], [[Isoproterenol (aerosol)]], [[Isopropyl alcohol]], [[Isosorbide mononitrate]], [[Isotretinoin]], [[Itraconazole]], [[Ivacaftor]], [[Ivermectin]], [[Ixabepilone]], [[kaopectate]], [[ketorolac]], [[lacosamide]], [[lactulose]], [[lamivudine]], [[lanreotide]], [[lansoprazole]], [[lanthanum carbonate]], [[lapatinib]], [[lenalidomide]], [[letrozole ]], [[leuprolide ]], [[Levodopa and Carbidopa|levodopa and carbidopa ]], [[levofloxacin]], [[levonorgestrel]], [[lidocaine (ointment)]], [[lithium nitrate]], [[lomefloxacin hydrochloride]], [[lorcaserin]], [[lopinavir]], [[loprazolam]], [[lorazepam]], [[lovaza]], [[malaria prophylaxis]], [[mazindol]], [[mechlorethamine ]], [[medazepam]], [[megestrol ]], [[melarsoprol]], [[melphalan ]], [[mercaptopurine]], [[meropenem]], [[mesalamine ]], [[mescaline]], [[mesna]], [[metformin]], [[methadone]], [[methenamine]], [[methotrexate]], [[methylergonovine]], [[methylketobemidone]], [[methylphenidate]], [[methyprylon]], [[metronidazole]], [[micafungin sodium]], [[mifepristone]], [[milk of magnesia]], [[milnacipran hydrochloride]], [[miltefosine]], [[mirtazapine]], [[misoprostol]], [[mitomycin ]], [[mitotane]], [[mitoxantrone]], [[moclobemide]], [[monocrotophos]], [[morphine]], [[motofen]], [[moxifloxacin]], [[mycophenolic acid]], [[nabilone]], [[nafcillin]], [[nalbuphine]], [[nalmefene]], [[naloxone]], [[naphthalene]], [[naproxen sodium]], [[natamycin]], [[niacin/simvastatin]], [[nicorandil]], [[nilotinib]], [[nilutamide]], [[nintedanib]], [[nitrazepam]], [[nitrofurantoin]], [[nizatidine]], [[Norethindrone acetate and Ethinyl estradiol|norethindrone acetate and ethinyl estradiol]], [[Norgestimate and Ethinyl estradiol|norgestimate and ethinyl estradiol]], [[Norgestrel and Ethinyl estradiol|norgestrel and ethinyl estradiol]], [[olanzapine ]], [[olsalazine]], [[omeprazole ]], [[ondansetron]], [[opioid]], [[oprelvekin]], [[oritavancin]], [[oseltamivir ]], [[oxaliplatin]], [[oxamniquine]], [[oxazepam]], [[oxcarbazepine]], [[oxybutynin ]], [[oxycodone and aspirin ]], [[oxytocin]], [[Paclitaxel]], [[palbociclib]], [[paliperidone ]], [[palonosetron]], [[panitumumab]], [[pantoprazole]], [[papaverine]], [[paromomycin sulfate]], [[pazopanib hydrochloride]], [[paracetamol]], [[paroxetine]], [[pasireotide]], [[pegaspargase ]], [[pemetrexed ]], [[penicillin]], [[pentamidine]], [[pentavalent antimonial]], [[pentetic acid]], [[pentostatin ]], [[pergolide ]], [[perhexiline]], [[pertuzumab]], [[pirfenidone]], [[piroxicam]], [[phenelzine]], [[phenoxymethylpenicillin]], [[phentermine]], [[phenylephrine]], [[physostigmine]], [[pholcodine]], [[pilocarpine]], [[pioglitazone ]], [[piribedil]], [[plerixafor]], [[plicamycin ]],[[posaconazole ]], [[potassium chloride]], [[potassium citrate]], [[praziquantel]], [[pregabalin ]], [[primaquine phosphate]], [[potassium iodide]], [[primaquine]][[procainamide ]], [[procarbazine ]], [[prochlorperazine]], [[progesterone]], [[propiram]], [[propylketobemidone]], [[prosidol]], [[protriptyline ]], [[pyrantel pamoate]][[pyrazinamide]], [[pyridostigmine]], [[quetiapine ]], [[quinupristin/dalfopristin]], [[radium chloride]], [[ramelteon]], [[ranolazine ]], [[ranitidine]], [[rasburicase]], [[rasagiline ]], [[reserpine]], [[ribavirin]], [[rifabutin]], [[rifaximin]], [[risedronate ]], [[ritonavir]], [[rituximab ]], [[rivastigmine ]], [[rizatriptan ]], [[ropinirole ]], [[roflumilast]], [[rotigotine]], [[roxithromycin]], [[rubbing alcohol]], [[salsalate ]], [[saquinavir mesylate]], [[sarin]], [[sargramostim]], [[stavudine]], [[sativex]], [[saxagliptin hydrochloride and Metformin hydrochloride]], [[secretin human]], [[secobarbital]], [[selegiline ]], [[seliciclib]], [[serotonin]], [[sibutramine]], [[sipuleucel-T]], [[sodium oxybate]], [[sodium polystyrene sulfonate]], [[sodium stibogluconate]], [[sodium sulfate, potassium sulfate and magnesium sulfate]], [[solanine]], [[spironolactone]], [[Stiripentol]], [[streptozocin]], [[streptomycin]], [[streptozocin]], [[sufentanil]], [[Sulfamethoxazole/Trimethoprim (oral)]], [[sultiame]], [[sumatriptan]], [[sunitinib ]], [[suramin]],[[tacrolimus]], [[tapentadol]], [[tedizolid]], [[telavancin hydrochloride]], [[telbivudine ]], [[telithromycin ]], [[taliglucerase alfa]][[temozolomide]], [[teniposide ]], [[teriparatide]], [[tetracaine]], [[tetraferric tricitrate decahydrate]], [[tetrahydrocannabinol]], [[tetrahydrozoline]], [[tetramethylsuccinonitrile]], [[tetrodotoxin]], [[thallous Chloride Tl 201]], [[thiabendazole]], [[thiethylperazine]], [[thioguanine]], [[thiotepa ]], [[Thyroid Medication|thyroid medication]], [[tigecycline]], [[tocopherol]], [[tolcapone ]], [[tolmetin]], [[topiramate]], [[tolbutamide]], [[topotecan Hydrochloride|topotecan hydrochloride]], [[toremifene]], [[tralomethrin]], [[tramadol]], [[trametinib dimethyl sulfoxide]], [[trandolapril]], [[trastuzumab]], [[trazodone]], [[tretinoin]], [[triamterene]], [[triazolam]], [[triclofos]], [[tricyclic antidepressant]], [[trifluoperazine]], [[trifluoromethylphenylpiperazine]], [[trimeperidine]], [[trimethobenzamide]], [[trimetrexate Glucuronate]], [[tropisetron]], [[trovafloxacin mesylate]], [[valaciclovir]], [[valganciclovir hydrochloride]], [[valproic acid ]], [[vancomycin]], [[varenicline]], [[venlafaxine]], [[vicodin]], [[vidarabine]], [[vigabatrin]], [[vilazodone]], [[viloxazine]], [[vinblastine ]], [[vinorelbine Tartrate]], [[vismodegib]], [[von Willebrand factor]], [[voriconazole]], [[vorinostat]], [[vortioxetine]], [[zafirlukast]], [[zidovudine]], [[zolpidem ]], [[zopiclone]], [[zoledronate]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"|[[Balance disorder]], [[decompression sickness]], [[ear infection]], [[epistaxis]], [[glaucoma]], [[labyrinthitis]], [[Ménière's disease]], [[pharyngitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"|[[Acromegaly]], [[addison's disease]], [[adrenal failure]], [[adrenal insufficiency]], [[amyloidosis]], [[anorexia nervosa]], [[carcinoid tumours and carcinoid syndrome]], [[contraceptive patch]], [[diabetic gastroparesis]], [[diabetic ketoacidosis]], [[diabetes mellitus]],[[emergency contraception]], [[gangrene]], [[gestational diabetes]], [[hormone replacement therapy (trans)]],[[hypocalcemia]], [[hypoglycemia]], [[hyperparathyroidism]], [[hyperthyroidism]], [[prolactinoma]], [[syndrome of inappropriate antidiuretic hormone]]([[SIADH]]), [[thyrotoxicosis]], [[Estrogen and Progestin (Hormone Replacement Therapy) (patient information)|estrogen and progestin]], [[multiple endocrine neoplasia type 1]]
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"|[[Bothrops|Bothrops bite]], [[bromomethane]], [[carbon monoxide poisoning]], [[dioxin]], [[heat stroke]], [[hyperthermia]]
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"|[[Achalasia]], [[acute abdomen]], [[accessory pancreas]] , [[acute fatty liver of pregnancy]], [[acute pancreatitis]], [[adjustable gastric band]], [[afferent loop syndrome]], [[alcoholic Hepatitis]], [[alcoholism]], [[anastomosis]] [[stenosis]], [[ anorexia nervosa]], [[appendicitis]], [[bacterial gastroenteritis]], [[beef tapeworm]], [[biliary colic]], [[blastocystosis]], [[bowel obstruction]], [[brucella]], [[bulimia nervosa]], [[caecitis]], [[carcinoid tumours and carcinoid syndrome]], [[chronic intestinal pseudo-obstruction]], [[cholecystitis]], [[cholecystolithiasis]], [[ciguatera]], [[colorectal cancer]], [[congenital hypertrophic pyloric stenosis]], [[Crohn's disease]], [[cryptosporidium parvum]], [[cyclic vomiting syndrome]], [[cyclospora cayetanensis]], [[diabetic gastroparesis]], [[dientamoebiasis]], [[diverticulitis]], [[dumping syndrome]], [[enteric Neuropathy]], [[eosinophilic esophagitis]], [[eosinophilic gastroenteritis]], [[epiploic appendagitis]], [[esophageal achalasia]], [[esophageal cancer]], [[esophageal diverticulum]], [[esophageal stenosis]], [[esophagitis]], [[femoral hernia]], [[food allergies]], [[food poisoning]], [[fundic gland polyposis]], [[functional dyspepsia]], [[gastric carcinoma]], [[gastric outlet obstruction]], [[gastritis]], [[gastrocolic fistula]], [[gastroenteritis]], [[gastroesophageal reflux disease]], [[gastrointestinal perforation]], [[gastroparesis]], [[giardiasis]], [[helicobacter pylori infection]], [[Hellp syndrome]], [[hematemesis]], [[hepatic coma]], [[hepatic porphyria]], [[hepatitis]], [[hepatitis A]], [[hepatitis B]], [[hepatitis D]], [[hepatitis E]], [[hepatobiliary disease]], [[hepatotoxicity ]], [[hernia]], [[hirschsprung disease]], [[Ileus]], [[Intussusception (medical disorder)]], [[Irritable bowel syndrome]], [[Ischemic bowel]], [[Mesenteric ischemia]], [[peptic ulcer]], [[peritonitis]], [[pyloric stenosis]], [[Reye's syndrome]], [[Small bowel bacterial overgrowth syndrome]], [[Small intestine cancer]], [[traveler's diarrhea]]
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"|[[Acute intermittent porphyria]], [[congenital malformation]], [[Down syndrome]], [[episodic ataxia]], [[familial hemiplegic migraine]], [[fundic gland polyposis]], [[galactosemia]], [[hereditary fructose intolerance]], [[slone's disease]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"|[[HELLP syndrome]], [[hemorrhage]], [[mastocytosis]], [[porphyria]], [[splenic infarction]], [[thrombotic thrombocytopenic purpura]]
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"|[[Essure]], [[dumping syndrome]], [[high doses of ionizing radiation]], [[Instillation abortion]], [[Minimally Invasive Thorasic Spinal Fusion|minimally Invasive thorasic spinal fusion]]
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"|[[Infections|Acute infections]], [[acute viral nasopharyngitis (common cold)]], [[AIDS]], [[aseptic meningitis]], [[astrovirus]], [[bacillus cereus|bacillus cereus infection]], [[bacterial gastroenteritis]], [[Barcoo Fever|barcoo fever]], [[beef tapeworm]], [[blastocystosis]], [[brucella]], [[colorado tick fever]], [[community-acquired pneumonia]], [[croup]], [[cryptosporidium parvum|cryptosporidium parvum infection]], [[cyclospora cayetanensis|cyclospora cayetanensis infection]], [[dengue fever]], [[diarrheal shellfish poisoning]], [[dientamoebiasis]], [[diphtheria]], [[Duke's disease]], [[ebola]], [[giardia lamblia]], [[Hantavirus pulmonary syndrome]], [[helicobacter pylori infection]], [[henipavirus]], [[hepatitis B]], [[hepatitis D]], [[hepatitis E]], [[hookworm]], [[human ehrlichiosis]], [[Influenza]], [[Intestinal parasite]], [[lassa fever]], [[listeria monocytogenes]], [[malaria]], [[meningococcemia]], [[Naegleria fowleri]], [[norovirus]], [[norwalk Virus]], [[pfiesteria piscicida]], [[poliomyelitis]], [[Q fever]], [[Rocky Mountain spotted fever]], [[Scarlet fever]], [[shigella]], [[Sporotrichosis]], [[staphylococcal enteritis]], [[tularemia]], [[vibrio parahaemolyticus]], [[West Nile virus]], [[waterborne diseases]], [[Yellow fever]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"|[[Decompression sickness]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"|[[Acoustic neuroma]], [[airsickness]], [[altitude sickness]], [[arachnoid cyst]], [[Aseptic meningitis|aseptic meningitis]], [[autonomic neuropathy]], [[balance disorder]], [[benign intracranial hypertension]] ,[[Brain Stem Gliomas|brain stem gliomas]], [[brain tumor]], [[stroke|cerebellar stroke]], [[cerebral aneurysm]], [[cerebral arteriovenous malformation]], [[cerebral hemorrhage]], [[cerebrovascular disease]], [[cerebral oedema]],[[cerebral shunt ]], [[cerebrovascular disease]], [[ciguatera]], [[concussion]], [[craniopharyngioma]], [[cyclic vomiting syndrome]], [[decompression sickness]], [[encephalitis]], [[enteric Neuropathy|enteric neuropathy]], [[ependymoma]], [[epidural haemorrhage]], [[episodic ataxia]], [[familial hemiplegic migraine]], [[glioblastoma multiforme]], [[glioma]], [[heavy metal ingestion]], [[hemicrania continua]], [[hepatic coma]], [[hydrocephalus]], [[La Crosse encephalitis]], [[Sea sickness]], [[subdural hematoma]], [[Tabes dorsalis]], [[vagal episode]], [[vertebrobasilar insufficiency]], [[vestibular neuritis]]
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"|[[5-hydroxytryptophan]], [[acute intermittent porphyria]], [[amnesic shellfish poisoning]], [[amyloidosis]], [[bromelain]], [[cicuta]], [[cimicifuga racemosa]],[[coprinopsis atramentaria]], [[food allergies]], [[food intolerance]], [[food poisoning]], [[galactosemia]], [[ginger]], [[hereditary fructose intolerance]], [[hypercalcemia]], [[hypermagnesemia]], [[hypervitaminosis A]], [[hypervitaminosis]], [[hypocalcemia]], [[hypocholermia]], [[hypoglycemia]], [[hypokalemia]], [[hyponatremia]], [[ketogenic diet]], [[lactose intolerance]], [[metabolic acidosis]], [[pyridoxine deficiency]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"|[[Acute fatty liver of pregnancy]], [[breastfeeding complications]], [[childbirth]], [[contraceptive patch]], [[endometriosis]], [[emergency contraception]],[[Estrogen and Progestin (Oral Contraceptives)|estrogen and progestin]], [[essure]], [[gestational diabetes]], [[HELLP syndrome]], [[hydatidiform mole]], [[hyperemesis gravidarum]], [[ovarian cyst]], [[ovarian hyperstimulation syndrome]], [[ovarian torsion]], [[pregnancy]], [[salpingitis]], [[twisted ovarian cyst]]
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"|[[Acoustic neuroma]], [[Brain Stem Gliomas|brain stem gliomas]], [[brain tumor]], [[cancer]], [[carcinoid tumours and carcinoid syndrome]], [[colorectal cancer]][[craniopharyngioma]], [[ependymoma]], [[esophageal cancer]], [[gastric carcinoma]], [[glioblastoma multiforme]], [[glioma]], [[Kaposi's sarcoma]], [[Non-Hodgkin lymphoma]], [[osteosarcoma]], [[prolactinoma]], [[Zollinger-Ellison Syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"|[[Acute angle-closure glaucoma]], [[glaucoma]], [[refractive error]]
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| [[1,2-Dichloroethene]], [[1,3-Dichloropropene]], [[2C-E]], [[2C-I]], [[2C-T-7]], [[abrin]], [[alcoholism]], [[alcohol withdrawal]], [[beleric]], [[cinchonism]], [[ethanol abuse]], [[hangover]], [[heavy metal ingestion]], [[heroin]], [[orellanine]], [[Reye's syndrome]], [[marine toxins]], [[PMA]]
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"|[[Alcohol Withdrawal]], [[alcoholism]], [[anorexia nervosa]], [[anxiety]], [[anxiety disorders]], [[bulimia nervosa]], [[chronic fatigue syndrome]], [[combat stress reaction]], [[depression]], [[ethanol abuse]], [[hangover]], [[sexual fetish]] ([[emetophilia]]), [[SSRI discontinuation syndrome]] [[Hypochondriasis]]<ref name="pmid1263596">{{cite journal |vauthors=Swanson DW, Swenson WM, Huizenga KA, Melson SJ |title=Persistent Nausea without organic cause |journal=Mayo Clin Proc |volume=51 |issue=5 |pages=257–62 |date=May 1976 |pmid=1263596 |doi= |url=}}</ref>
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"|[[Acute viral nasopharyngitis (common cold)]], [[altitude sickness]], [[anaphylaxis]], [[aortic arch anomalies]], [[community acquired pneumonia]], [[croup]], [[decompression sickness]], [[Hantavirus pulmonary syndrome]], [[lower respiratory tract infection]], [[pulmonary embolism]], [[ pharyngitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"|[[Dehydration]], [[diabetic ketoacidosis]], [[hypercalcemia]], [[hypermagnesemia]], [[hypocalcemia]], [[hypocholermia]], [[hypokalemia]], [[hyponatraemia]], [[Interstitial nephritis]], [[nutcracker syndrome]], [[pyelonephritis]], [[renal colic]], [[renal failure]], [[renal stones]], [[ urinary tract infections]]
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"|[[Amyloidosis]], [[anaphylaxis]], [[chronic fatigue syndrome]], [[Crohn's disease]], [[food allergies]], [[food intolerance]], [[Graft-versus-host disease]], [[scleroderma]], [[Tetanus, Diphtheria, and Pertussis (Tdap) Vaccine|tetanus, diphtheria, and pertussis (Tdap) vaccine]], [[typhoid Vaccine]], [[HIV]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"|[[HIV]]
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"|[[Head trauma]], [[hemorrhage]], [[post-concussion syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"|[[Acute prostatitis]], [[testicular rupture]], [[testicular torsion]], [[urinary tract infections]], [[urolithiasis]]
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"|[[Anadenanthera peregrina]], [[exercise induced nausea]], [[extreme pain]], [[foreign bodies]], [[sleep deprivation]], [[soapwort]], [[ulcers]], [[water intoxication]], [[cyclic vomiting syndrome]], [[DTPA]], [[ginkgo]]
|-
|}

===Causes in Alphabetical Order===
{{columns-list|4|
* [[1,2-Dichloroethene]]
* [[1,3-Dichloropropene]]
* [[2C-E]]
* [[2C-I]]
* [[2C-T-7]]
* [[2-Ethylhexanol]]
* [[5-Hydroxytryptophan]]
* [[5-MeO-AMT]]
* [[Abrin]]
* [[Abscess]]
* [[ABVD]]
* [[Acamprosate calcium]]
* [[Accessory pancreas]]
* [[Acetaminophen]]
* [[Acetoxyketobemidone]]
* [[Acetylcysteine]]
* [[Achalasia]]
* [[Aclarubicin]]
* [[Acyclovir]]
* [[Aconitine]]
* [[Acoustic neuroma]]
* [[Acromegaly]]
* [[Actinomycin|Actinomycin D]]
* [[Acute angle-closure glaucoma]]
* [[Acute coronary syndromes]]
* [[Acute fatty liver of pregnancy]]
* [[Acute intermittent porphyria]]
* [[Acute pancreatitis]]
* [[Acute prostatitis]]
* [[Acute viral nasopharyngitis (common cold)]]
* [[Adamsite]]
* [[Adenovirus]]
* [[Addison's Disease]]
* [[Adjustable gastric band]]
* [[Adrenal insufficiency]]
* [[Afferent loop syndrome]]
* [[Airsickness]]
* [[Alatrofloxacin Injection]]
* [[Albuterol Inhalation]]
* [[Alcohol withdrawal]]
* [[Alcoholism]]
* [[Aldesleukin]]
* [[Alemtuzumab]]
* [[Allylprodine]]
* [[Alpha-Methyltryptamine]]
* [[Alprazolam]]
* [[Altitude sickness]]
* [[Altretamine]]
* [[Amantadine]]
* [[Amifostine]]
* [[Amineptine]]
* [[Aminocaproic acid]]
* [[Aminophylline]]
* [[Aminopterin]]
* [[Aminosalicylic acid]]
* [[Amitriptyline]]
* [[Ammonium chloride]]
* [[Amnesic shellfish poisoning]]
* [[Amoxicillin]]
* [[Amphotericin B]]
* [[Amrinone]]
* [[Amyl nitrite]]
* [[Amyloidosis]]
* [[Anadenanthera peregrina]]
* [[Anaphylaxis]]
* [[Anastrozole]]
* [[Anesthesia]]
* [[Angina pectoris]]
* [[Anorexia nervosa]]
* [[Antiarrhythmics]]
* [[Antibiotics]]
* [[Anticonvulsants]]
* [[Antihistamine]]
* [[Antihypertensives]]
* [[Antiretroviral drug]]
* [[Anxiety]]
* [[Aortic arch anomalies]]
* [[Apomorphine hydrochloride]]
* [[Appendicitis]]
* [[Aprepitant]]
* [[Arachnoid cyst]]
* [[Aripiprazole]]
* [[Arsenicals]]
* [[Arsenic Poisoning]]
* [[Arsenic trioxide]]
* [[Ascariasis]]
* [[Aseptic meningitis]]
* [[Asparaginase]]
* [[Aspirin]]
* [[Astrovirus]]
* [[Atomoxetine]]
* [[Atosiban]]
* [[Atripala]] ([[Efavirenz, emtricitabine and tenofovir disoproxil fumarate]])
* [[Auranofin]]
* [[Autonomic neuropathy]]
* [[Azathioprine]]
* [[Azithromycin]]
* [[Aztreonam]]
* [[Bacillus cereus]]
* [[Bacterial gastroenteritis]]
* [[Balance disorder]]
* [[Barbiturate]]
* [[Barcoo Fever|Barcoo fever]]
* [[Barium oxalate]]
* [[Barium sulfate]]
* [[BCG vaccine]]
* [[Beef tapeworm]]
* [[Beleric]]
* [[Belladonna Alkaloid Combinations and Phenobarbital|Belladonna alkaloid combinations]]
* [[Benign intracranial hypertension]]
* [[Benzodiazepine]]
* [[Benzylpiperazine]]
* [[Beta blockers]]
* [[Beta-lactam antibiotic]]
* [[Bevacizumab Injection (patient information)|Bevacizumab Injection]]
* [[Bezafibrate]]
* [[Bicalutamide]]
* [[Biliary colic]]
* [[Blastocystosis]]
* [[Bleomycin ]]
* [[Bortezomib]]
* [[Botulinum toxin]]
* [[Bowel obstruction]]
* [[Brain Stem Gliomas|Brain stem gliomas]]
* [[Brain tumor]]
* [[Breastfeeding complications]]
* [[Bromelain]]
* [[Bromomethane]]
* [[Bronchodilator]]
* [[Brucella]]
* [[Buprenorphine Hydrochloride, Naloxone Hydrochloride|Buprenorphine,naloxone]]
* [[Bulimia nervosa]]
* [[Buprenorphine]]
* [[Bupropion]]
* [[Busulfan]]
* [[Butanethiol]]
* [[Butorphanol]]
* [[Cabergoline]]
* [[Caecitis]]
* [[Calcitonin]]
* [[Calcitriol]]
* [[Calcium carbamide]]
* [[Calcium channel antagonists]]
* [[Camphor|Camphor poisoning]]
* [[Cancer]]
* [[Capecitabine]]
* [[Capsaicin]]
* [[Carbon monoxide poisoning]]
* [[Carboplatin]]
* [[Carcinoid tumours and carcinoid syndrome]]
* [[Cardiac arrhythmia]]
* [[Carmustine]]
* [[Carprofen]]
* [[Carvedilol]]
* [[Caspofungin]]
* [[Cefaclor]]
* [[Cefixime]]
* [[Cefoperazone Sodium Injection (patient information)|Cefoperazone Sodium Injection]]
* [[Cefotetan disodium]]
* [[Cefprozil]]
* [[Ceftaroline fosamil]]
* [[Ceftibuten]]
* [[Cefuroxime]]
* [[Cephalosporin]]
* [[Cerebral aneurysm]]
* [[Cerebral arteriovenous malformation]]
* [[Cerebral edema]]
* [[Cerebral hemorrhage]]
* [[Cerebral shunt]]
* [[Cerebrovascular disease]]
* [[Cetuximab Injection]]
* [[Cevimeline]]
* [[Chelation therapy]]
* [[Chemotherapy]]
* [[Childbirth]]
* [[Chloral hydrate]]
* [[Chlordiazepoxide]]
* [[Chloromethane]]
* [[Chlorothiazide]]
* [[Chlorpropamide]]
* [[Cholecystitis]]
* [[Cholecystolithiasis]]
* [[CHOP]]
* [[Chronic fatigue syndrome]]
* [[Chronic intestinal pseudo-obstruction]]
* [[Cicuta]]
* [[Ciguatera]]
* [[Cimicifuga racemosa]]
* [[Cinchonism]]
* [[Ciprofloxacin]]
* [[Cisplatin]]
* [[Citalopram]]
* [[Cladribine]]
* [[Clarithromycin]]
* [[Clindamycin]]
* [[Clofarabine]]
* [[Clofibrate]]
* [[Clomifene]]
* [[Clorazepate]]
* [[Clostridium perfringens]]
* [[Cobicistat]]
* [[Co-codamol]]
* [[Codeine]]
* [[Colchicine]]
* [[Colestyramine]]
* [[Colorado tick fever]]
* [[Colorectal cancer]]
* [[Combat stress reaction]]
* [[Community-acquired pneumonia]]
* [[Concussion]]
* [[Congenital hypertrophic pyloric stenosis]]
* [[Congenital malformation]]
* [[Contraceptive patch]]
* [[Copper|Copper salts]]
* [[Coprinopsis atramentaria]]
* [[Craniopharyngioma]]
* [[Crohn's disease]]
* [[Croup]]
* [[Cryptosporidium parvum]]
* [[Cyanogen]]
* [[Cyclic vomiting syndrome]]
* [[Cyclobenzaprine]]
* [[Cyclophosphamide]]
* [[Cyclospora cayetanensis]]
* [[Cytarabine]]
* [[Cytisine]]
* [[Dacarbazine]]
* [[Dactinomycin]]
* [[Danazol]]
* [[Dantrolene]]
* [[Daptomycin]]
* [[Darbepoetin Alfa Injection (patient information)|Darbepoetin Alfa Injection]]
* [[Darunavir]]
* [[Daunorubicin]]
* [[Decompression sickness]]
* [[Deferasirox]]
* [[Deferiprone]]
* [[Defibrotide]]
* [[Dehydration]]
* [[Dengue fever]]
* [[Depression]]
* [[Desmopressin]]
* [[Dexamethasone]]
* [[Dextroamphetamine and Amphetamine (patient information)|Dextroamphetamine and Amphetamine]]
* [[Dextromethorphan]]
* [[Dextropropoxyphene]]
* [[Diabetes mellitus]]
* [[Diabetic gastroparesis]]
* [[Diabetic Ketoacidosis]]
* [[Diarrheal shellfish poisoning]]
* [[Diazepam]]
* [[Diazinon]]
* [[Dicofol]]
* [[Didanosine]]
* [[Dientamoebiasis]]
* [[Diethyl ether]]
* [[Diethylcathinone]]
* [[Diflunisal]]
* [[Digitalis purpurea]]
* [[Digitoxin]]
* [[Digoxin]]
* [[Dioxathion]]
* [[Dioxin]]
* [[Diphtheria]]
* [[Disulfiram]]
* [[Diuretic]]
* [[Diverticulitis]]
* [[Docetaxel]]
* [[Dofetilide]]
* [[Dolasetron]]
* [[Donepezil]]
* [[Doripenem]]
* [[Dosulepin hydrochloride]]
* [[Down syndrome]]
* [[Doxorubicin Hydrochloride]]
* [[DTPA]]
* [[Duke's disease]]
* [[Duloxetine]]
* [[Dumping syndrome]]
* [[Ear infection]]
* [[Ebola virus disease]]
* [[Eculizumab]]
* [[Efavirenz]]
* [[Elvitegravir]]
* [[Emergency contraception]]
* [[Emetine]]
* [[Encephalitis]]
* [[Endometriosis]]
* [[Endosulfan]]
* [[Enfuvirtide]]
* [[Entecavir]]
* [[Enteric Neuropathy]]
* [[Enterobiasis]]
* [[Eosinophilic gastroenteritis]]
* [[Epidural haemorrhage]]
* [[Ependymoma]]
* [[Epiploic appendagitis]]
* [[Epirubicin hydrochloride]]
* [[Episodic ataxia]]
* [[Epistaxis]]
* [[Epoetin Alfa Injection (patient information)|Epoetin Alfa Injection]]
* [[Ergotamine]]
* [[Ergotism]]
* [[Eribulin]]
* [[Erlotinib]]
* [[Erythromycin]]
* [[Esophageal achalasia]]
* [[Esophageal cancer]]
* [[Esophageal diverticulum]]
* [[Esophageal stenosis]]
* [[Esophagitis]]
* [[Essure]]
* [[Estradiol]]
* [[Estrogen and Progestin (Oral Contraceptives) (patient information)|Estrogen and Progestin ]]
* [[Ethanol abuse]]
* [[Ethcathinone]]
* [[Ethchlorvynol]]
* [[Ethosuximide]]
* [[Ethyl carbamate]]
* [[Ethylmorphine]]
* [[Etidronate]]
* [[Etoposide]]
* [[Exemestane]]
* [[Exenatide]]
* [[Exercise induced nausea]]
* [[Exercise urticaria]]
* [[Extreme pain]]
* [[Familial hemiplegic migraine]]
* [[Felbamate]]
* [[Femoral hernia]]
* [[Fentanyl Oral Transmucosal (patient information)|Fentanyl Oral Transmucosal]]
* [[Fexofenadine]]
* [[Filgrastim]]
* [[Fioricet]]
* [[Fluorouracil]]
* [[Floxuridine]]
* [[Flu]]
* [[Fluconazole]]
* [[Flucytosine]]
* [[Fludarabine Phosphate]]
* [[Flunisolide]]
* [[Fluorescein sodium]]
* [[Fluoride poisoning]]
* [[Fluorouracil]]
* [[Flurazepam]]
* [[Flurbiprofen]]
* [[Flutamide]]
* [[Fluticasone]]
* [[Food allergies]]
* [[Food intolerance]]
* [[Food poisoning]]
* [[Foreign bodies]]
* [[Fructose intolerance]] [[hypoglycemia]]
* [[Fulvestrant Injection (patient information)|Fulvestrant Injection]]
* [[Functional dyspepsia]]
* [[Fundic gland polyposis]]
* [[Gabapentin]]
* [[Galactosemia]]
* [[Galantamine]]
* [[Gamma-Hydroxybutyric acid]]
* [[Gangrene]]
* [[Gastric carcinoma]]
* [[Gastric outlet obstruction]]
* [[Gastritis]]
* [[Gastrocolic fistula]]
* [[Gastroenteritis]]
* [[Gastroesophageal reflux disease]]
* [[Gastrointestinal perforation]]
* [[Gastroparesis]]
* [[Gatifloxacin]]
* [[Gefitinib]]
* [[Gemcitabine Hydrochloride (patient information)|Gemcitabine hydrochloride]]
* [[Gemeprost]]
* [[Gestational diabetes]]
* [[Gestrinone]]
* [[Giardia lamblia]]
* [[Giardiasis]]
* [[Ginger]]
* [[Ginkgo]]
* [[Glaucoma]]
* [[Glioblastoma multiforme]]
* [[Glioma]]
* [[Glucagon]]
* [[Glycylcycline]]
* [[Goserelin]]
* [[Graft-versus-host disease]]
* [[Granisetron]]
* [[Green Tobacco Sickness|Green tobacco sickness]]
* [[Grifulvin V]]
* [[Griseofulvin]]
* [[Guaifenesin]]
* [[Hangover]]
* [[Hantavirus pulmonary syndrome]]
* [[Head trauma]]
* [[Heart failure]]
* [[Heat stroke]]
* [[Heavy metal ingestion]]
* [[Helicobacter pylori infection]]
* [[HELLP syndrome]]
* [[Hematemesis]]
* [[Hemicrania continua]]
* [[Hemorrhage]]
* [[Henipavirus]]
* [[Hepatic coma]]
* [[Hepatic porphyria]]
* [[Hepatitis]]
* [[Hepatitis B]]
* [[Hepatitis D]]
* [[Hepatitis E]]
* [[Hepatobiliary disease]]
* [[Hereditary fructose intolerance]]
* [[Herkinorin]]
* [[Hernia]]
* [[Heroin]]
* [[Hirschsprung disease]]
* [[HIV]]
* [[Hookworm]]
* [[Hormone replacement therapy (trans)]]
* [[Human ehrlichiosis]]
* [[Hydralazine]]
* [[Hydrocephalus]]
* [[Hydrochlorothiazide]]
* [[Hydrocodone]]
* [[Hydromorphone]]
* [[Hydroxychloroquine]]
* [[Hydroxocobalamin]]
* [[Hydroxyurea]]
* [[Hydroxyzine]]
* [[Hypercalcemia]]
* [[Hyperemesis gravidarum]]
* [[Hypermagnesemia]]
* [[Hyperparathyroidism]]
* [[Hypertension]]
* [[Hyperthermia]]
* [[Hyperthyroidism]]
* [[Hypervitaminosis A]]
* [[Hypocalcemia]]
* [[Hypocholermia]]
* [[Hypoglycemia]]
* [[Hypokalemia]]
* [[Hyponatremia]]
* [[Hypoparathyroidism]]
* [[Hysterical contagion]]
* [[Iatrogenesis]]
* [[Ibogaine]]
* [[Ibuprofen]]
* [[Idarubicin]]
* [[Idiopathic]]
* [[Ifosfamide]]
* [[Ileus]]
* [[Imatinib]]
* [[Imipenem]]
* [[Inappetence]]
* [[Inborn errors of metabolism]]
* [[Incarcerated hernia]]
* [[Indinavir]]
* [[Indometacin]]
* [[Infarction]]
* [[Inflammatory bowel disease]]
* [[Infliximab]]
* [[Influenza]]
* [[Inguinal hernia]]
* [[Instillation abortion]]
* [[Insulin lispro]]
* [[Interferon gamma]]
* [[Interstitial nephritis]]
* [[Intracranial mass]]
* [[Intestinal atresia]]
* [[Intestinal parasite]]
* [[Intestinal volvulus]]
* [[Intracranial haemorrhage]]
* [[Intracranial hypertension]]
* [[Intussusception]]
* [[Ipecacuanha]]
* [[Iodomethane]]
* [[Irinotecan hydrochloride]]
* [[Iron(II) sulfate]]
* [[Irritable bowel syndrome]]
* [[Irukandji syndrome]]
* [[Ischemic bowel]]
* [[Isoniazid]]
* [[Isopropyl alcohol]]
* [[Isosorbide mononitrate]]
* [[Isotretinoin]]
* [[Itraconazole]]
* [[Ivacaftor]]
* [[Ixabepilone]]
* [[Jamaican vomiting sickness]]
* [[Janumet]] ([[sitagliptin]] and [[metformin]])
* [[Kaopectate]]
* [[Kaposi's sarcoma]]
* [[Ketoconazole]]
* [[Ketogenic diet]]
* [[Ketorolac]]
* [[Ketotic hypoglycemia]]
* [[La Crosse encephalitis]]
* [[Labyrinthitis]]
* [[Lactose intolerance]]
* [[Lanreotide]]
* [[Lansoprazole]]
* [[Large bowel obstruction]]
* [[Lassa fever]]
* [[Lead poisoning]]
* [[Letrozole]]
* [[Leuprolide]]
* [[Levodopa and Carbidopa]]
* [[Levofloxacin]]
* [[Levonorgestrel]]
* [[Lewisite]]
* [[Lindane]]
* [[Listeria monocytogenes]]
* [[Lithium]]
* [[Lithium nitrate]]
* [[Lobelia]]
* [[Lomefloxacin hydrochloride]]
* [[Lomotil]]
* [[Lopinavir]]
* [[Loprazolam]]
* [[Lorazepam]]
* [[Lower respiratory tract infection]]
* [[Lubiprostone]]
* [[Lysuride]]
* [[Malaria]]
* [[Malaria prophylaxis]]
* [[Malignancy]]
* [[Intestinal malrotation|Malrotation]]
* [[Marine toxins]]
* [[Mass effect (medicine)|Mass lesion]]
* [[Mastocytosis]]
* [[Mazindol]]
* [[Mechlorethamine]]
* [[Medazepam]]
* [[Medical cannabis]]
* [[Megestrol]]
* [[Melarsoprol]]
* [[Melphalan]]
* [[Ménière's disease]]
* [[Meningitis]]
* [[Meningococcemia]]
* [[Meningoencephalitis]]
* [[Mercaptopurine]]
* [[Mesoamerican nephropathy]]
* [[Meropenem]]
* [[Mesalamine]]
* [[Mescaline]]
* [[Mesenteric infarction]]
* [[Mesna]]
* [[Metabolic acidosis]]
* [[Metal fume fever]]
* [[Metformin]]
* [[Methadone]]
* [[Methotrexate]]
* [[Methylergonovine]]
* [[Methylketobemidone]]
* [[Methylphenidate]]
* [[Methyprylon]]
* [[Metronidazole]]
* [[Micafungin sodium]]
* [[Mifepristone]]
* [[Migraine]]
* [[Milk of Magnesia]]
* [[Milnacipran hydrochloride]]
* [[Miltefosine]]
* [[Minimally Invasive Thorasic Spinal Fusion]]
* [[Mirtazapine]]
* [[Misoprostol]]
* [[Mitomycin]]
* [[Mitotane]]
* [[Mitoxantrone]]
* [[Moclobemide]]
* [[Monocrotophos]]
* [[Mood stabilizer]]
* [[MOPP (medicine)|MOPP]]
* [[Morning sickness]]
* [[Morphine]]
* [[Motion sickness]]
* [[Motofen]]
* [[Moxifloxacin]]
* [[Multiple chemical sensitivity]]
* [[Multiple endocrine neoplasia type 1]]
* [[Munchausen syndrome by proxy]]
* [[Murray Valley encephalitis virus]]
* [[Mushroom poisoning]]
* [[Mycophenolic acid]]
* [[Mycoplasma pneumoniae]]
* [[Myocardial infarction]]
* [[Nabilone]]
* [[Naegleria fowleri]]
* [[Nafcillin]]
* [[Nalbuphine]]
* [[Nalidixic acid]]
* [[Nalmefene]]
* [[Naloxone]]
* [[Naphthalene]]
* [[Naproxen sodium]]
* [[Narcotics]]
* [[Natamycin]]
* [[Necrotizing enterocolitis]]
* [[Nerve agent]]
* [[Nervousness]]
* [[N-Ethyl-3-piperidyl benzilate]]
* [[Nicorandil]]
* [[Nicotine poisoning]]
* [[Nilutamide]]
* [[Nintedanib]]
* [[Nitrazepam]]
* [[Nitrogen mustard]]
* [[N-Nitroso-N-Methylurea]]
* [[Non-Hodgkin lymphoma]]
* [[Non steroidal anti-inflammatory drugs]]
* [[Nootropic]]
* [[Norfloxacin]]
* [[Norgestimate and Ethinyl estradiol]]
* [[Norgestrel and Ethinyl estradiol]]
* [[Norovirus]]
* [[Norplant]]
* [[Nortriptyline]]
* [[Norwalk Virus]]
* [[Nutcracker syndrome]]
* [[Nystatin]]
* [[Obidoxime]]
* [[Obstructive uropathy]]
* [[Obturator hernia]]
* [[Oesophageal cancer]]
* [[Ofloxacin]]
* [[Olanzapine]]
* [[Omeprazole]]
* [[Ondansetron]]
* [[Opioid]]
* [[Oprelvekin]]
* [[Oral contraceptives]]
* [[Orellanine]]
* [[Organic acidemia]]
* [[Organophosphates]]
* [[Oritavancin]]
* [[Oseltamivir]]
* [[Osteosarcoma]]
* [[Otitis interna]]
* [[Otitis media]]
* [[Ovarian cancer]]
* [[Ovarian cyst]]
* [[Ovarian hyperstimulation syndrome]]
* [[Ovarian torsion]]
* [[Oxaliplatin]]
* [[Oxamniquine]]
* [[Oxazepam]]
* [[Oxcarbazepine]]
* [[Oxybutynin]]
* [[Oxycodone and aspirin]]
* [[Paclitaxel]]
* [[Pain]]
* [[Palbociclib]]
* [[Pancreatic adenocarcinoma]]
* [[Pancreatitis]]
* [[Panitumumab]]
* [[Pantoprazole]]
* [[Palbociclib]]
* [[Paliperidone]]
* [[Palonosetron]]
* [[Panic attack]]
* [[Paralytic ileus]]
* [[Paraneoplastic syndrome]]
* [[Paraquat]]
* [[Paroxetine]]
* [[Pegaspargase]]
* [[Pemetrexed injection]]
* [[Penicillin]]
* [[Pentamidine]]
* [[Pentavalent antimonial]]
* [[Pentetic acid]]
* [[Pentostatin]]
* [[Peptic ulcer]]
* [[Pergolide]]
* [[Perhexiline]]
* [[Peritonitis]]
* [[Pesticide]]
* [[Pethidine]]
* [[Pfiesteria piscicida]]
* [[PFPP]]
* [[Pharyngeal pouch]]
* [[Pharyngitis]]
* [[Phenelzine]]
* [[Phenoxymethylpenicillin]]
* [[Phentermine]]
* [[Phentolamine]]
* [[Pholcodine]]
* [[Physostigmine]]
* [[Phytohaemagglutinin]]
* [[Pioglitazone]]
* [[Pirfenidone]]
* [[Piribedil]]
* [[Plerixafor]]
* [[Plicamycin]]
* [[Piroxicam]]
* [[PMA]]
* [[Pneumonia]]
* [[Polio]]
* [[Poliomyelitis]]
* [[Porphyria]]
* [[Posaconazole]]
* [[Post-concussion syndrome]]
* [[Post-exposure prophylaxis]]
* [[Ileus|Postoperative ileus]]
* [[Postoperative nausea and vomiting]]
* [[Pain|Postoperative pain]]
* [[Potassium bromide]]
* [[Potassium chloride]]
* [[Potassium citrate]]
* [[Praziquantel]]
* [[Pregabalin]]
* [[Pregnancy]]
* [[Primaquine]]
* [[Procainamide]]
* [[Procarbazine]]
* [[Prochlorperazine]]
* [[Progesterone]]
* [[Prolactinoma]]
* [[Propiram]]
* [[Propylketobemidone]]
* [[Prosidol]]
* [[Protriptyline]]
* [[Pseudotumor cerebri]]
* [[Psychogenic]]
* [[Pulmonary embolism]]
* [[Pyelonephritis]]
* [[Pyloric stenosis]]
* [[Pyrazinamide]]
* [[Pyrantel pamoate]]
* [[Pyridostigmine]]
* [[Pyridoxine deficiency]]
* [[Q fever]]
* [[Quetiapine]]
* [[Quinidine]]
* [[Quinupristin/dalfopristin]]
* [[Radiation poisoning]]
* [[Radiation therapy]]
* [[Raised intracranial pressure]]
* [[Radium chloride]]
* [[Ramelteon]]
* [[Ranolazine]]
* [[Rasagiline]]
* [[Refractive error]]
* [[Renal colic]]
* [[Renal failure]]
* [[Renal insufficiency]]
* [[Reserpine]]
* [[Retroperitoneal fibrosis]]
* [[Reversible cerebral vasoconstriction syndrome]]
* [[Reye's syndrome]]
* [[Ribavirin]]
* [[Rifabutin]]
* [[Riluzole]]
* [[Risedronate]]
* [[Rituximab injection]]
* [[Rivastigmine]]
* [[Rizatriptan]]
* [[Rocky mountain spotted fever]]
* [[Ropinirole]]
* [[Rotavirus]]
* [[Rotigotine]]
* [[Roxithromycin]]
* [[Rubbing alcohol]]
* [[Rumination disorder]]
* [[Salicylate poisoning]]
* [[Salmonella]]
* [[Salpingitis]]
* [[Salsalate]]
* [[Saquinavir mesylate]]
* [[Sargramostim]]
* [[Sarin]]
* [[Sativex]]
* [[Scarlet fever]]
* [[Scleroderma]]
* [[Seasickness]]
* [[Secobarbital]]
* [[second-hand smoke]]
* [[Secretin human]]
* [[Seizure disorders]]
* [[Selective serotonin reuptake inhibitor]]
* [[Selegiline]]
* [[Seliciclib]]
* [[Sepsis]]
* [[Sexual fetish]]
* [[Shigella]]
* [[Sibutramine]]
* [[Sipuleucel-T]]
* [[Ski sickness]]
* [[Sleep deprivation]]
* [[Slone's disease]]
* [[Small bowel bacterial overgrowth syndrome]]
* [[Small bowel lymphoma]]
* [[Small bowel obstruction]]
* [[Small intestine cancer]]
* [[Smoke inhalation]]
* [[Snakebites]]
* [[Soapwort]]
* [[Sodium oxybate]]
* [[Sodium polystyrene sulfonate]]
* [[Sodium stibogluconate]]
* [[Sofosbuvir]]
* [[Solanine]]
* [[Somatization]]
* [[Spider bite]]
* [[Spironolactone]]
* [[Splenic infarction]]
* [[Sporotrichosis]]
* [[Spotted fever]]
* [[SSRI discontinuation syndrome]]
* [[Staphylococcal enteritis]]
* [[Starvation]]
* [[Stavudine]]
* [[Stomach cancer]]
* [[Streptococcal pharyngitis]]
* [[Stribild]] ([[Elvitegravir, Cobicistat, Emtricitabine, And Tenofovir Disoproxil Fumarate]])
* [[Strongyloidiasis]]
* [[Stiripentol]]
* [[Strep throat]]
* [[Streptozocin]]
* [[Subdural hematoma]]
* [[Sufentanil]]
* [[Sulfasalazine]]
* [[Sulfonamides]]
* [[Sulprostone]]
* [[Suicide attempt]]
* [[Sultiame]]
* [[Sumatriptan injection]]
* [[Sunitinib]]
* [[Suramin]]
* [[Syndrome of inappropriate antidiuretic hormone]] [[SIADH]]
* [[Tabes dorsalis]]
* [[Tacrine]]
* [[Tacrolimus]]
* [[Tamoxifen]]
* [[Tapentadol]]
* [[Telavancin hydrochloride]]
* [[Telbivudine]]
* [[Telithromycin]]
* [[Tetracycline]]
* [[Temik]]
* [[Temozolomide]]
* [[Teniposide]]
* [[Testicular rupture]]
* [[Testicular torsion]]
* [[Tetanus, Diphtheria, and Pertussis (Tdap) Vaccine]]
* [[Tetracaine]]
* [[Tetrahydrocannabinol]]
* [[Tetrahydrozoline]]
* [[Tetramethylsuccinonitrile]]
* [[Tetrodotoxin]]
* [[Thallium]]
* [[Theobromine]]
* [[Theophylline]]
* [[Thiabendazole]]
* [[Thiethylperazine]]
* [[Thioguanine]]
* [[Thiotepa]]
* [[Thrombotic thrombocytopenic purpura]]
* [[Thyroid Medication (patient information)|Thyroid medication]]
* [[Thyrotoxicosis]]
* [[Tigecycline]]
* [[smoking|Tobacco smoking]]
* [[Tocopherol]]
* [[Tolmetin]]
* [[Topiramate]]
* [[Topotecan Hydrochloride|Topotecan Hydrochloride]]
* [[Toxic ingestion]]
* [[Toxidrome]]
* [[Tralomethrin]]
* [[Tramadol]]
* [[Trametinib dimethyl sulfoxide]]
* [[Trandolapril]]
* [[Tranexamic acid]]
* [[Trastuzumab]]
* [[Traumatic brain injury]]
* [[Traveler's diarrhea]]
* [[Trazodone]]
* [[Tretinoin]]
* [[Triamterene]]
* [[Triazolam]]
* [[Trichuriasis]]
* [[Triclofos]]
* [[Tricyclic antidepressant]]
* [[Trifluoperazine]]
* [[Trifluoromethylphenylpiperazine]]
* [[Trimeperidine]]
* [[Trimethobenzamide]]
* [[Trimetrexate glucuronate]]
* [[Tropisetron]]
* [[Trovafloxacin mesylate]]
* [[Tularemia]]
* [[Tumors]]
* [[Twisted ovarian cyst]]
* [[Typhoid Vaccine (patient information)|Typhoid Vaccine]]
* [[Typhus]]
* [[Ulcers]]
* [[Urea cycle disorders]]
* [[Uremia]]
* [[Urinary tract infection]]
* [[Urofollitropin]]
* [[Urolithiasis]]
* [[Vagotomy]]
* [[Valaciclovir]]
* [[Valganciclovir hydrochloride]]
* [[Valproic Acid]]
* [[Varenicline]]
* [[Vasovagal syncope]]
* [[Venlafaxine]]
* [[Verapamil]]
* [[Vertebro-basilar syndrome]]
* [[Vertigo]]
* [[Vestibular balance disorder]]
* [[Vestibular neuronitis]]
* [[Vibrio parahaemolyticus]]
* [[Vicodin]]
* [[Vidarabine]]
* [[Vigabatrin]]
* [[Vilazodone]]
* [[Viloxazine]]
* [[Vinblastine]]
* [[Vinorelbine Tartrate]]
* [[Viral gastroenteritis]]
* [[emotion|Violent emotions]]
* [[Cough|Violent fits of coughing]]
* [[hiccups|Violent fits of coughing]]
* [[Vitamin A]]
* [[Vitamin C]]
* [[Vitamin D]]
* [[Volvulus]]
* [[Von Willebrand factor]]
* [[Voriconazole]]
* [[Vorinostat]]
* [[Vortioxetine]]
* [[Water intoxication]]
* [[Waterborne diseases]]
* [[West Nile virus]]
* [[Yellow fever]]
* [[Zanamivir Inhalation]]
* [[Zidovudine]]
* [[Ziprasidone]]
* [[Zollinger-Ellison Syndrome]]
* [[Zolpidem]]
* [[Zopiclone]]

}}

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Emergency medicine]]
[[Category:Gastroenterology]]
[[Category:Obstetrics]]
[[Category:Crowdiagnosis]]

Nausea and vomiting causes

2021-01-28T02:57:24Z

Shaik Aisha sultana: /* Causes */

__NOTOC__
{{Nausea and vomiting}}
{{CMG}}; {{AE}} {{VVS}} {{KS}}

==Overview==
Life threatening causes of nausea and vomiting include [[acute coronary syndrome]], [[anaphylaxis]], and [[heart failure]]. Other common causes of nausea and vomiting are [[food allergies]], [[food poisoning]], [[gastroenteritis]], and [[gastroesophageal reflux]].

==Causes==
===Life Threatening Causes===
*[[Acute Coronary Syndromes]]<ref name="pmid637006">{{cite journal |vauthors=Ahmed SS, Gupta RC, Brancato RR |title=Significance of nausea and vomiting during acute myocardial infarction |journal=Am Heart J |volume=95 |issue=5 |pages=671–2 |date=May 1978 |pmid=637006 |doi=10.1016/0002-8703(78)90311-3 |url=}}</ref>
*[[Anaphylaxis]]
*[[Angina pectoris]]
*[[Heart failure]]

===Common Causes===
*[[Chemotherapy]]<ref>{{cite journal|doi=10.1002/j.1875-9114.1990.tb02560.x}}</ref>

*[[Food allergies]]
*[[Food poisoning]]
*[[Migraine]]
*[[Morning sickness]]
*[[Rotavirus]]
*[[Viral gastroenteritis]]

===Causes by Organ System===

{|style="width: 80%; height: 100px; text-align: justify; text-justify: distribute;" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |[[Acute Coronary Syndromes]], [[amyloidosis]], [[anaphylaxis]], [[angina pectoris]], [[aortic arch anomalies]], [[cardiac arrhythmia]], [[cerebral aneurysm]], [[cerebral arteriovenous malformation]], [[cerebrovascular disease]], [[myocardial infarction]], [[heart failure]], [[hypercalcemia]], [[hypertension]], [[hypercalcemia]], [[hypocalcemia]], [[hypokalemia]]
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"|[[1,2-Dichloroethene]], [[2-Ethylhexanol]], [[1,3-Dichloropropene]], [[abrin]], [[aconitine]], [[adamsite]], [[ammonium chloride]], [[amnesic shellfish poisoning]], [[arsenic Poisoning]], [[barium oxalate]], [[barium sulfate]], [[butanethiol]], [[camphor|camphor poisoning]], [[capsaicin]], [[carbon monoxide poisoning]], [[chloromethane]], [[cicuta]], [[ciguatera]], [[cinchonism]], [[coprinopsis atramentaria]], [[cyanogen]], [[daunorubicin]], [[diethyl ether]], [[digitalis purpurea]], [[dioxathion]], [[dioxin]], [[endosulfan]], [[ergotism]], [[fluoride poisoning]], [[fluoxymesterone]], [[ginkgo]], [[Green Tobacco Sickness|green tobacco sickness]], [[heavy metal ingestion]], [[Iodomethane]], [[Iron poisoning]], [[Iron(II) sulfate]], [[lead poisoning]], [[lenvatinib]], [[lewisite]], [[lindane]], [[lithium]], [[lobelia]], [[metal fume fever]], [[mushroom poisoning]], [[N-Ethyl-3-piperidyl benzilate]], [[nerve agent]], [[nicotine poisoning]], [[N-Nitroso-N-methylurea]], [[PFPP]], [[pesticide]], [[potassium bromide]], [[phytohaemagglutinin]], [[smoke inhalation]], [[snakebites]], [[temik]], [[theobromine]]
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"|[[Abscess]], [[decompression sickness]], [[exercise urticaria]]
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"|[[2C-E]], [[2C-I]], [[2C-T-7]], [[5-Hydroxytryptophan]], [[5-MeO-AMT]], [[ABVD]], [[acamprosate calcium]], [[acetaminophen]], [[acetoxyketobemidone]], [[acetylcysteine]], [[acetylsalicylic acid]],[[acyclovir]], [[aclarubicin]], [[actinomycin D]], [[alatrofloxacin Injection (patient information)|alatrofloxacin]], [[albuterol]], [[aldesleukin]], [[alemtuzumab]], [[allylprodine]], [[alpha-Methyltryptamine]], [[alprazolam]], [[altretamine]], [[amifostine]], [[amineptine]], [[aminocaproic acid]], [[aminoglutethimide]], [[aminopterin]], [[aminosalicylic acid]], [[amitriptyline (patient information)|amitriptyline]], [[amoxicillin]], [[amphotericin B]], [[amrinone]], [[amyl nitrite]], [[anadenanthera peregrina]], [[analgesic]], [[anastrozole]], [[anesthesia]], [[anticonvulsants]], [[antigout]], [[antihistamine]], [[antihypertensives]],[[antiretroviral drug]], [[apremilast]], [[apomorphine hydrochloride]], [[aprepitant]], [[aripiprazole]], [[armodafinil]], [[asparaginase (patient information)|asparaginase]], [[aspirin]], [[atomoxetine]], [[atosiban]], [[atropine]], [[auranofin]], [[axitinib]], [[azacitidine]], [[azathioprine]], [[azithromycin]], [[aztreonam]], [[barbiturate]], [[barium Sulfate]], [[basiliximab]], [[bCG vaccine]], [[Belladonna Alkaloid Combinations and Phenobarbital|belladonna alkaloid]] [[benzodiazepine]], [[benztropine]], [[benzphetamine]], [[benzylpiperazine]], [[betaine]], [[beta-lactam antibiotic]], [[Bevacizumab|bevacizumab]], [[beta blockers]], [[bezafibrate]], [[bicalutamide]], [[bleomycin]], [[blinatumomab]], [[botulinum antitoxin]], [[bortezomib]], [[bosutinib]], [[botulinum toxin]], [[bromelain]], [[bromocriptine]], [[bromomethane]], [[bronchodilator]], [[butalbital]], [[buprenorphine]], [[bupropion]], [[busulfan]], [[butanethiol]], [[butorphanol]], [[cabergoline]], [[calcitonin]], [[calcitriol]], [[calcium carbamide]], [[calcium channel antagonists]], [[capecitabine]], [[capsaicin]], [[carbamates]], [[Carbidopa and Levodopa|carbidopa and levodopa]], [[carboplatin]], [[carmustine]], [[carprofen]], [[carvedilol]], [[caspofungin]], [[cefaclor]], [[cefixime]], [[ceritinib]], [[cetrorelix]], [[cefoperazone Sodium Injection (patient information)|cefoperazone sodium]], [[cefotaxime sodium]], [[cefotetan disodium]], [[cefprozil]], [[ceftibuten]], [[cefuroxime]], [[ceftibuten]], [[ceftaroline fosamil]], [[cefuroxime]], [[cephalosporin]], [[cetuximab]], [[cetuximab injection ]], [[cevimeline]], [[chelation therapy]], [[chemotherapy]], [[chloral hydrate]], [[chlordiazepoxide]], [[chloromethane]], [[chlorothiazide]], [[chlorpropamide]], [[CHOP]], [[cimicifuga racemosa]], [[ciprofloxacin]], [[cisplatin]], [[citalopram]], [[cladribine]], [[clarithromycin]], [[clindamycin]], [[clofarabine]], [[clofibrate]], [[clomifene]], [[clorazepate]], [[clozapine]], [[cobicistat]], [[co-codamol]], [[codeine]], [[colchicine]], [[colestyramine]], [[combined oral contraceptive pill]], [[conjugated estrogens/bazedoxifene]], [[contraceptive patch]], [[crizotinib]], [[cyclobenzaprine]], [[cyclophosphamide]], [[cytisine]], [[cytarabine]], [[cytarabine liposome]], [[cytisine]],[[capsaicin]], [[dacarbazine ]], [[dactinomycin ]], [[dalfampridine]], [[danazol]], [[dantrolene]], [[daptomycin]], [[Darbepoetin Alfa Injection|darbepoetin alfa Injection ]], [[darunavir ]], [[daunorubicin ]], [[deferasirox ]], [[deferiprone]], [[defibrotide]], [[denileukin diftitox]], [[desmopressin]], [[dexamethasone]], [[dexchlorpheniramine]], [[dexrazoxane]], [[Dextroamphetamine and Amphetamine|dextroamphetamine and amphetamine]], [[dextromethorphan]], [[dextropropoxyphene]], [[diazepam]], [[diazinon]], [[dicofol]], [[didanosine]], [[diethyl ether]], [[diethylcathinone]], [[diflunisal]], [[digitoxin]], [[digoxin]], [[diethylcathinone]], [[diethyl ether]], [[dimercaprol]], [[dinoprostone]], [[dipyridamole]], [[disulfiram ]], [[diuretic]], [[docetaxel ]], [[dofetilide ]], [[dolasetron ]], [[donepezil ]], [[doripenem]], [[dosulepin hydrochloride]], [[doxorubicin hydrochloride]], [[doxycycline]], [[Drospirenone and Ethinyl estradiol|drospirenone and ethinyl estradiol]], [[DTPA]], [[duloxetine]], [[ecallantide]], [[eculizumab]], [[efavirenz]], [[elvitegravir]], [[enfuvirtide]], [[entecavir]], [[epinephrine (aerosol)]], [[ergometrine]], [[ergotamine]], [[eribulin]], [[erlotinib]], [[erythromycin]], [[estradiol valerate and estradiol valerate/dienogest]], [[eslicarbazepine acetate]], [[ethcathinone]], [[ethchlorvynol]], [[ethosuximide]], [[ethynodiol diacetate and ethinyl estradiol]], [[ethyl carbamate]], [[emetine]], [[emtricitabine]], [[Emtricitabine, Rilpivirine Hydrochloride, And Tenofovir Disoproxil Fumarate|rilpivirine hydrochloride, and tenofovir disoproxil fumarate]], [[endosulfan]], [[entacapone]], [[efavirenz]], [[enfuvirtide]], [[entecavir ]], [[elosulfase alfa]], [[epinephrine (aerosol)]], [[epirubicin hydrochloride]], [[epoetin Alfa ]], [[eribulin]], [[eliglustat]], [[erlotinib ]], [[erythromycin]], [[estradiol]], [[estrogen and Progestin (Oral Contraceptives) ]], [[ethcathinone]], [[ethchlorvynol]], [[ethyl carbamate]], [[ethylmorphine]], [[etidronate ]], [[etodolac]], [[etoposide]], [[exemestane]], [[exenatide]], [[felbamate]], [[fentanyl Oral Transmucosal ]][[fexofenadine]], [[filgrastim]], [[fioricet]], [[flavoxate]], [[fludarabine phosphate]], [[fluorouracil]], [[flurazepam]],[[Flurbiprofen]], [[floxuridine]], [[fluconazole]], [[flucytosine]], [[fludarabine Phosphate]], [[flunisolide]], [[fluorescein sodium]], [[fluorouracil ]], [[flurazepam]], [[flurbiprofen]], [[flutamide ]], [[Fluticasone]], [[foscarnet sodium]], [[fulvestrant]], [[galantamine]], [[gallium nitrate]], [[gabapentin]], [[gamma-Hydroxybutyric acid]], [[gatifloxacin ]], [[gefitinib ]], [[gemcitabine]], [[gemeprost]], [[general anaesthesia]], [[gestrinone]], [[glimepiride]], [[glipizide]], [[glucagon]], [[glucarpidase]], [[glycylcycline]], [[glycopyrrolate]], [[glyburide]], [[glyburide and Metformin]], [[glycylcycline]], [[goserelin ]], [[Graft-versus-host disease]], [[granisetron ]], [[grifulvin V]], [[guaifenesin]], [[H1 antihistamine]], [[herkinorin]], [[heroin]], [[hydralazine]], [[hydrochlorothiazide]], [[hydrocodone]], [[Hydrocodone bitartrate and Homatropine methylbromide|hydrocodone bitartrate and homatropine methylbromide]], [[hydrocortisone]], [[hydromorphone]], [[hydroxycarbamide]], [[hydroxychloroquine]], [[hydroxocobalamin]], [[hydroxyurea]], [[hydroxyzine]], [[hydroxyprogesterone caproate]], [[Ibogaine]], [[Ibuprofen]], [[Ibrutinib]], [[Ibritumomab tiuxetan]], [[Idarubicin ]], [[Idursulfase]], [[Ifosfamide ]], [[Imatinib ]], [[Imiglucerase]], [[Imipenem]], [[Indinavir]], [[Interferon gamma]], [[Interferon alfa-2b]], [[Iodomethane]], [[Irinotecan hydrochloride]], [[Isoniazid]], [[Isoproterenol (aerosol)]], [[Isopropyl alcohol]], [[Isosorbide mononitrate]], [[Isotretinoin]], [[Itraconazole]], [[Ivacaftor]], [[Ivermectin]], [[Ixabepilone]], [[kaopectate]], [[ketorolac]], [[lacosamide]], [[lactulose]], [[lamivudine]], [[lanreotide]], [[lansoprazole]], [[lanthanum carbonate]], [[lapatinib]], [[lenalidomide]], [[letrozole ]], [[leuprolide ]], [[Levodopa and Carbidopa|levodopa and carbidopa ]], [[levofloxacin]], [[levonorgestrel]], [[lidocaine (ointment)]], [[lithium nitrate]], [[lomefloxacin hydrochloride]], [[lorcaserin]], [[lopinavir]], [[loprazolam]], [[lorazepam]], [[lovaza]], [[malaria prophylaxis]], [[mazindol]], [[mechlorethamine ]], [[medazepam]], [[megestrol ]], [[melarsoprol]], [[melphalan ]], [[mercaptopurine]], [[meropenem]], [[mesalamine ]], [[mescaline]], [[mesna]], [[metformin]], [[methadone]], [[methenamine]], [[methotrexate]], [[methylergonovine]], [[methylketobemidone]], [[methylphenidate]], [[methyprylon]], [[metronidazole]], [[micafungin sodium]], [[mifepristone]], [[milk of magnesia]], [[milnacipran hydrochloride]], [[miltefosine]], [[mirtazapine]], [[misoprostol]], [[mitomycin ]], [[mitotane]], [[mitoxantrone]], [[moclobemide]], [[monocrotophos]], [[morphine]], [[motofen]], [[moxifloxacin]], [[mycophenolic acid]], [[nabilone]], [[nafcillin]], [[nalbuphine]], [[nalmefene]], [[naloxone]], [[naphthalene]], [[naproxen sodium]], [[natamycin]], [[niacin/simvastatin]], [[nicorandil]], [[nilotinib]], [[nilutamide]], [[nintedanib]], [[nitrazepam]], [[nitrofurantoin]], [[nizatidine]], [[Norethindrone acetate and Ethinyl estradiol|norethindrone acetate and ethinyl estradiol]], [[Norgestimate and Ethinyl estradiol|norgestimate and ethinyl estradiol]], [[Norgestrel and Ethinyl estradiol|norgestrel and ethinyl estradiol]], [[olanzapine ]], [[olsalazine]], [[omeprazole ]], [[ondansetron]], [[opioid]], [[oprelvekin]], [[oritavancin]], [[oseltamivir ]], [[oxaliplatin]], [[oxamniquine]], [[oxazepam]], [[oxcarbazepine]], [[oxybutynin ]], [[oxycodone and aspirin ]], [[oxytocin]], [[Paclitaxel]], [[palbociclib]], [[paliperidone ]], [[palonosetron]], [[panitumumab]], [[pantoprazole]], [[papaverine]], [[paromomycin sulfate]], [[pazopanib hydrochloride]], [[paracetamol]], [[paroxetine]], [[pasireotide]], [[pegaspargase ]], [[pemetrexed ]], [[penicillin]], [[pentamidine]], [[pentavalent antimonial]], [[pentetic acid]], [[pentostatin ]], [[pergolide ]], [[perhexiline]], [[pertuzumab]], [[pirfenidone]], [[piroxicam]], [[phenelzine]], [[phenoxymethylpenicillin]], [[phentermine]], [[phenylephrine]], [[physostigmine]], [[pholcodine]], [[pilocarpine]], [[pioglitazone ]], [[piribedil]], [[plerixafor]], [[plicamycin ]],[[posaconazole ]], [[potassium chloride]], [[potassium citrate]], [[praziquantel]], [[pregabalin ]], [[primaquine phosphate]], [[potassium iodide]], [[primaquine]][[procainamide ]], [[procarbazine ]], [[prochlorperazine]], [[progesterone]], [[propiram]], [[propylketobemidone]], [[prosidol]], [[protriptyline ]], [[pyrantel pamoate]][[pyrazinamide]], [[pyridostigmine]], [[quetiapine ]], [[quinupristin/dalfopristin]], [[radium chloride]], [[ramelteon]], [[ranolazine ]], [[ranitidine]], [[rasburicase]], [[rasagiline ]], [[reserpine]], [[ribavirin]], [[rifabutin]], [[rifaximin]], [[risedronate ]], [[ritonavir]], [[rituximab ]], [[rivastigmine ]], [[rizatriptan ]], [[ropinirole ]], [[roflumilast]], [[rotigotine]], [[roxithromycin]], [[rubbing alcohol]], [[salsalate ]], [[saquinavir mesylate]], [[sarin]], [[sargramostim]], [[stavudine]], [[sativex]], [[saxagliptin hydrochloride and Metformin hydrochloride]], [[secretin human]], [[secobarbital]], [[selegiline ]], [[seliciclib]], [[serotonin]], [[sibutramine]], [[sipuleucel-T]], [[sodium oxybate]], [[sodium polystyrene sulfonate]], [[sodium stibogluconate]], [[sodium sulfate, potassium sulfate and magnesium sulfate]], [[solanine]], [[spironolactone]], [[Stiripentol]], [[streptozocin]], [[streptomycin]], [[streptozocin]], [[sufentanil]], [[Sulfamethoxazole/Trimethoprim (oral)]], [[sultiame]], [[sumatriptan]], [[sunitinib ]], [[suramin]],[[tacrolimus]], [[tapentadol]], [[tedizolid]], [[telavancin hydrochloride]], [[telbivudine ]], [[telithromycin ]], [[taliglucerase alfa]][[temozolomide]], [[teniposide ]], [[teriparatide]], [[tetracaine]], [[tetraferric tricitrate decahydrate]], [[tetrahydrocannabinol]], [[tetrahydrozoline]], [[tetramethylsuccinonitrile]], [[tetrodotoxin]], [[thallous Chloride Tl 201]], [[thiabendazole]], [[thiethylperazine]], [[thioguanine]], [[thiotepa ]], [[Thyroid Medication|thyroid medication]], [[tigecycline]], [[tocopherol]], [[tolcapone ]], [[tolmetin]], [[topiramate]], [[tolbutamide]], [[topotecan Hydrochloride|topotecan hydrochloride]], [[toremifene]], [[tralomethrin]], [[tramadol]], [[trametinib dimethyl sulfoxide]], [[trandolapril]], [[trastuzumab]], [[trazodone]], [[tretinoin]], [[triamterene]], [[triazolam]], [[triclofos]], [[tricyclic antidepressant]], [[trifluoperazine]], [[trifluoromethylphenylpiperazine]], [[trimeperidine]], [[trimethobenzamide]], [[trimetrexate Glucuronate]], [[tropisetron]], [[trovafloxacin mesylate]], [[valaciclovir]], [[valganciclovir hydrochloride]], [[valproic acid ]], [[vancomycin]], [[varenicline]], [[venlafaxine]], [[vicodin]], [[vidarabine]], [[vigabatrin]], [[vilazodone]], [[viloxazine]], [[vinblastine ]], [[vinorelbine Tartrate]], [[vismodegib]], [[von Willebrand factor]], [[voriconazole]], [[vorinostat]], [[vortioxetine]], [[zafirlukast]], [[zidovudine]], [[zolpidem ]], [[zopiclone]], [[zoledronate]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"|[[Balance disorder]], [[decompression sickness]], [[ear infection]], [[epistaxis]], [[glaucoma]], [[labyrinthitis]], [[Ménière's disease]], [[pharyngitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"|[[Acromegaly]], [[addison's disease]], [[adrenal failure]], [[adrenal insufficiency]], [[amyloidosis]], [[anorexia nervosa]], [[carcinoid tumours and carcinoid syndrome]], [[contraceptive patch]], [[diabetic gastroparesis]], [[diabetic ketoacidosis]], [[diabetes mellitus]],[[emergency contraception]], [[gangrene]], [[gestational diabetes]], [[hormone replacement therapy (trans)]],[[hypocalcemia]], [[hypoglycemia]], [[hyperparathyroidism]], [[hyperthyroidism]], [[prolactinoma]], [[syndrome of inappropriate antidiuretic hormone]]([[SIADH]]), [[thyrotoxicosis]], [[Estrogen and Progestin (Hormone Replacement Therapy) (patient information)|estrogen and progestin]], [[multiple endocrine neoplasia type 1]]
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"|[[Bothrops|Bothrops bite]], [[bromomethane]], [[carbon monoxide poisoning]], [[dioxin]], [[heat stroke]], [[hyperthermia]]
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"|[[Achalasia]], [[acute abdomen]], [[accessory pancreas]] , [[acute fatty liver of pregnancy]], [[acute pancreatitis]], [[adjustable gastric band]], [[afferent loop syndrome]], [[alcoholic Hepatitis]], [[alcoholism]], [[anastomosis]] [[stenosis]], [[ anorexia nervosa]], [[appendicitis]], [[bacterial gastroenteritis]], [[beef tapeworm]], [[biliary colic]], [[blastocystosis]], [[bowel obstruction]], [[brucella]], [[bulimia nervosa]], [[caecitis]], [[carcinoid tumours and carcinoid syndrome]], [[chronic intestinal pseudo-obstruction]], [[cholecystitis]], [[cholecystolithiasis]], [[ciguatera]], [[colorectal cancer]], [[congenital hypertrophic pyloric stenosis]], [[Crohn's disease]], [[cryptosporidium parvum]], [[cyclic vomiting syndrome]], [[cyclospora cayetanensis]], [[diabetic gastroparesis]], [[dientamoebiasis]], [[diverticulitis]], [[dumping syndrome]], [[enteric Neuropathy]], [[eosinophilic esophagitis]], [[eosinophilic gastroenteritis]], [[epiploic appendagitis]], [[esophageal achalasia]], [[esophageal cancer]], [[esophageal diverticulum]], [[esophageal stenosis]], [[esophagitis]], [[femoral hernia]], [[food allergies]], [[food poisoning]], [[fundic gland polyposis]], [[functional dyspepsia]], [[gastric carcinoma]], [[gastric outlet obstruction]], [[gastritis]], [[gastrocolic fistula]], [[gastroenteritis]], [[gastroesophageal reflux disease]], [[gastrointestinal perforation]], [[gastroparesis]], [[giardiasis]], [[helicobacter pylori infection]], [[Hellp syndrome]], [[hematemesis]], [[hepatic coma]], [[hepatic porphyria]], [[hepatitis]], [[hepatitis A]], [[hepatitis B]], [[hepatitis D]], [[hepatitis E]], [[hepatobiliary disease]], [[hepatotoxicity ]], [[hernia]], [[hirschsprung disease]], [[Ileus]], [[Intussusception (medical disorder)]], [[Irritable bowel syndrome]], [[Ischemic bowel]], [[Mesenteric ischemia]], [[peptic ulcer]], [[peritonitis]], [[pyloric stenosis]], [[Reye's syndrome]], [[Small bowel bacterial overgrowth syndrome]], [[Small intestine cancer]], [[traveler's diarrhea]]
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"|[[Acute intermittent porphyria]], [[congenital malformation]], [[Down syndrome]], [[episodic ataxia]], [[familial hemiplegic migraine]], [[fundic gland polyposis]], [[galactosemia]], [[hereditary fructose intolerance]], [[slone's disease]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"|[[HELLP syndrome]], [[hemorrhage]], [[mastocytosis]], [[porphyria]], [[splenic infarction]], [[thrombotic thrombocytopenic purpura]]
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"|[[Essure]], [[dumping syndrome]], [[high doses of ionizing radiation]], [[Instillation abortion]], [[Minimally Invasive Thorasic Spinal Fusion|minimally Invasive thorasic spinal fusion]]
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"|[[Infections|Acute infections]], [[acute viral nasopharyngitis (common cold)]], [[AIDS]], [[aseptic meningitis]], [[astrovirus]], [[bacillus cereus|bacillus cereus infection]], [[bacterial gastroenteritis]], [[Barcoo Fever|barcoo fever]], [[beef tapeworm]], [[blastocystosis]], [[brucella]], [[colorado tick fever]], [[community-acquired pneumonia]], [[croup]], [[cryptosporidium parvum|cryptosporidium parvum infection]], [[cyclospora cayetanensis|cyclospora cayetanensis infection]], [[dengue fever]], [[diarrheal shellfish poisoning]], [[dientamoebiasis]], [[diphtheria]], [[Duke's disease]], [[ebola]], [[giardia lamblia]], [[Hantavirus pulmonary syndrome]], [[helicobacter pylori infection]], [[henipavirus]], [[hepatitis B]], [[hepatitis D]], [[hepatitis E]], [[hookworm]], [[human ehrlichiosis]], [[Influenza]], [[Intestinal parasite]], [[lassa fever]], [[listeria monocytogenes]], [[malaria]], [[meningococcemia]], [[Naegleria fowleri]], [[norovirus]], [[norwalk Virus]], [[pfiesteria piscicida]], [[poliomyelitis]], [[Q fever]], [[Rocky Mountain spotted fever]], [[Scarlet fever]], [[shigella]], [[Sporotrichosis]], [[staphylococcal enteritis]], [[tularemia]], [[vibrio parahaemolyticus]], [[West Nile virus]], [[waterborne diseases]], [[Yellow fever]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"|[[Decompression sickness]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"|[[Acoustic neuroma]], [[airsickness]], [[altitude sickness]], [[arachnoid cyst]], [[Aseptic meningitis|aseptic meningitis]], [[autonomic neuropathy]], [[balance disorder]], [[benign intracranial hypertension]] ,[[Brain Stem Gliomas|brain stem gliomas]], [[brain tumor]], [[stroke|cerebellar stroke]], [[cerebral aneurysm]], [[cerebral arteriovenous malformation]], [[cerebral hemorrhage]], [[cerebrovascular disease]], [[cerebral oedema]],[[cerebral shunt ]], [[cerebrovascular disease]], [[ciguatera]], [[concussion]], [[craniopharyngioma]], [[cyclic vomiting syndrome]], [[decompression sickness]], [[encephalitis]], [[enteric Neuropathy|enteric neuropathy]], [[ependymoma]], [[epidural haemorrhage]], [[episodic ataxia]], [[familial hemiplegic migraine]], [[glioblastoma multiforme]], [[glioma]], [[heavy metal ingestion]], [[hemicrania continua]], [[hepatic coma]], [[hydrocephalus]], [[La Crosse encephalitis]], [[Sea sickness]], [[subdural hematoma]], [[Tabes dorsalis]], [[vagal episode]], [[vertebrobasilar insufficiency]], [[vestibular neuritis]]
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"|[[5-hydroxytryptophan]], [[acute intermittent porphyria]], [[amnesic shellfish poisoning]], [[amyloidosis]], [[bromelain]], [[cicuta]], [[cimicifuga racemosa]],[[coprinopsis atramentaria]], [[food allergies]], [[food intolerance]], [[food poisoning]], [[galactosemia]], [[ginger]], [[hereditary fructose intolerance]], [[hypercalcemia]], [[hypermagnesemia]], [[hypervitaminosis A]], [[hypervitaminosis]], [[hypocalcemia]], [[hypocholermia]], [[hypoglycemia]], [[hypokalemia]], [[hyponatremia]], [[ketogenic diet]], [[lactose intolerance]], [[metabolic acidosis]], [[pyridoxine deficiency]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"|[[Acute fatty liver of pregnancy]], [[breastfeeding complications]], [[childbirth]], [[contraceptive patch]], [[endometriosis]], [[emergency contraception]],[[Estrogen and Progestin (Oral Contraceptives)|estrogen and progestin]], [[essure]], [[gestational diabetes]], [[HELLP syndrome]], [[hydatidiform mole]], [[hyperemesis gravidarum]], [[ovarian cyst]], [[ovarian hyperstimulation syndrome]], [[ovarian torsion]], [[pregnancy]], [[salpingitis]], [[twisted ovarian cyst]]
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"|[[Acoustic neuroma]], [[Brain Stem Gliomas|brain stem gliomas]], [[brain tumor]], [[cancer]], [[carcinoid tumours and carcinoid syndrome]], [[colorectal cancer]][[craniopharyngioma]], [[ependymoma]], [[esophageal cancer]], [[gastric carcinoma]], [[glioblastoma multiforme]], [[glioma]], [[Kaposi's sarcoma]], [[Non-Hodgkin lymphoma]], [[osteosarcoma]], [[prolactinoma]], [[Zollinger-Ellison Syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"|[[Acute angle-closure glaucoma]], [[glaucoma]], [[refractive error]]
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| [[1,2-Dichloroethene]], [[1,3-Dichloropropene]], [[2C-E]], [[2C-I]], [[2C-T-7]], [[abrin]], [[alcoholism]], [[alcohol withdrawal]], [[beleric]], [[cinchonism]], [[ethanol abuse]], [[hangover]], [[heavy metal ingestion]], [[heroin]], [[orellanine]], [[Reye's syndrome]], [[marine toxins]], [[PMA]]
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"|[[Alcohol Withdrawal]], [[alcoholism]], [[anorexia nervosa]], [[anxiety]], [[anxiety disorders]], [[bulimia nervosa]], [[chronic fatigue syndrome]], [[combat stress reaction]], [[depression]], [[ethanol abuse]], [[hangover]], [[sexual fetish]] ([[emetophilia]]), [[SSRI discontinuation syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"|[[Acute viral nasopharyngitis (common cold)]], [[altitude sickness]], [[anaphylaxis]], [[aortic arch anomalies]], [[community acquired pneumonia]], [[croup]], [[decompression sickness]], [[Hantavirus pulmonary syndrome]], [[lower respiratory tract infection]], [[pulmonary embolism]], [[ pharyngitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"|[[Dehydration]], [[diabetic ketoacidosis]], [[hypercalcemia]], [[hypermagnesemia]], [[hypocalcemia]], [[hypocholermia]], [[hypokalemia]], [[hyponatraemia]], [[Interstitial nephritis]], [[nutcracker syndrome]], [[pyelonephritis]], [[renal colic]], [[renal failure]], [[renal stones]], [[ urinary tract infections]]
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"|[[Amyloidosis]], [[anaphylaxis]], [[chronic fatigue syndrome]], [[Crohn's disease]], [[food allergies]], [[food intolerance]], [[Graft-versus-host disease]], [[scleroderma]], [[Tetanus, Diphtheria, and Pertussis (Tdap) Vaccine|tetanus, diphtheria, and pertussis (Tdap) vaccine]], [[typhoid Vaccine]], [[HIV]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"|[[HIV]]
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"|[[Head trauma]], [[hemorrhage]], [[post-concussion syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"|[[Acute prostatitis]], [[testicular rupture]], [[testicular torsion]], [[urinary tract infections]], [[urolithiasis]]
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"|[[Anadenanthera peregrina]], [[exercise induced nausea]], [[extreme pain]], [[foreign bodies]], [[sleep deprivation]], [[soapwort]], [[ulcers]], [[water intoxication]], [[cyclic vomiting syndrome]], [[DTPA]], [[ginkgo]]
|-
|}

===Causes in Alphabetical Order===
{{columns-list|4|
* [[1,2-Dichloroethene]]
* [[1,3-Dichloropropene]]
* [[2C-E]]
* [[2C-I]]
* [[2C-T-7]]
* [[2-Ethylhexanol]]
* [[5-Hydroxytryptophan]]
* [[5-MeO-AMT]]
* [[Abrin]]
* [[Abscess]]
* [[ABVD]]
* [[Acamprosate calcium]]
* [[Accessory pancreas]]
* [[Acetaminophen]]
* [[Acetoxyketobemidone]]
* [[Acetylcysteine]]
* [[Achalasia]]
* [[Aclarubicin]]
* [[Acyclovir]]
* [[Aconitine]]
* [[Acoustic neuroma]]
* [[Acromegaly]]
* [[Actinomycin|Actinomycin D]]
* [[Acute angle-closure glaucoma]]
* [[Acute coronary syndromes]]
* [[Acute fatty liver of pregnancy]]
* [[Acute intermittent porphyria]]
* [[Acute pancreatitis]]
* [[Acute prostatitis]]
* [[Acute viral nasopharyngitis (common cold)]]
* [[Adamsite]]
* [[Adenovirus]]
* [[Addison's Disease]]
* [[Adjustable gastric band]]
* [[Adrenal insufficiency]]
* [[Afferent loop syndrome]]
* [[Airsickness]]
* [[Alatrofloxacin Injection]]
* [[Albuterol Inhalation]]
* [[Alcohol withdrawal]]
* [[Alcoholism]]
* [[Aldesleukin]]
* [[Alemtuzumab]]
* [[Allylprodine]]
* [[Alpha-Methyltryptamine]]
* [[Alprazolam]]
* [[Altitude sickness]]
* [[Altretamine]]
* [[Amantadine]]
* [[Amifostine]]
* [[Amineptine]]
* [[Aminocaproic acid]]
* [[Aminophylline]]
* [[Aminopterin]]
* [[Aminosalicylic acid]]
* [[Amitriptyline]]
* [[Ammonium chloride]]
* [[Amnesic shellfish poisoning]]
* [[Amoxicillin]]
* [[Amphotericin B]]
* [[Amrinone]]
* [[Amyl nitrite]]
* [[Amyloidosis]]
* [[Anadenanthera peregrina]]
* [[Anaphylaxis]]
* [[Anastrozole]]
* [[Anesthesia]]
* [[Angina pectoris]]
* [[Anorexia nervosa]]
* [[Antiarrhythmics]]
* [[Antibiotics]]
* [[Anticonvulsants]]
* [[Antihistamine]]
* [[Antihypertensives]]
* [[Antiretroviral drug]]
* [[Anxiety]]
* [[Aortic arch anomalies]]
* [[Apomorphine hydrochloride]]
* [[Appendicitis]]
* [[Aprepitant]]
* [[Arachnoid cyst]]
* [[Aripiprazole]]
* [[Arsenicals]]
* [[Arsenic Poisoning]]
* [[Arsenic trioxide]]
* [[Ascariasis]]
* [[Aseptic meningitis]]
* [[Asparaginase]]
* [[Aspirin]]
* [[Astrovirus]]
* [[Atomoxetine]]
* [[Atosiban]]
* [[Atripala]] ([[Efavirenz, emtricitabine and tenofovir disoproxil fumarate]])
* [[Auranofin]]
* [[Autonomic neuropathy]]
* [[Azathioprine]]
* [[Azithromycin]]
* [[Aztreonam]]
* [[Bacillus cereus]]
* [[Bacterial gastroenteritis]]
* [[Balance disorder]]
* [[Barbiturate]]
* [[Barcoo Fever|Barcoo fever]]
* [[Barium oxalate]]
* [[Barium sulfate]]
* [[BCG vaccine]]
* [[Beef tapeworm]]
* [[Beleric]]
* [[Belladonna Alkaloid Combinations and Phenobarbital|Belladonna alkaloid combinations]]
* [[Benign intracranial hypertension]]
* [[Benzodiazepine]]
* [[Benzylpiperazine]]
* [[Beta blockers]]
* [[Beta-lactam antibiotic]]
* [[Bevacizumab Injection (patient information)|Bevacizumab Injection]]
* [[Bezafibrate]]
* [[Bicalutamide]]
* [[Biliary colic]]
* [[Blastocystosis]]
* [[Bleomycin ]]
* [[Bortezomib]]
* [[Botulinum toxin]]
* [[Bowel obstruction]]
* [[Brain Stem Gliomas|Brain stem gliomas]]
* [[Brain tumor]]
* [[Breastfeeding complications]]
* [[Bromelain]]
* [[Bromomethane]]
* [[Bronchodilator]]
* [[Brucella]]
* [[Buprenorphine Hydrochloride, Naloxone Hydrochloride|Buprenorphine,naloxone]]
* [[Bulimia nervosa]]
* [[Buprenorphine]]
* [[Bupropion]]
* [[Busulfan]]
* [[Butanethiol]]
* [[Butorphanol]]
* [[Cabergoline]]
* [[Caecitis]]
* [[Calcitonin]]
* [[Calcitriol]]
* [[Calcium carbamide]]
* [[Calcium channel antagonists]]
* [[Camphor|Camphor poisoning]]
* [[Cancer]]
* [[Capecitabine]]
* [[Capsaicin]]
* [[Carbon monoxide poisoning]]
* [[Carboplatin]]
* [[Carcinoid tumours and carcinoid syndrome]]
* [[Cardiac arrhythmia]]
* [[Carmustine]]
* [[Carprofen]]
* [[Carvedilol]]
* [[Caspofungin]]
* [[Cefaclor]]
* [[Cefixime]]
* [[Cefoperazone Sodium Injection (patient information)|Cefoperazone Sodium Injection]]
* [[Cefotetan disodium]]
* [[Cefprozil]]
* [[Ceftaroline fosamil]]
* [[Ceftibuten]]
* [[Cefuroxime]]
* [[Cephalosporin]]
* [[Cerebral aneurysm]]
* [[Cerebral arteriovenous malformation]]
* [[Cerebral edema]]
* [[Cerebral hemorrhage]]
* [[Cerebral shunt]]
* [[Cerebrovascular disease]]
* [[Cetuximab Injection]]
* [[Cevimeline]]
* [[Chelation therapy]]
* [[Chemotherapy]]
* [[Childbirth]]
* [[Chloral hydrate]]
* [[Chlordiazepoxide]]
* [[Chloromethane]]
* [[Chlorothiazide]]
* [[Chlorpropamide]]
* [[Cholecystitis]]
* [[Cholecystolithiasis]]
* [[CHOP]]
* [[Chronic fatigue syndrome]]
* [[Chronic intestinal pseudo-obstruction]]
* [[Cicuta]]
* [[Ciguatera]]
* [[Cimicifuga racemosa]]
* [[Cinchonism]]
* [[Ciprofloxacin]]
* [[Cisplatin]]
* [[Citalopram]]
* [[Cladribine]]
* [[Clarithromycin]]
* [[Clindamycin]]
* [[Clofarabine]]
* [[Clofibrate]]
* [[Clomifene]]
* [[Clorazepate]]
* [[Clostridium perfringens]]
* [[Cobicistat]]
* [[Co-codamol]]
* [[Codeine]]
* [[Colchicine]]
* [[Colestyramine]]
* [[Colorado tick fever]]
* [[Colorectal cancer]]
* [[Combat stress reaction]]
* [[Community-acquired pneumonia]]
* [[Concussion]]
* [[Congenital hypertrophic pyloric stenosis]]
* [[Congenital malformation]]
* [[Contraceptive patch]]
* [[Copper|Copper salts]]
* [[Coprinopsis atramentaria]]
* [[Craniopharyngioma]]
* [[Crohn's disease]]
* [[Croup]]
* [[Cryptosporidium parvum]]
* [[Cyanogen]]
* [[Cyclic vomiting syndrome]]
* [[Cyclobenzaprine]]
* [[Cyclophosphamide]]
* [[Cyclospora cayetanensis]]
* [[Cytarabine]]
* [[Cytisine]]
* [[Dacarbazine]]
* [[Dactinomycin]]
* [[Danazol]]
* [[Dantrolene]]
* [[Daptomycin]]
* [[Darbepoetin Alfa Injection (patient information)|Darbepoetin Alfa Injection]]
* [[Darunavir]]
* [[Daunorubicin]]
* [[Decompression sickness]]
* [[Deferasirox]]
* [[Deferiprone]]
* [[Defibrotide]]
* [[Dehydration]]
* [[Dengue fever]]
* [[Depression]]
* [[Desmopressin]]
* [[Dexamethasone]]
* [[Dextroamphetamine and Amphetamine (patient information)|Dextroamphetamine and Amphetamine]]
* [[Dextromethorphan]]
* [[Dextropropoxyphene]]
* [[Diabetes mellitus]]
* [[Diabetic gastroparesis]]
* [[Diabetic Ketoacidosis]]
* [[Diarrheal shellfish poisoning]]
* [[Diazepam]]
* [[Diazinon]]
* [[Dicofol]]
* [[Didanosine]]
* [[Dientamoebiasis]]
* [[Diethyl ether]]
* [[Diethylcathinone]]
* [[Diflunisal]]
* [[Digitalis purpurea]]
* [[Digitoxin]]
* [[Digoxin]]
* [[Dioxathion]]
* [[Dioxin]]
* [[Diphtheria]]
* [[Disulfiram]]
* [[Diuretic]]
* [[Diverticulitis]]
* [[Docetaxel]]
* [[Dofetilide]]
* [[Dolasetron]]
* [[Donepezil]]
* [[Doripenem]]
* [[Dosulepin hydrochloride]]
* [[Down syndrome]]
* [[Doxorubicin Hydrochloride]]
* [[DTPA]]
* [[Duke's disease]]
* [[Duloxetine]]
* [[Dumping syndrome]]
* [[Ear infection]]
* [[Ebola virus disease]]
* [[Eculizumab]]
* [[Efavirenz]]
* [[Elvitegravir]]
* [[Emergency contraception]]
* [[Emetine]]
* [[Encephalitis]]
* [[Endometriosis]]
* [[Endosulfan]]
* [[Enfuvirtide]]
* [[Entecavir]]
* [[Enteric Neuropathy]]
* [[Enterobiasis]]
* [[Eosinophilic gastroenteritis]]
* [[Epidural haemorrhage]]
* [[Ependymoma]]
* [[Epiploic appendagitis]]
* [[Epirubicin hydrochloride]]
* [[Episodic ataxia]]
* [[Epistaxis]]
* [[Epoetin Alfa Injection (patient information)|Epoetin Alfa Injection]]
* [[Ergotamine]]
* [[Ergotism]]
* [[Eribulin]]
* [[Erlotinib]]
* [[Erythromycin]]
* [[Esophageal achalasia]]
* [[Esophageal cancer]]
* [[Esophageal diverticulum]]
* [[Esophageal stenosis]]
* [[Esophagitis]]
* [[Essure]]
* [[Estradiol]]
* [[Estrogen and Progestin (Oral Contraceptives) (patient information)|Estrogen and Progestin ]]
* [[Ethanol abuse]]
* [[Ethcathinone]]
* [[Ethchlorvynol]]
* [[Ethosuximide]]
* [[Ethyl carbamate]]
* [[Ethylmorphine]]
* [[Etidronate]]
* [[Etoposide]]
* [[Exemestane]]
* [[Exenatide]]
* [[Exercise induced nausea]]
* [[Exercise urticaria]]
* [[Extreme pain]]
* [[Familial hemiplegic migraine]]
* [[Felbamate]]
* [[Femoral hernia]]
* [[Fentanyl Oral Transmucosal (patient information)|Fentanyl Oral Transmucosal]]
* [[Fexofenadine]]
* [[Filgrastim]]
* [[Fioricet]]
* [[Fluorouracil]]
* [[Floxuridine]]
* [[Flu]]
* [[Fluconazole]]
* [[Flucytosine]]
* [[Fludarabine Phosphate]]
* [[Flunisolide]]
* [[Fluorescein sodium]]
* [[Fluoride poisoning]]
* [[Fluorouracil]]
* [[Flurazepam]]
* [[Flurbiprofen]]
* [[Flutamide]]
* [[Fluticasone]]
* [[Food allergies]]
* [[Food intolerance]]
* [[Food poisoning]]
* [[Foreign bodies]]
* [[Fructose intolerance]] [[hypoglycemia]]
* [[Fulvestrant Injection (patient information)|Fulvestrant Injection]]
* [[Functional dyspepsia]]
* [[Fundic gland polyposis]]
* [[Gabapentin]]
* [[Galactosemia]]
* [[Galantamine]]
* [[Gamma-Hydroxybutyric acid]]
* [[Gangrene]]
* [[Gastric carcinoma]]
* [[Gastric outlet obstruction]]
* [[Gastritis]]
* [[Gastrocolic fistula]]
* [[Gastroenteritis]]
* [[Gastroesophageal reflux disease]]
* [[Gastrointestinal perforation]]
* [[Gastroparesis]]
* [[Gatifloxacin]]
* [[Gefitinib]]
* [[Gemcitabine Hydrochloride (patient information)|Gemcitabine hydrochloride]]
* [[Gemeprost]]
* [[Gestational diabetes]]
* [[Gestrinone]]
* [[Giardia lamblia]]
* [[Giardiasis]]
* [[Ginger]]
* [[Ginkgo]]
* [[Glaucoma]]
* [[Glioblastoma multiforme]]
* [[Glioma]]
* [[Glucagon]]
* [[Glycylcycline]]
* [[Goserelin]]
* [[Graft-versus-host disease]]
* [[Granisetron]]
* [[Green Tobacco Sickness|Green tobacco sickness]]
* [[Grifulvin V]]
* [[Griseofulvin]]
* [[Guaifenesin]]
* [[Hangover]]
* [[Hantavirus pulmonary syndrome]]
* [[Head trauma]]
* [[Heart failure]]
* [[Heat stroke]]
* [[Heavy metal ingestion]]
* [[Helicobacter pylori infection]]
* [[HELLP syndrome]]
* [[Hematemesis]]
* [[Hemicrania continua]]
* [[Hemorrhage]]
* [[Henipavirus]]
* [[Hepatic coma]]
* [[Hepatic porphyria]]
* [[Hepatitis]]
* [[Hepatitis B]]
* [[Hepatitis D]]
* [[Hepatitis E]]
* [[Hepatobiliary disease]]
* [[Hereditary fructose intolerance]]
* [[Herkinorin]]
* [[Hernia]]
* [[Heroin]]
* [[Hirschsprung disease]]
* [[HIV]]
* [[Hookworm]]
* [[Hormone replacement therapy (trans)]]
* [[Human ehrlichiosis]]
* [[Hydralazine]]
* [[Hydrocephalus]]
* [[Hydrochlorothiazide]]
* [[Hydrocodone]]
* [[Hydromorphone]]
* [[Hydroxychloroquine]]
* [[Hydroxocobalamin]]
* [[Hydroxyurea]]
* [[Hydroxyzine]]
* [[Hypercalcemia]]
* [[Hyperemesis gravidarum]]
* [[Hypermagnesemia]]
* [[Hyperparathyroidism]]
* [[Hypertension]]
* [[Hyperthermia]]
* [[Hyperthyroidism]]
* [[Hypervitaminosis A]]
* [[Hypocalcemia]]
* [[Hypocholermia]]
* [[Hypoglycemia]]
* [[Hypokalemia]]
* [[Hyponatremia]]
* [[Hypoparathyroidism]]
* [[Hysterical contagion]]
* [[Iatrogenesis]]
* [[Ibogaine]]
* [[Ibuprofen]]
* [[Idarubicin]]
* [[Idiopathic]]
* [[Ifosfamide]]
* [[Ileus]]
* [[Imatinib]]
* [[Imipenem]]
* [[Inappetence]]
* [[Inborn errors of metabolism]]
* [[Incarcerated hernia]]
* [[Indinavir]]
* [[Indometacin]]
* [[Infarction]]
* [[Inflammatory bowel disease]]
* [[Infliximab]]
* [[Influenza]]
* [[Inguinal hernia]]
* [[Instillation abortion]]
* [[Insulin lispro]]
* [[Interferon gamma]]
* [[Interstitial nephritis]]
* [[Intracranial mass]]
* [[Intestinal atresia]]
* [[Intestinal parasite]]
* [[Intestinal volvulus]]
* [[Intracranial haemorrhage]]
* [[Intracranial hypertension]]
* [[Intussusception]]
* [[Ipecacuanha]]
* [[Iodomethane]]
* [[Irinotecan hydrochloride]]
* [[Iron(II) sulfate]]
* [[Irritable bowel syndrome]]
* [[Irukandji syndrome]]
* [[Ischemic bowel]]
* [[Isoniazid]]
* [[Isopropyl alcohol]]
* [[Isosorbide mononitrate]]
* [[Isotretinoin]]
* [[Itraconazole]]
* [[Ivacaftor]]
* [[Ixabepilone]]
* [[Jamaican vomiting sickness]]
* [[Janumet]] ([[sitagliptin]] and [[metformin]])
* [[Kaopectate]]
* [[Kaposi's sarcoma]]
* [[Ketoconazole]]
* [[Ketogenic diet]]
* [[Ketorolac]]
* [[Ketotic hypoglycemia]]
* [[La Crosse encephalitis]]
* [[Labyrinthitis]]
* [[Lactose intolerance]]
* [[Lanreotide]]
* [[Lansoprazole]]
* [[Large bowel obstruction]]
* [[Lassa fever]]
* [[Lead poisoning]]
* [[Letrozole]]
* [[Leuprolide]]
* [[Levodopa and Carbidopa]]
* [[Levofloxacin]]
* [[Levonorgestrel]]
* [[Lewisite]]
* [[Lindane]]
* [[Listeria monocytogenes]]
* [[Lithium]]
* [[Lithium nitrate]]
* [[Lobelia]]
* [[Lomefloxacin hydrochloride]]
* [[Lomotil]]
* [[Lopinavir]]
* [[Loprazolam]]
* [[Lorazepam]]
* [[Lower respiratory tract infection]]
* [[Lubiprostone]]
* [[Lysuride]]
* [[Malaria]]
* [[Malaria prophylaxis]]
* [[Malignancy]]
* [[Intestinal malrotation|Malrotation]]
* [[Marine toxins]]
* [[Mass effect (medicine)|Mass lesion]]
* [[Mastocytosis]]
* [[Mazindol]]
* [[Mechlorethamine]]
* [[Medazepam]]
* [[Medical cannabis]]
* [[Megestrol]]
* [[Melarsoprol]]
* [[Melphalan]]
* [[Ménière's disease]]
* [[Meningitis]]
* [[Meningococcemia]]
* [[Meningoencephalitis]]
* [[Mercaptopurine]]
* [[Mesoamerican nephropathy]]
* [[Meropenem]]
* [[Mesalamine]]
* [[Mescaline]]
* [[Mesenteric infarction]]
* [[Mesna]]
* [[Metabolic acidosis]]
* [[Metal fume fever]]
* [[Metformin]]
* [[Methadone]]
* [[Methotrexate]]
* [[Methylergonovine]]
* [[Methylketobemidone]]
* [[Methylphenidate]]
* [[Methyprylon]]
* [[Metronidazole]]
* [[Micafungin sodium]]
* [[Mifepristone]]
* [[Migraine]]
* [[Milk of Magnesia]]
* [[Milnacipran hydrochloride]]
* [[Miltefosine]]
* [[Minimally Invasive Thorasic Spinal Fusion]]
* [[Mirtazapine]]
* [[Misoprostol]]
* [[Mitomycin]]
* [[Mitotane]]
* [[Mitoxantrone]]
* [[Moclobemide]]
* [[Monocrotophos]]
* [[Mood stabilizer]]
* [[MOPP (medicine)|MOPP]]
* [[Morning sickness]]
* [[Morphine]]
* [[Motion sickness]]
* [[Motofen]]
* [[Moxifloxacin]]
* [[Multiple chemical sensitivity]]
* [[Multiple endocrine neoplasia type 1]]
* [[Munchausen syndrome by proxy]]
* [[Murray Valley encephalitis virus]]
* [[Mushroom poisoning]]
* [[Mycophenolic acid]]
* [[Mycoplasma pneumoniae]]
* [[Myocardial infarction]]
* [[Nabilone]]
* [[Naegleria fowleri]]
* [[Nafcillin]]
* [[Nalbuphine]]
* [[Nalidixic acid]]
* [[Nalmefene]]
* [[Naloxone]]
* [[Naphthalene]]
* [[Naproxen sodium]]
* [[Narcotics]]
* [[Natamycin]]
* [[Necrotizing enterocolitis]]
* [[Nerve agent]]
* [[Nervousness]]
* [[N-Ethyl-3-piperidyl benzilate]]
* [[Nicorandil]]
* [[Nicotine poisoning]]
* [[Nilutamide]]
* [[Nintedanib]]
* [[Nitrazepam]]
* [[Nitrogen mustard]]
* [[N-Nitroso-N-Methylurea]]
* [[Non-Hodgkin lymphoma]]
* [[Non steroidal anti-inflammatory drugs]]
* [[Nootropic]]
* [[Norfloxacin]]
* [[Norgestimate and Ethinyl estradiol]]
* [[Norgestrel and Ethinyl estradiol]]
* [[Norovirus]]
* [[Norplant]]
* [[Nortriptyline]]
* [[Norwalk Virus]]
* [[Nutcracker syndrome]]
* [[Nystatin]]
* [[Obidoxime]]
* [[Obstructive uropathy]]
* [[Obturator hernia]]
* [[Oesophageal cancer]]
* [[Ofloxacin]]
* [[Olanzapine]]
* [[Omeprazole]]
* [[Ondansetron]]
* [[Opioid]]
* [[Oprelvekin]]
* [[Oral contraceptives]]
* [[Orellanine]]
* [[Organic acidemia]]
* [[Organophosphates]]
* [[Oritavancin]]
* [[Oseltamivir]]
* [[Osteosarcoma]]
* [[Otitis interna]]
* [[Otitis media]]
* [[Ovarian cancer]]
* [[Ovarian cyst]]
* [[Ovarian hyperstimulation syndrome]]
* [[Ovarian torsion]]
* [[Oxaliplatin]]
* [[Oxamniquine]]
* [[Oxazepam]]
* [[Oxcarbazepine]]
* [[Oxybutynin]]
* [[Oxycodone and aspirin]]
* [[Paclitaxel]]
* [[Pain]]
* [[Palbociclib]]
* [[Pancreatic adenocarcinoma]]
* [[Pancreatitis]]
* [[Panitumumab]]
* [[Pantoprazole]]
* [[Palbociclib]]
* [[Paliperidone]]
* [[Palonosetron]]
* [[Panic attack]]
* [[Paralytic ileus]]
* [[Paraneoplastic syndrome]]
* [[Paraquat]]
* [[Paroxetine]]
* [[Pegaspargase]]
* [[Pemetrexed injection]]
* [[Penicillin]]
* [[Pentamidine]]
* [[Pentavalent antimonial]]
* [[Pentetic acid]]
* [[Pentostatin]]
* [[Peptic ulcer]]
* [[Pergolide]]
* [[Perhexiline]]
* [[Peritonitis]]
* [[Pesticide]]
* [[Pethidine]]
* [[Pfiesteria piscicida]]
* [[PFPP]]
* [[Pharyngeal pouch]]
* [[Pharyngitis]]
* [[Phenelzine]]
* [[Phenoxymethylpenicillin]]
* [[Phentermine]]
* [[Phentolamine]]
* [[Pholcodine]]
* [[Physostigmine]]
* [[Phytohaemagglutinin]]
* [[Pioglitazone]]
* [[Pirfenidone]]
* [[Piribedil]]
* [[Plerixafor]]
* [[Plicamycin]]
* [[Piroxicam]]
* [[PMA]]
* [[Pneumonia]]
* [[Polio]]
* [[Poliomyelitis]]
* [[Porphyria]]
* [[Posaconazole]]
* [[Post-concussion syndrome]]
* [[Post-exposure prophylaxis]]
* [[Ileus|Postoperative ileus]]
* [[Postoperative nausea and vomiting]]
* [[Pain|Postoperative pain]]
* [[Potassium bromide]]
* [[Potassium chloride]]
* [[Potassium citrate]]
* [[Praziquantel]]
* [[Pregabalin]]
* [[Pregnancy]]
* [[Primaquine]]
* [[Procainamide]]
* [[Procarbazine]]
* [[Prochlorperazine]]
* [[Progesterone]]
* [[Prolactinoma]]
* [[Propiram]]
* [[Propylketobemidone]]
* [[Prosidol]]
* [[Protriptyline]]
* [[Pseudotumor cerebri]]
* [[Psychogenic]]
* [[Pulmonary embolism]]
* [[Pyelonephritis]]
* [[Pyloric stenosis]]
* [[Pyrazinamide]]
* [[Pyrantel pamoate]]
* [[Pyridostigmine]]
* [[Pyridoxine deficiency]]
* [[Q fever]]
* [[Quetiapine]]
* [[Quinidine]]
* [[Quinupristin/dalfopristin]]
* [[Radiation poisoning]]
* [[Radiation therapy]]
* [[Raised intracranial pressure]]
* [[Radium chloride]]
* [[Ramelteon]]
* [[Ranolazine]]
* [[Rasagiline]]
* [[Refractive error]]
* [[Renal colic]]
* [[Renal failure]]
* [[Renal insufficiency]]
* [[Reserpine]]
* [[Retroperitoneal fibrosis]]
* [[Reversible cerebral vasoconstriction syndrome]]
* [[Reye's syndrome]]
* [[Ribavirin]]
* [[Rifabutin]]
* [[Riluzole]]
* [[Risedronate]]
* [[Rituximab injection]]
* [[Rivastigmine]]
* [[Rizatriptan]]
* [[Rocky mountain spotted fever]]
* [[Ropinirole]]
* [[Rotavirus]]
* [[Rotigotine]]
* [[Roxithromycin]]
* [[Rubbing alcohol]]
* [[Rumination disorder]]
* [[Salicylate poisoning]]
* [[Salmonella]]
* [[Salpingitis]]
* [[Salsalate]]
* [[Saquinavir mesylate]]
* [[Sargramostim]]
* [[Sarin]]
* [[Sativex]]
* [[Scarlet fever]]
* [[Scleroderma]]
* [[Seasickness]]
* [[Secobarbital]]
* [[second-hand smoke]]
* [[Secretin human]]
* [[Seizure disorders]]
* [[Selective serotonin reuptake inhibitor]]
* [[Selegiline]]
* [[Seliciclib]]
* [[Sepsis]]
* [[Sexual fetish]]
* [[Shigella]]
* [[Sibutramine]]
* [[Sipuleucel-T]]
* [[Ski sickness]]
* [[Sleep deprivation]]
* [[Slone's disease]]
* [[Small bowel bacterial overgrowth syndrome]]
* [[Small bowel lymphoma]]
* [[Small bowel obstruction]]
* [[Small intestine cancer]]
* [[Smoke inhalation]]
* [[Snakebites]]
* [[Soapwort]]
* [[Sodium oxybate]]
* [[Sodium polystyrene sulfonate]]
* [[Sodium stibogluconate]]
* [[Sofosbuvir]]
* [[Solanine]]
* [[Somatization]]
* [[Spider bite]]
* [[Spironolactone]]
* [[Splenic infarction]]
* [[Sporotrichosis]]
* [[Spotted fever]]
* [[SSRI discontinuation syndrome]]
* [[Staphylococcal enteritis]]
* [[Starvation]]
* [[Stavudine]]
* [[Stomach cancer]]
* [[Streptococcal pharyngitis]]
* [[Stribild]] ([[Elvitegravir, Cobicistat, Emtricitabine, And Tenofovir Disoproxil Fumarate]])
* [[Strongyloidiasis]]
* [[Stiripentol]]
* [[Strep throat]]
* [[Streptozocin]]
* [[Subdural hematoma]]
* [[Sufentanil]]
* [[Sulfasalazine]]
* [[Sulfonamides]]
* [[Sulprostone]]
* [[Suicide attempt]]
* [[Sultiame]]
* [[Sumatriptan injection]]
* [[Sunitinib]]
* [[Suramin]]
* [[Syndrome of inappropriate antidiuretic hormone]] [[SIADH]]
* [[Tabes dorsalis]]
* [[Tacrine]]
* [[Tacrolimus]]
* [[Tamoxifen]]
* [[Tapentadol]]
* [[Telavancin hydrochloride]]
* [[Telbivudine]]
* [[Telithromycin]]
* [[Tetracycline]]
* [[Temik]]
* [[Temozolomide]]
* [[Teniposide]]
* [[Testicular rupture]]
* [[Testicular torsion]]
* [[Tetanus, Diphtheria, and Pertussis (Tdap) Vaccine]]
* [[Tetracaine]]
* [[Tetrahydrocannabinol]]
* [[Tetrahydrozoline]]
* [[Tetramethylsuccinonitrile]]
* [[Tetrodotoxin]]
* [[Thallium]]
* [[Theobromine]]
* [[Theophylline]]
* [[Thiabendazole]]
* [[Thiethylperazine]]
* [[Thioguanine]]
* [[Thiotepa]]
* [[Thrombotic thrombocytopenic purpura]]
* [[Thyroid Medication (patient information)|Thyroid medication]]
* [[Thyrotoxicosis]]
* [[Tigecycline]]
* [[smoking|Tobacco smoking]]
* [[Tocopherol]]
* [[Tolmetin]]
* [[Topiramate]]
* [[Topotecan Hydrochloride|Topotecan Hydrochloride]]
* [[Toxic ingestion]]
* [[Toxidrome]]
* [[Tralomethrin]]
* [[Tramadol]]
* [[Trametinib dimethyl sulfoxide]]
* [[Trandolapril]]
* [[Tranexamic acid]]
* [[Trastuzumab]]
* [[Traumatic brain injury]]
* [[Traveler's diarrhea]]
* [[Trazodone]]
* [[Tretinoin]]
* [[Triamterene]]
* [[Triazolam]]
* [[Trichuriasis]]
* [[Triclofos]]
* [[Tricyclic antidepressant]]
* [[Trifluoperazine]]
* [[Trifluoromethylphenylpiperazine]]
* [[Trimeperidine]]
* [[Trimethobenzamide]]
* [[Trimetrexate glucuronate]]
* [[Tropisetron]]
* [[Trovafloxacin mesylate]]
* [[Tularemia]]
* [[Tumors]]
* [[Twisted ovarian cyst]]
* [[Typhoid Vaccine (patient information)|Typhoid Vaccine]]
* [[Typhus]]
* [[Ulcers]]
* [[Urea cycle disorders]]
* [[Uremia]]
* [[Urinary tract infection]]
* [[Urofollitropin]]
* [[Urolithiasis]]
* [[Vagotomy]]
* [[Valaciclovir]]
* [[Valganciclovir hydrochloride]]
* [[Valproic Acid]]
* [[Varenicline]]
* [[Vasovagal syncope]]
* [[Venlafaxine]]
* [[Verapamil]]
* [[Vertebro-basilar syndrome]]
* [[Vertigo]]
* [[Vestibular balance disorder]]
* [[Vestibular neuronitis]]
* [[Vibrio parahaemolyticus]]
* [[Vicodin]]
* [[Vidarabine]]
* [[Vigabatrin]]
* [[Vilazodone]]
* [[Viloxazine]]
* [[Vinblastine]]
* [[Vinorelbine Tartrate]]
* [[Viral gastroenteritis]]
* [[emotion|Violent emotions]]
* [[Cough|Violent fits of coughing]]
* [[hiccups|Violent fits of coughing]]
* [[Vitamin A]]
* [[Vitamin C]]
* [[Vitamin D]]
* [[Volvulus]]
* [[Von Willebrand factor]]
* [[Voriconazole]]
* [[Vorinostat]]
* [[Vortioxetine]]
* [[Water intoxication]]
* [[Waterborne diseases]]
* [[West Nile virus]]
* [[Yellow fever]]
* [[Zanamivir Inhalation]]
* [[Zidovudine]]
* [[Ziprasidone]]
* [[Zollinger-Ellison Syndrome]]
* [[Zolpidem]]
* [[Zopiclone]]

}}

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Emergency medicine]]
[[Category:Gastroenterology]]
[[Category:Obstetrics]]
[[Category:Crowdiagnosis]]

Nausea and vomiting causes

2021-01-28T02:54:42Z

Shaik Aisha sultana: /* Common Causes */

__NOTOC__
{{Nausea and vomiting}}
{{CMG}}; {{AE}} {{VVS}} {{KS}}

==Overview==
Life threatening causes of nausea and vomiting include [[acute coronary syndrome]], [[anaphylaxis]], and [[heart failure]]. Other common causes of nausea and vomiting are [[food allergies]], [[food poisoning]], [[gastroenteritis]], and [[gastroesophageal reflux]].

==Causes==
===Life Threatening Causes===
*[[Acute Coronary Syndromes]]
*[[Anaphylaxis]]
*[[Angina pectoris]]
*[[Heart failure]]

===Common Causes===
*[[Chemotherapy]]<ref>{{cite journal|doi=10.1002/j.1875-9114.1990.tb02560.x}}</ref>

*[[Food allergies]]
*[[Food poisoning]]
*[[Migraine]]
*[[Morning sickness]]
*[[Rotavirus]]
*[[Viral gastroenteritis]]

===Causes by Organ System===

{|style="width: 80%; height: 100px; text-align: justify; text-justify: distribute;" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |[[Acute Coronary Syndromes]], [[amyloidosis]], [[anaphylaxis]], [[angina pectoris]], [[aortic arch anomalies]], [[cardiac arrhythmia]], [[cerebral aneurysm]], [[cerebral arteriovenous malformation]], [[cerebrovascular disease]], [[myocardial infarction]], [[heart failure]], [[hypercalcemia]], [[hypertension]], [[hypercalcemia]], [[hypocalcemia]], [[hypokalemia]]
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"|[[1,2-Dichloroethene]], [[2-Ethylhexanol]], [[1,3-Dichloropropene]], [[abrin]], [[aconitine]], [[adamsite]], [[ammonium chloride]], [[amnesic shellfish poisoning]], [[arsenic Poisoning]], [[barium oxalate]], [[barium sulfate]], [[butanethiol]], [[camphor|camphor poisoning]], [[capsaicin]], [[carbon monoxide poisoning]], [[chloromethane]], [[cicuta]], [[ciguatera]], [[cinchonism]], [[coprinopsis atramentaria]], [[cyanogen]], [[daunorubicin]], [[diethyl ether]], [[digitalis purpurea]], [[dioxathion]], [[dioxin]], [[endosulfan]], [[ergotism]], [[fluoride poisoning]], [[fluoxymesterone]], [[ginkgo]], [[Green Tobacco Sickness|green tobacco sickness]], [[heavy metal ingestion]], [[Iodomethane]], [[Iron poisoning]], [[Iron(II) sulfate]], [[lead poisoning]], [[lenvatinib]], [[lewisite]], [[lindane]], [[lithium]], [[lobelia]], [[metal fume fever]], [[mushroom poisoning]], [[N-Ethyl-3-piperidyl benzilate]], [[nerve agent]], [[nicotine poisoning]], [[N-Nitroso-N-methylurea]], [[PFPP]], [[pesticide]], [[potassium bromide]], [[phytohaemagglutinin]], [[smoke inhalation]], [[snakebites]], [[temik]], [[theobromine]]
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"|[[Abscess]], [[decompression sickness]], [[exercise urticaria]]
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"|[[2C-E]], [[2C-I]], [[2C-T-7]], [[5-Hydroxytryptophan]], [[5-MeO-AMT]], [[ABVD]], [[acamprosate calcium]], [[acetaminophen]], [[acetoxyketobemidone]], [[acetylcysteine]], [[acetylsalicylic acid]],[[acyclovir]], [[aclarubicin]], [[actinomycin D]], [[alatrofloxacin Injection (patient information)|alatrofloxacin]], [[albuterol]], [[aldesleukin]], [[alemtuzumab]], [[allylprodine]], [[alpha-Methyltryptamine]], [[alprazolam]], [[altretamine]], [[amifostine]], [[amineptine]], [[aminocaproic acid]], [[aminoglutethimide]], [[aminopterin]], [[aminosalicylic acid]], [[amitriptyline (patient information)|amitriptyline]], [[amoxicillin]], [[amphotericin B]], [[amrinone]], [[amyl nitrite]], [[anadenanthera peregrina]], [[analgesic]], [[anastrozole]], [[anesthesia]], [[anticonvulsants]], [[antigout]], [[antihistamine]], [[antihypertensives]],[[antiretroviral drug]], [[apremilast]], [[apomorphine hydrochloride]], [[aprepitant]], [[aripiprazole]], [[armodafinil]], [[asparaginase (patient information)|asparaginase]], [[aspirin]], [[atomoxetine]], [[atosiban]], [[atropine]], [[auranofin]], [[axitinib]], [[azacitidine]], [[azathioprine]], [[azithromycin]], [[aztreonam]], [[barbiturate]], [[barium Sulfate]], [[basiliximab]], [[bCG vaccine]], [[Belladonna Alkaloid Combinations and Phenobarbital|belladonna alkaloid]] [[benzodiazepine]], [[benztropine]], [[benzphetamine]], [[benzylpiperazine]], [[betaine]], [[beta-lactam antibiotic]], [[Bevacizumab|bevacizumab]], [[beta blockers]], [[bezafibrate]], [[bicalutamide]], [[bleomycin]], [[blinatumomab]], [[botulinum antitoxin]], [[bortezomib]], [[bosutinib]], [[botulinum toxin]], [[bromelain]], [[bromocriptine]], [[bromomethane]], [[bronchodilator]], [[butalbital]], [[buprenorphine]], [[bupropion]], [[busulfan]], [[butanethiol]], [[butorphanol]], [[cabergoline]], [[calcitonin]], [[calcitriol]], [[calcium carbamide]], [[calcium channel antagonists]], [[capecitabine]], [[capsaicin]], [[carbamates]], [[Carbidopa and Levodopa|carbidopa and levodopa]], [[carboplatin]], [[carmustine]], [[carprofen]], [[carvedilol]], [[caspofungin]], [[cefaclor]], [[cefixime]], [[ceritinib]], [[cetrorelix]], [[cefoperazone Sodium Injection (patient information)|cefoperazone sodium]], [[cefotaxime sodium]], [[cefotetan disodium]], [[cefprozil]], [[ceftibuten]], [[cefuroxime]], [[ceftibuten]], [[ceftaroline fosamil]], [[cefuroxime]], [[cephalosporin]], [[cetuximab]], [[cetuximab injection ]], [[cevimeline]], [[chelation therapy]], [[chemotherapy]], [[chloral hydrate]], [[chlordiazepoxide]], [[chloromethane]], [[chlorothiazide]], [[chlorpropamide]], [[CHOP]], [[cimicifuga racemosa]], [[ciprofloxacin]], [[cisplatin]], [[citalopram]], [[cladribine]], [[clarithromycin]], [[clindamycin]], [[clofarabine]], [[clofibrate]], [[clomifene]], [[clorazepate]], [[clozapine]], [[cobicistat]], [[co-codamol]], [[codeine]], [[colchicine]], [[colestyramine]], [[combined oral contraceptive pill]], [[conjugated estrogens/bazedoxifene]], [[contraceptive patch]], [[crizotinib]], [[cyclobenzaprine]], [[cyclophosphamide]], [[cytisine]], [[cytarabine]], [[cytarabine liposome]], [[cytisine]],[[capsaicin]], [[dacarbazine ]], [[dactinomycin ]], [[dalfampridine]], [[danazol]], [[dantrolene]], [[daptomycin]], [[Darbepoetin Alfa Injection|darbepoetin alfa Injection ]], [[darunavir ]], [[daunorubicin ]], [[deferasirox ]], [[deferiprone]], [[defibrotide]], [[denileukin diftitox]], [[desmopressin]], [[dexamethasone]], [[dexchlorpheniramine]], [[dexrazoxane]], [[Dextroamphetamine and Amphetamine|dextroamphetamine and amphetamine]], [[dextromethorphan]], [[dextropropoxyphene]], [[diazepam]], [[diazinon]], [[dicofol]], [[didanosine]], [[diethyl ether]], [[diethylcathinone]], [[diflunisal]], [[digitoxin]], [[digoxin]], [[diethylcathinone]], [[diethyl ether]], [[dimercaprol]], [[dinoprostone]], [[dipyridamole]], [[disulfiram ]], [[diuretic]], [[docetaxel ]], [[dofetilide ]], [[dolasetron ]], [[donepezil ]], [[doripenem]], [[dosulepin hydrochloride]], [[doxorubicin hydrochloride]], [[doxycycline]], [[Drospirenone and Ethinyl estradiol|drospirenone and ethinyl estradiol]], [[DTPA]], [[duloxetine]], [[ecallantide]], [[eculizumab]], [[efavirenz]], [[elvitegravir]], [[enfuvirtide]], [[entecavir]], [[epinephrine (aerosol)]], [[ergometrine]], [[ergotamine]], [[eribulin]], [[erlotinib]], [[erythromycin]], [[estradiol valerate and estradiol valerate/dienogest]], [[eslicarbazepine acetate]], [[ethcathinone]], [[ethchlorvynol]], [[ethosuximide]], [[ethynodiol diacetate and ethinyl estradiol]], [[ethyl carbamate]], [[emetine]], [[emtricitabine]], [[Emtricitabine, Rilpivirine Hydrochloride, And Tenofovir Disoproxil Fumarate|rilpivirine hydrochloride, and tenofovir disoproxil fumarate]], [[endosulfan]], [[entacapone]], [[efavirenz]], [[enfuvirtide]], [[entecavir ]], [[elosulfase alfa]], [[epinephrine (aerosol)]], [[epirubicin hydrochloride]], [[epoetin Alfa ]], [[eribulin]], [[eliglustat]], [[erlotinib ]], [[erythromycin]], [[estradiol]], [[estrogen and Progestin (Oral Contraceptives) ]], [[ethcathinone]], [[ethchlorvynol]], [[ethyl carbamate]], [[ethylmorphine]], [[etidronate ]], [[etodolac]], [[etoposide]], [[exemestane]], [[exenatide]], [[felbamate]], [[fentanyl Oral Transmucosal ]][[fexofenadine]], [[filgrastim]], [[fioricet]], [[flavoxate]], [[fludarabine phosphate]], [[fluorouracil]], [[flurazepam]],[[Flurbiprofen]], [[floxuridine]], [[fluconazole]], [[flucytosine]], [[fludarabine Phosphate]], [[flunisolide]], [[fluorescein sodium]], [[fluorouracil ]], [[flurazepam]], [[flurbiprofen]], [[flutamide ]], [[Fluticasone]], [[foscarnet sodium]], [[fulvestrant]], [[galantamine]], [[gallium nitrate]], [[gabapentin]], [[gamma-Hydroxybutyric acid]], [[gatifloxacin ]], [[gefitinib ]], [[gemcitabine]], [[gemeprost]], [[general anaesthesia]], [[gestrinone]], [[glimepiride]], [[glipizide]], [[glucagon]], [[glucarpidase]], [[glycylcycline]], [[glycopyrrolate]], [[glyburide]], [[glyburide and Metformin]], [[glycylcycline]], [[goserelin ]], [[Graft-versus-host disease]], [[granisetron ]], [[grifulvin V]], [[guaifenesin]], [[H1 antihistamine]], [[herkinorin]], [[heroin]], [[hydralazine]], [[hydrochlorothiazide]], [[hydrocodone]], [[Hydrocodone bitartrate and Homatropine methylbromide|hydrocodone bitartrate and homatropine methylbromide]], [[hydrocortisone]], [[hydromorphone]], [[hydroxycarbamide]], [[hydroxychloroquine]], [[hydroxocobalamin]], [[hydroxyurea]], [[hydroxyzine]], [[hydroxyprogesterone caproate]], [[Ibogaine]], [[Ibuprofen]], [[Ibrutinib]], [[Ibritumomab tiuxetan]], [[Idarubicin ]], [[Idursulfase]], [[Ifosfamide ]], [[Imatinib ]], [[Imiglucerase]], [[Imipenem]], [[Indinavir]], [[Interferon gamma]], [[Interferon alfa-2b]], [[Iodomethane]], [[Irinotecan hydrochloride]], [[Isoniazid]], [[Isoproterenol (aerosol)]], [[Isopropyl alcohol]], [[Isosorbide mononitrate]], [[Isotretinoin]], [[Itraconazole]], [[Ivacaftor]], [[Ivermectin]], [[Ixabepilone]], [[kaopectate]], [[ketorolac]], [[lacosamide]], [[lactulose]], [[lamivudine]], [[lanreotide]], [[lansoprazole]], [[lanthanum carbonate]], [[lapatinib]], [[lenalidomide]], [[letrozole ]], [[leuprolide ]], [[Levodopa and Carbidopa|levodopa and carbidopa ]], [[levofloxacin]], [[levonorgestrel]], [[lidocaine (ointment)]], [[lithium nitrate]], [[lomefloxacin hydrochloride]], [[lorcaserin]], [[lopinavir]], [[loprazolam]], [[lorazepam]], [[lovaza]], [[malaria prophylaxis]], [[mazindol]], [[mechlorethamine ]], [[medazepam]], [[megestrol ]], [[melarsoprol]], [[melphalan ]], [[mercaptopurine]], [[meropenem]], [[mesalamine ]], [[mescaline]], [[mesna]], [[metformin]], [[methadone]], [[methenamine]], [[methotrexate]], [[methylergonovine]], [[methylketobemidone]], [[methylphenidate]], [[methyprylon]], [[metronidazole]], [[micafungin sodium]], [[mifepristone]], [[milk of magnesia]], [[milnacipran hydrochloride]], [[miltefosine]], [[mirtazapine]], [[misoprostol]], [[mitomycin ]], [[mitotane]], [[mitoxantrone]], [[moclobemide]], [[monocrotophos]], [[morphine]], [[motofen]], [[moxifloxacin]], [[mycophenolic acid]], [[nabilone]], [[nafcillin]], [[nalbuphine]], [[nalmefene]], [[naloxone]], [[naphthalene]], [[naproxen sodium]], [[natamycin]], [[niacin/simvastatin]], [[nicorandil]], [[nilotinib]], [[nilutamide]], [[nintedanib]], [[nitrazepam]], [[nitrofurantoin]], [[nizatidine]], [[Norethindrone acetate and Ethinyl estradiol|norethindrone acetate and ethinyl estradiol]], [[Norgestimate and Ethinyl estradiol|norgestimate and ethinyl estradiol]], [[Norgestrel and Ethinyl estradiol|norgestrel and ethinyl estradiol]], [[olanzapine ]], [[olsalazine]], [[omeprazole ]], [[ondansetron]], [[opioid]], [[oprelvekin]], [[oritavancin]], [[oseltamivir ]], [[oxaliplatin]], [[oxamniquine]], [[oxazepam]], [[oxcarbazepine]], [[oxybutynin ]], [[oxycodone and aspirin ]], [[oxytocin]], [[Paclitaxel]], [[palbociclib]], [[paliperidone ]], [[palonosetron]], [[panitumumab]], [[pantoprazole]], [[papaverine]], [[paromomycin sulfate]], [[pazopanib hydrochloride]], [[paracetamol]], [[paroxetine]], [[pasireotide]], [[pegaspargase ]], [[pemetrexed ]], [[penicillin]], [[pentamidine]], [[pentavalent antimonial]], [[pentetic acid]], [[pentostatin ]], [[pergolide ]], [[perhexiline]], [[pertuzumab]], [[pirfenidone]], [[piroxicam]], [[phenelzine]], [[phenoxymethylpenicillin]], [[phentermine]], [[phenylephrine]], [[physostigmine]], [[pholcodine]], [[pilocarpine]], [[pioglitazone ]], [[piribedil]], [[plerixafor]], [[plicamycin ]],[[posaconazole ]], [[potassium chloride]], [[potassium citrate]], [[praziquantel]], [[pregabalin ]], [[primaquine phosphate]], [[potassium iodide]], [[primaquine]][[procainamide ]], [[procarbazine ]], [[prochlorperazine]], [[progesterone]], [[propiram]], [[propylketobemidone]], [[prosidol]], [[protriptyline ]], [[pyrantel pamoate]][[pyrazinamide]], [[pyridostigmine]], [[quetiapine ]], [[quinupristin/dalfopristin]], [[radium chloride]], [[ramelteon]], [[ranolazine ]], [[ranitidine]], [[rasburicase]], [[rasagiline ]], [[reserpine]], [[ribavirin]], [[rifabutin]], [[rifaximin]], [[risedronate ]], [[ritonavir]], [[rituximab ]], [[rivastigmine ]], [[rizatriptan ]], [[ropinirole ]], [[roflumilast]], [[rotigotine]], [[roxithromycin]], [[rubbing alcohol]], [[salsalate ]], [[saquinavir mesylate]], [[sarin]], [[sargramostim]], [[stavudine]], [[sativex]], [[saxagliptin hydrochloride and Metformin hydrochloride]], [[secretin human]], [[secobarbital]], [[selegiline ]], [[seliciclib]], [[serotonin]], [[sibutramine]], [[sipuleucel-T]], [[sodium oxybate]], [[sodium polystyrene sulfonate]], [[sodium stibogluconate]], [[sodium sulfate, potassium sulfate and magnesium sulfate]], [[solanine]], [[spironolactone]], [[Stiripentol]], [[streptozocin]], [[streptomycin]], [[streptozocin]], [[sufentanil]], [[Sulfamethoxazole/Trimethoprim (oral)]], [[sultiame]], [[sumatriptan]], [[sunitinib ]], [[suramin]],[[tacrolimus]], [[tapentadol]], [[tedizolid]], [[telavancin hydrochloride]], [[telbivudine ]], [[telithromycin ]], [[taliglucerase alfa]][[temozolomide]], [[teniposide ]], [[teriparatide]], [[tetracaine]], [[tetraferric tricitrate decahydrate]], [[tetrahydrocannabinol]], [[tetrahydrozoline]], [[tetramethylsuccinonitrile]], [[tetrodotoxin]], [[thallous Chloride Tl 201]], [[thiabendazole]], [[thiethylperazine]], [[thioguanine]], [[thiotepa ]], [[Thyroid Medication|thyroid medication]], [[tigecycline]], [[tocopherol]], [[tolcapone ]], [[tolmetin]], [[topiramate]], [[tolbutamide]], [[topotecan Hydrochloride|topotecan hydrochloride]], [[toremifene]], [[tralomethrin]], [[tramadol]], [[trametinib dimethyl sulfoxide]], [[trandolapril]], [[trastuzumab]], [[trazodone]], [[tretinoin]], [[triamterene]], [[triazolam]], [[triclofos]], [[tricyclic antidepressant]], [[trifluoperazine]], [[trifluoromethylphenylpiperazine]], [[trimeperidine]], [[trimethobenzamide]], [[trimetrexate Glucuronate]], [[tropisetron]], [[trovafloxacin mesylate]], [[valaciclovir]], [[valganciclovir hydrochloride]], [[valproic acid ]], [[vancomycin]], [[varenicline]], [[venlafaxine]], [[vicodin]], [[vidarabine]], [[vigabatrin]], [[vilazodone]], [[viloxazine]], [[vinblastine ]], [[vinorelbine Tartrate]], [[vismodegib]], [[von Willebrand factor]], [[voriconazole]], [[vorinostat]], [[vortioxetine]], [[zafirlukast]], [[zidovudine]], [[zolpidem ]], [[zopiclone]], [[zoledronate]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"|[[Balance disorder]], [[decompression sickness]], [[ear infection]], [[epistaxis]], [[glaucoma]], [[labyrinthitis]], [[Ménière's disease]], [[pharyngitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"|[[Acromegaly]], [[addison's disease]], [[adrenal failure]], [[adrenal insufficiency]], [[amyloidosis]], [[anorexia nervosa]], [[carcinoid tumours and carcinoid syndrome]], [[contraceptive patch]], [[diabetic gastroparesis]], [[diabetic ketoacidosis]], [[diabetes mellitus]],[[emergency contraception]], [[gangrene]], [[gestational diabetes]], [[hormone replacement therapy (trans)]],[[hypocalcemia]], [[hypoglycemia]], [[hyperparathyroidism]], [[hyperthyroidism]], [[prolactinoma]], [[syndrome of inappropriate antidiuretic hormone]]([[SIADH]]), [[thyrotoxicosis]], [[Estrogen and Progestin (Hormone Replacement Therapy) (patient information)|estrogen and progestin]], [[multiple endocrine neoplasia type 1]]
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"|[[Bothrops|Bothrops bite]], [[bromomethane]], [[carbon monoxide poisoning]], [[dioxin]], [[heat stroke]], [[hyperthermia]]
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"|[[Achalasia]], [[acute abdomen]], [[accessory pancreas]] , [[acute fatty liver of pregnancy]], [[acute pancreatitis]], [[adjustable gastric band]], [[afferent loop syndrome]], [[alcoholic Hepatitis]], [[alcoholism]], [[anastomosis]] [[stenosis]], [[ anorexia nervosa]], [[appendicitis]], [[bacterial gastroenteritis]], [[beef tapeworm]], [[biliary colic]], [[blastocystosis]], [[bowel obstruction]], [[brucella]], [[bulimia nervosa]], [[caecitis]], [[carcinoid tumours and carcinoid syndrome]], [[chronic intestinal pseudo-obstruction]], [[cholecystitis]], [[cholecystolithiasis]], [[ciguatera]], [[colorectal cancer]], [[congenital hypertrophic pyloric stenosis]], [[Crohn's disease]], [[cryptosporidium parvum]], [[cyclic vomiting syndrome]], [[cyclospora cayetanensis]], [[diabetic gastroparesis]], [[dientamoebiasis]], [[diverticulitis]], [[dumping syndrome]], [[enteric Neuropathy]], [[eosinophilic esophagitis]], [[eosinophilic gastroenteritis]], [[epiploic appendagitis]], [[esophageal achalasia]], [[esophageal cancer]], [[esophageal diverticulum]], [[esophageal stenosis]], [[esophagitis]], [[femoral hernia]], [[food allergies]], [[food poisoning]], [[fundic gland polyposis]], [[functional dyspepsia]], [[gastric carcinoma]], [[gastric outlet obstruction]], [[gastritis]], [[gastrocolic fistula]], [[gastroenteritis]], [[gastroesophageal reflux disease]], [[gastrointestinal perforation]], [[gastroparesis]], [[giardiasis]], [[helicobacter pylori infection]], [[Hellp syndrome]], [[hematemesis]], [[hepatic coma]], [[hepatic porphyria]], [[hepatitis]], [[hepatitis A]], [[hepatitis B]], [[hepatitis D]], [[hepatitis E]], [[hepatobiliary disease]], [[hepatotoxicity ]], [[hernia]], [[hirschsprung disease]], [[Ileus]], [[Intussusception (medical disorder)]], [[Irritable bowel syndrome]], [[Ischemic bowel]], [[Mesenteric ischemia]], [[peptic ulcer]], [[peritonitis]], [[pyloric stenosis]], [[Reye's syndrome]], [[Small bowel bacterial overgrowth syndrome]], [[Small intestine cancer]], [[traveler's diarrhea]]
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"|[[Acute intermittent porphyria]], [[congenital malformation]], [[Down syndrome]], [[episodic ataxia]], [[familial hemiplegic migraine]], [[fundic gland polyposis]], [[galactosemia]], [[hereditary fructose intolerance]], [[slone's disease]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"|[[HELLP syndrome]], [[hemorrhage]], [[mastocytosis]], [[porphyria]], [[splenic infarction]], [[thrombotic thrombocytopenic purpura]]
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"|[[Essure]], [[dumping syndrome]], [[high doses of ionizing radiation]], [[Instillation abortion]], [[Minimally Invasive Thorasic Spinal Fusion|minimally Invasive thorasic spinal fusion]]
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"|[[Infections|Acute infections]], [[acute viral nasopharyngitis (common cold)]], [[AIDS]], [[aseptic meningitis]], [[astrovirus]], [[bacillus cereus|bacillus cereus infection]], [[bacterial gastroenteritis]], [[Barcoo Fever|barcoo fever]], [[beef tapeworm]], [[blastocystosis]], [[brucella]], [[colorado tick fever]], [[community-acquired pneumonia]], [[croup]], [[cryptosporidium parvum|cryptosporidium parvum infection]], [[cyclospora cayetanensis|cyclospora cayetanensis infection]], [[dengue fever]], [[diarrheal shellfish poisoning]], [[dientamoebiasis]], [[diphtheria]], [[Duke's disease]], [[ebola]], [[giardia lamblia]], [[Hantavirus pulmonary syndrome]], [[helicobacter pylori infection]], [[henipavirus]], [[hepatitis B]], [[hepatitis D]], [[hepatitis E]], [[hookworm]], [[human ehrlichiosis]], [[Influenza]], [[Intestinal parasite]], [[lassa fever]], [[listeria monocytogenes]], [[malaria]], [[meningococcemia]], [[Naegleria fowleri]], [[norovirus]], [[norwalk Virus]], [[pfiesteria piscicida]], [[poliomyelitis]], [[Q fever]], [[Rocky Mountain spotted fever]], [[Scarlet fever]], [[shigella]], [[Sporotrichosis]], [[staphylococcal enteritis]], [[tularemia]], [[vibrio parahaemolyticus]], [[West Nile virus]], [[waterborne diseases]], [[Yellow fever]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"|[[Decompression sickness]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"|[[Acoustic neuroma]], [[airsickness]], [[altitude sickness]], [[arachnoid cyst]], [[Aseptic meningitis|aseptic meningitis]], [[autonomic neuropathy]], [[balance disorder]], [[benign intracranial hypertension]] ,[[Brain Stem Gliomas|brain stem gliomas]], [[brain tumor]], [[stroke|cerebellar stroke]], [[cerebral aneurysm]], [[cerebral arteriovenous malformation]], [[cerebral hemorrhage]], [[cerebrovascular disease]], [[cerebral oedema]],[[cerebral shunt ]], [[cerebrovascular disease]], [[ciguatera]], [[concussion]], [[craniopharyngioma]], [[cyclic vomiting syndrome]], [[decompression sickness]], [[encephalitis]], [[enteric Neuropathy|enteric neuropathy]], [[ependymoma]], [[epidural haemorrhage]], [[episodic ataxia]], [[familial hemiplegic migraine]], [[glioblastoma multiforme]], [[glioma]], [[heavy metal ingestion]], [[hemicrania continua]], [[hepatic coma]], [[hydrocephalus]], [[La Crosse encephalitis]], [[Sea sickness]], [[subdural hematoma]], [[Tabes dorsalis]], [[vagal episode]], [[vertebrobasilar insufficiency]], [[vestibular neuritis]]
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"|[[5-hydroxytryptophan]], [[acute intermittent porphyria]], [[amnesic shellfish poisoning]], [[amyloidosis]], [[bromelain]], [[cicuta]], [[cimicifuga racemosa]],[[coprinopsis atramentaria]], [[food allergies]], [[food intolerance]], [[food poisoning]], [[galactosemia]], [[ginger]], [[hereditary fructose intolerance]], [[hypercalcemia]], [[hypermagnesemia]], [[hypervitaminosis A]], [[hypervitaminosis]], [[hypocalcemia]], [[hypocholermia]], [[hypoglycemia]], [[hypokalemia]], [[hyponatremia]], [[ketogenic diet]], [[lactose intolerance]], [[metabolic acidosis]], [[pyridoxine deficiency]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"|[[Acute fatty liver of pregnancy]], [[breastfeeding complications]], [[childbirth]], [[contraceptive patch]], [[endometriosis]], [[emergency contraception]],[[Estrogen and Progestin (Oral Contraceptives)|estrogen and progestin]], [[essure]], [[gestational diabetes]], [[HELLP syndrome]], [[hydatidiform mole]], [[hyperemesis gravidarum]], [[ovarian cyst]], [[ovarian hyperstimulation syndrome]], [[ovarian torsion]], [[pregnancy]], [[salpingitis]], [[twisted ovarian cyst]]
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"|[[Acoustic neuroma]], [[Brain Stem Gliomas|brain stem gliomas]], [[brain tumor]], [[cancer]], [[carcinoid tumours and carcinoid syndrome]], [[colorectal cancer]][[craniopharyngioma]], [[ependymoma]], [[esophageal cancer]], [[gastric carcinoma]], [[glioblastoma multiforme]], [[glioma]], [[Kaposi's sarcoma]], [[Non-Hodgkin lymphoma]], [[osteosarcoma]], [[prolactinoma]], [[Zollinger-Ellison Syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"|[[Acute angle-closure glaucoma]], [[glaucoma]], [[refractive error]]
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| [[1,2-Dichloroethene]], [[1,3-Dichloropropene]], [[2C-E]], [[2C-I]], [[2C-T-7]], [[abrin]], [[alcoholism]], [[alcohol withdrawal]], [[beleric]], [[cinchonism]], [[ethanol abuse]], [[hangover]], [[heavy metal ingestion]], [[heroin]], [[orellanine]], [[Reye's syndrome]], [[marine toxins]], [[PMA]]
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"|[[Alcohol Withdrawal]], [[alcoholism]], [[anorexia nervosa]], [[anxiety]], [[anxiety disorders]], [[bulimia nervosa]], [[chronic fatigue syndrome]], [[combat stress reaction]], [[depression]], [[ethanol abuse]], [[hangover]], [[sexual fetish]] ([[emetophilia]]), [[SSRI discontinuation syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"|[[Acute viral nasopharyngitis (common cold)]], [[altitude sickness]], [[anaphylaxis]], [[aortic arch anomalies]], [[community acquired pneumonia]], [[croup]], [[decompression sickness]], [[Hantavirus pulmonary syndrome]], [[lower respiratory tract infection]], [[pulmonary embolism]], [[ pharyngitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"|[[Dehydration]], [[diabetic ketoacidosis]], [[hypercalcemia]], [[hypermagnesemia]], [[hypocalcemia]], [[hypocholermia]], [[hypokalemia]], [[hyponatraemia]], [[Interstitial nephritis]], [[nutcracker syndrome]], [[pyelonephritis]], [[renal colic]], [[renal failure]], [[renal stones]], [[ urinary tract infections]]
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"|[[Amyloidosis]], [[anaphylaxis]], [[chronic fatigue syndrome]], [[Crohn's disease]], [[food allergies]], [[food intolerance]], [[Graft-versus-host disease]], [[scleroderma]], [[Tetanus, Diphtheria, and Pertussis (Tdap) Vaccine|tetanus, diphtheria, and pertussis (Tdap) vaccine]], [[typhoid Vaccine]], [[HIV]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"|[[HIV]]
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"|[[Head trauma]], [[hemorrhage]], [[post-concussion syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"|[[Acute prostatitis]], [[testicular rupture]], [[testicular torsion]], [[urinary tract infections]], [[urolithiasis]]
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"|[[Anadenanthera peregrina]], [[exercise induced nausea]], [[extreme pain]], [[foreign bodies]], [[sleep deprivation]], [[soapwort]], [[ulcers]], [[water intoxication]], [[cyclic vomiting syndrome]], [[DTPA]], [[ginkgo]]
|-
|}

===Causes in Alphabetical Order===
{{columns-list|4|
* [[1,2-Dichloroethene]]
* [[1,3-Dichloropropene]]
* [[2C-E]]
* [[2C-I]]
* [[2C-T-7]]
* [[2-Ethylhexanol]]
* [[5-Hydroxytryptophan]]
* [[5-MeO-AMT]]
* [[Abrin]]
* [[Abscess]]
* [[ABVD]]
* [[Acamprosate calcium]]
* [[Accessory pancreas]]
* [[Acetaminophen]]
* [[Acetoxyketobemidone]]
* [[Acetylcysteine]]
* [[Achalasia]]
* [[Aclarubicin]]
* [[Acyclovir]]
* [[Aconitine]]
* [[Acoustic neuroma]]
* [[Acromegaly]]
* [[Actinomycin|Actinomycin D]]
* [[Acute angle-closure glaucoma]]
* [[Acute coronary syndromes]]
* [[Acute fatty liver of pregnancy]]
* [[Acute intermittent porphyria]]
* [[Acute pancreatitis]]
* [[Acute prostatitis]]
* [[Acute viral nasopharyngitis (common cold)]]
* [[Adamsite]]
* [[Adenovirus]]
* [[Addison's Disease]]
* [[Adjustable gastric band]]
* [[Adrenal insufficiency]]
* [[Afferent loop syndrome]]
* [[Airsickness]]
* [[Alatrofloxacin Injection]]
* [[Albuterol Inhalation]]
* [[Alcohol withdrawal]]
* [[Alcoholism]]
* [[Aldesleukin]]
* [[Alemtuzumab]]
* [[Allylprodine]]
* [[Alpha-Methyltryptamine]]
* [[Alprazolam]]
* [[Altitude sickness]]
* [[Altretamine]]
* [[Amantadine]]
* [[Amifostine]]
* [[Amineptine]]
* [[Aminocaproic acid]]
* [[Aminophylline]]
* [[Aminopterin]]
* [[Aminosalicylic acid]]
* [[Amitriptyline]]
* [[Ammonium chloride]]
* [[Amnesic shellfish poisoning]]
* [[Amoxicillin]]
* [[Amphotericin B]]
* [[Amrinone]]
* [[Amyl nitrite]]
* [[Amyloidosis]]
* [[Anadenanthera peregrina]]
* [[Anaphylaxis]]
* [[Anastrozole]]
* [[Anesthesia]]
* [[Angina pectoris]]
* [[Anorexia nervosa]]
* [[Antiarrhythmics]]
* [[Antibiotics]]
* [[Anticonvulsants]]
* [[Antihistamine]]
* [[Antihypertensives]]
* [[Antiretroviral drug]]
* [[Anxiety]]
* [[Aortic arch anomalies]]
* [[Apomorphine hydrochloride]]
* [[Appendicitis]]
* [[Aprepitant]]
* [[Arachnoid cyst]]
* [[Aripiprazole]]
* [[Arsenicals]]
* [[Arsenic Poisoning]]
* [[Arsenic trioxide]]
* [[Ascariasis]]
* [[Aseptic meningitis]]
* [[Asparaginase]]
* [[Aspirin]]
* [[Astrovirus]]
* [[Atomoxetine]]
* [[Atosiban]]
* [[Atripala]] ([[Efavirenz, emtricitabine and tenofovir disoproxil fumarate]])
* [[Auranofin]]
* [[Autonomic neuropathy]]
* [[Azathioprine]]
* [[Azithromycin]]
* [[Aztreonam]]
* [[Bacillus cereus]]
* [[Bacterial gastroenteritis]]
* [[Balance disorder]]
* [[Barbiturate]]
* [[Barcoo Fever|Barcoo fever]]
* [[Barium oxalate]]
* [[Barium sulfate]]
* [[BCG vaccine]]
* [[Beef tapeworm]]
* [[Beleric]]
* [[Belladonna Alkaloid Combinations and Phenobarbital|Belladonna alkaloid combinations]]
* [[Benign intracranial hypertension]]
* [[Benzodiazepine]]
* [[Benzylpiperazine]]
* [[Beta blockers]]
* [[Beta-lactam antibiotic]]
* [[Bevacizumab Injection (patient information)|Bevacizumab Injection]]
* [[Bezafibrate]]
* [[Bicalutamide]]
* [[Biliary colic]]
* [[Blastocystosis]]
* [[Bleomycin ]]
* [[Bortezomib]]
* [[Botulinum toxin]]
* [[Bowel obstruction]]
* [[Brain Stem Gliomas|Brain stem gliomas]]
* [[Brain tumor]]
* [[Breastfeeding complications]]
* [[Bromelain]]
* [[Bromomethane]]
* [[Bronchodilator]]
* [[Brucella]]
* [[Buprenorphine Hydrochloride, Naloxone Hydrochloride|Buprenorphine,naloxone]]
* [[Bulimia nervosa]]
* [[Buprenorphine]]
* [[Bupropion]]
* [[Busulfan]]
* [[Butanethiol]]
* [[Butorphanol]]
* [[Cabergoline]]
* [[Caecitis]]
* [[Calcitonin]]
* [[Calcitriol]]
* [[Calcium carbamide]]
* [[Calcium channel antagonists]]
* [[Camphor|Camphor poisoning]]
* [[Cancer]]
* [[Capecitabine]]
* [[Capsaicin]]
* [[Carbon monoxide poisoning]]
* [[Carboplatin]]
* [[Carcinoid tumours and carcinoid syndrome]]
* [[Cardiac arrhythmia]]
* [[Carmustine]]
* [[Carprofen]]
* [[Carvedilol]]
* [[Caspofungin]]
* [[Cefaclor]]
* [[Cefixime]]
* [[Cefoperazone Sodium Injection (patient information)|Cefoperazone Sodium Injection]]
* [[Cefotetan disodium]]
* [[Cefprozil]]
* [[Ceftaroline fosamil]]
* [[Ceftibuten]]
* [[Cefuroxime]]
* [[Cephalosporin]]
* [[Cerebral aneurysm]]
* [[Cerebral arteriovenous malformation]]
* [[Cerebral edema]]
* [[Cerebral hemorrhage]]
* [[Cerebral shunt]]
* [[Cerebrovascular disease]]
* [[Cetuximab Injection]]
* [[Cevimeline]]
* [[Chelation therapy]]
* [[Chemotherapy]]
* [[Childbirth]]
* [[Chloral hydrate]]
* [[Chlordiazepoxide]]
* [[Chloromethane]]
* [[Chlorothiazide]]
* [[Chlorpropamide]]
* [[Cholecystitis]]
* [[Cholecystolithiasis]]
* [[CHOP]]
* [[Chronic fatigue syndrome]]
* [[Chronic intestinal pseudo-obstruction]]
* [[Cicuta]]
* [[Ciguatera]]
* [[Cimicifuga racemosa]]
* [[Cinchonism]]
* [[Ciprofloxacin]]
* [[Cisplatin]]
* [[Citalopram]]
* [[Cladribine]]
* [[Clarithromycin]]
* [[Clindamycin]]
* [[Clofarabine]]
* [[Clofibrate]]
* [[Clomifene]]
* [[Clorazepate]]
* [[Clostridium perfringens]]
* [[Cobicistat]]
* [[Co-codamol]]
* [[Codeine]]
* [[Colchicine]]
* [[Colestyramine]]
* [[Colorado tick fever]]
* [[Colorectal cancer]]
* [[Combat stress reaction]]
* [[Community-acquired pneumonia]]
* [[Concussion]]
* [[Congenital hypertrophic pyloric stenosis]]
* [[Congenital malformation]]
* [[Contraceptive patch]]
* [[Copper|Copper salts]]
* [[Coprinopsis atramentaria]]
* [[Craniopharyngioma]]
* [[Crohn's disease]]
* [[Croup]]
* [[Cryptosporidium parvum]]
* [[Cyanogen]]
* [[Cyclic vomiting syndrome]]
* [[Cyclobenzaprine]]
* [[Cyclophosphamide]]
* [[Cyclospora cayetanensis]]
* [[Cytarabine]]
* [[Cytisine]]
* [[Dacarbazine]]
* [[Dactinomycin]]
* [[Danazol]]
* [[Dantrolene]]
* [[Daptomycin]]
* [[Darbepoetin Alfa Injection (patient information)|Darbepoetin Alfa Injection]]
* [[Darunavir]]
* [[Daunorubicin]]
* [[Decompression sickness]]
* [[Deferasirox]]
* [[Deferiprone]]
* [[Defibrotide]]
* [[Dehydration]]
* [[Dengue fever]]
* [[Depression]]
* [[Desmopressin]]
* [[Dexamethasone]]
* [[Dextroamphetamine and Amphetamine (patient information)|Dextroamphetamine and Amphetamine]]
* [[Dextromethorphan]]
* [[Dextropropoxyphene]]
* [[Diabetes mellitus]]
* [[Diabetic gastroparesis]]
* [[Diabetic Ketoacidosis]]
* [[Diarrheal shellfish poisoning]]
* [[Diazepam]]
* [[Diazinon]]
* [[Dicofol]]
* [[Didanosine]]
* [[Dientamoebiasis]]
* [[Diethyl ether]]
* [[Diethylcathinone]]
* [[Diflunisal]]
* [[Digitalis purpurea]]
* [[Digitoxin]]
* [[Digoxin]]
* [[Dioxathion]]
* [[Dioxin]]
* [[Diphtheria]]
* [[Disulfiram]]
* [[Diuretic]]
* [[Diverticulitis]]
* [[Docetaxel]]
* [[Dofetilide]]
* [[Dolasetron]]
* [[Donepezil]]
* [[Doripenem]]
* [[Dosulepin hydrochloride]]
* [[Down syndrome]]
* [[Doxorubicin Hydrochloride]]
* [[DTPA]]
* [[Duke's disease]]
* [[Duloxetine]]
* [[Dumping syndrome]]
* [[Ear infection]]
* [[Ebola virus disease]]
* [[Eculizumab]]
* [[Efavirenz]]
* [[Elvitegravir]]
* [[Emergency contraception]]
* [[Emetine]]
* [[Encephalitis]]
* [[Endometriosis]]
* [[Endosulfan]]
* [[Enfuvirtide]]
* [[Entecavir]]
* [[Enteric Neuropathy]]
* [[Enterobiasis]]
* [[Eosinophilic gastroenteritis]]
* [[Epidural haemorrhage]]
* [[Ependymoma]]
* [[Epiploic appendagitis]]
* [[Epirubicin hydrochloride]]
* [[Episodic ataxia]]
* [[Epistaxis]]
* [[Epoetin Alfa Injection (patient information)|Epoetin Alfa Injection]]
* [[Ergotamine]]
* [[Ergotism]]
* [[Eribulin]]
* [[Erlotinib]]
* [[Erythromycin]]
* [[Esophageal achalasia]]
* [[Esophageal cancer]]
* [[Esophageal diverticulum]]
* [[Esophageal stenosis]]
* [[Esophagitis]]
* [[Essure]]
* [[Estradiol]]
* [[Estrogen and Progestin (Oral Contraceptives) (patient information)|Estrogen and Progestin ]]
* [[Ethanol abuse]]
* [[Ethcathinone]]
* [[Ethchlorvynol]]
* [[Ethosuximide]]
* [[Ethyl carbamate]]
* [[Ethylmorphine]]
* [[Etidronate]]
* [[Etoposide]]
* [[Exemestane]]
* [[Exenatide]]
* [[Exercise induced nausea]]
* [[Exercise urticaria]]
* [[Extreme pain]]
* [[Familial hemiplegic migraine]]
* [[Felbamate]]
* [[Femoral hernia]]
* [[Fentanyl Oral Transmucosal (patient information)|Fentanyl Oral Transmucosal]]
* [[Fexofenadine]]
* [[Filgrastim]]
* [[Fioricet]]
* [[Fluorouracil]]
* [[Floxuridine]]
* [[Flu]]
* [[Fluconazole]]
* [[Flucytosine]]
* [[Fludarabine Phosphate]]
* [[Flunisolide]]
* [[Fluorescein sodium]]
* [[Fluoride poisoning]]
* [[Fluorouracil]]
* [[Flurazepam]]
* [[Flurbiprofen]]
* [[Flutamide]]
* [[Fluticasone]]
* [[Food allergies]]
* [[Food intolerance]]
* [[Food poisoning]]
* [[Foreign bodies]]
* [[Fructose intolerance]] [[hypoglycemia]]
* [[Fulvestrant Injection (patient information)|Fulvestrant Injection]]
* [[Functional dyspepsia]]
* [[Fundic gland polyposis]]
* [[Gabapentin]]
* [[Galactosemia]]
* [[Galantamine]]
* [[Gamma-Hydroxybutyric acid]]
* [[Gangrene]]
* [[Gastric carcinoma]]
* [[Gastric outlet obstruction]]
* [[Gastritis]]
* [[Gastrocolic fistula]]
* [[Gastroenteritis]]
* [[Gastroesophageal reflux disease]]
* [[Gastrointestinal perforation]]
* [[Gastroparesis]]
* [[Gatifloxacin]]
* [[Gefitinib]]
* [[Gemcitabine Hydrochloride (patient information)|Gemcitabine hydrochloride]]
* [[Gemeprost]]
* [[Gestational diabetes]]
* [[Gestrinone]]
* [[Giardia lamblia]]
* [[Giardiasis]]
* [[Ginger]]
* [[Ginkgo]]
* [[Glaucoma]]
* [[Glioblastoma multiforme]]
* [[Glioma]]
* [[Glucagon]]
* [[Glycylcycline]]
* [[Goserelin]]
* [[Graft-versus-host disease]]
* [[Granisetron]]
* [[Green Tobacco Sickness|Green tobacco sickness]]
* [[Grifulvin V]]
* [[Griseofulvin]]
* [[Guaifenesin]]
* [[Hangover]]
* [[Hantavirus pulmonary syndrome]]
* [[Head trauma]]
* [[Heart failure]]
* [[Heat stroke]]
* [[Heavy metal ingestion]]
* [[Helicobacter pylori infection]]
* [[HELLP syndrome]]
* [[Hematemesis]]
* [[Hemicrania continua]]
* [[Hemorrhage]]
* [[Henipavirus]]
* [[Hepatic coma]]
* [[Hepatic porphyria]]
* [[Hepatitis]]
* [[Hepatitis B]]
* [[Hepatitis D]]
* [[Hepatitis E]]
* [[Hepatobiliary disease]]
* [[Hereditary fructose intolerance]]
* [[Herkinorin]]
* [[Hernia]]
* [[Heroin]]
* [[Hirschsprung disease]]
* [[HIV]]
* [[Hookworm]]
* [[Hormone replacement therapy (trans)]]
* [[Human ehrlichiosis]]
* [[Hydralazine]]
* [[Hydrocephalus]]
* [[Hydrochlorothiazide]]
* [[Hydrocodone]]
* [[Hydromorphone]]
* [[Hydroxychloroquine]]
* [[Hydroxocobalamin]]
* [[Hydroxyurea]]
* [[Hydroxyzine]]
* [[Hypercalcemia]]
* [[Hyperemesis gravidarum]]
* [[Hypermagnesemia]]
* [[Hyperparathyroidism]]
* [[Hypertension]]
* [[Hyperthermia]]
* [[Hyperthyroidism]]
* [[Hypervitaminosis A]]
* [[Hypocalcemia]]
* [[Hypocholermia]]
* [[Hypoglycemia]]
* [[Hypokalemia]]
* [[Hyponatremia]]
* [[Hypoparathyroidism]]
* [[Hysterical contagion]]
* [[Iatrogenesis]]
* [[Ibogaine]]
* [[Ibuprofen]]
* [[Idarubicin]]
* [[Idiopathic]]
* [[Ifosfamide]]
* [[Ileus]]
* [[Imatinib]]
* [[Imipenem]]
* [[Inappetence]]
* [[Inborn errors of metabolism]]
* [[Incarcerated hernia]]
* [[Indinavir]]
* [[Indometacin]]
* [[Infarction]]
* [[Inflammatory bowel disease]]
* [[Infliximab]]
* [[Influenza]]
* [[Inguinal hernia]]
* [[Instillation abortion]]
* [[Insulin lispro]]
* [[Interferon gamma]]
* [[Interstitial nephritis]]
* [[Intracranial mass]]
* [[Intestinal atresia]]
* [[Intestinal parasite]]
* [[Intestinal volvulus]]
* [[Intracranial haemorrhage]]
* [[Intracranial hypertension]]
* [[Intussusception]]
* [[Ipecacuanha]]
* [[Iodomethane]]
* [[Irinotecan hydrochloride]]
* [[Iron(II) sulfate]]
* [[Irritable bowel syndrome]]
* [[Irukandji syndrome]]
* [[Ischemic bowel]]
* [[Isoniazid]]
* [[Isopropyl alcohol]]
* [[Isosorbide mononitrate]]
* [[Isotretinoin]]
* [[Itraconazole]]
* [[Ivacaftor]]
* [[Ixabepilone]]
* [[Jamaican vomiting sickness]]
* [[Janumet]] ([[sitagliptin]] and [[metformin]])
* [[Kaopectate]]
* [[Kaposi's sarcoma]]
* [[Ketoconazole]]
* [[Ketogenic diet]]
* [[Ketorolac]]
* [[Ketotic hypoglycemia]]
* [[La Crosse encephalitis]]
* [[Labyrinthitis]]
* [[Lactose intolerance]]
* [[Lanreotide]]
* [[Lansoprazole]]
* [[Large bowel obstruction]]
* [[Lassa fever]]
* [[Lead poisoning]]
* [[Letrozole]]
* [[Leuprolide]]
* [[Levodopa and Carbidopa]]
* [[Levofloxacin]]
* [[Levonorgestrel]]
* [[Lewisite]]
* [[Lindane]]
* [[Listeria monocytogenes]]
* [[Lithium]]
* [[Lithium nitrate]]
* [[Lobelia]]
* [[Lomefloxacin hydrochloride]]
* [[Lomotil]]
* [[Lopinavir]]
* [[Loprazolam]]
* [[Lorazepam]]
* [[Lower respiratory tract infection]]
* [[Lubiprostone]]
* [[Lysuride]]
* [[Malaria]]
* [[Malaria prophylaxis]]
* [[Malignancy]]
* [[Intestinal malrotation|Malrotation]]
* [[Marine toxins]]
* [[Mass effect (medicine)|Mass lesion]]
* [[Mastocytosis]]
* [[Mazindol]]
* [[Mechlorethamine]]
* [[Medazepam]]
* [[Medical cannabis]]
* [[Megestrol]]
* [[Melarsoprol]]
* [[Melphalan]]
* [[Ménière's disease]]
* [[Meningitis]]
* [[Meningococcemia]]
* [[Meningoencephalitis]]
* [[Mercaptopurine]]
* [[Mesoamerican nephropathy]]
* [[Meropenem]]
* [[Mesalamine]]
* [[Mescaline]]
* [[Mesenteric infarction]]
* [[Mesna]]
* [[Metabolic acidosis]]
* [[Metal fume fever]]
* [[Metformin]]
* [[Methadone]]
* [[Methotrexate]]
* [[Methylergonovine]]
* [[Methylketobemidone]]
* [[Methylphenidate]]
* [[Methyprylon]]
* [[Metronidazole]]
* [[Micafungin sodium]]
* [[Mifepristone]]
* [[Migraine]]
* [[Milk of Magnesia]]
* [[Milnacipran hydrochloride]]
* [[Miltefosine]]
* [[Minimally Invasive Thorasic Spinal Fusion]]
* [[Mirtazapine]]
* [[Misoprostol]]
* [[Mitomycin]]
* [[Mitotane]]
* [[Mitoxantrone]]
* [[Moclobemide]]
* [[Monocrotophos]]
* [[Mood stabilizer]]
* [[MOPP (medicine)|MOPP]]
* [[Morning sickness]]
* [[Morphine]]
* [[Motion sickness]]
* [[Motofen]]
* [[Moxifloxacin]]
* [[Multiple chemical sensitivity]]
* [[Multiple endocrine neoplasia type 1]]
* [[Munchausen syndrome by proxy]]
* [[Murray Valley encephalitis virus]]
* [[Mushroom poisoning]]
* [[Mycophenolic acid]]
* [[Mycoplasma pneumoniae]]
* [[Myocardial infarction]]
* [[Nabilone]]
* [[Naegleria fowleri]]
* [[Nafcillin]]
* [[Nalbuphine]]
* [[Nalidixic acid]]
* [[Nalmefene]]
* [[Naloxone]]
* [[Naphthalene]]
* [[Naproxen sodium]]
* [[Narcotics]]
* [[Natamycin]]
* [[Necrotizing enterocolitis]]
* [[Nerve agent]]
* [[Nervousness]]
* [[N-Ethyl-3-piperidyl benzilate]]
* [[Nicorandil]]
* [[Nicotine poisoning]]
* [[Nilutamide]]
* [[Nintedanib]]
* [[Nitrazepam]]
* [[Nitrogen mustard]]
* [[N-Nitroso-N-Methylurea]]
* [[Non-Hodgkin lymphoma]]
* [[Non steroidal anti-inflammatory drugs]]
* [[Nootropic]]
* [[Norfloxacin]]
* [[Norgestimate and Ethinyl estradiol]]
* [[Norgestrel and Ethinyl estradiol]]
* [[Norovirus]]
* [[Norplant]]
* [[Nortriptyline]]
* [[Norwalk Virus]]
* [[Nutcracker syndrome]]
* [[Nystatin]]
* [[Obidoxime]]
* [[Obstructive uropathy]]
* [[Obturator hernia]]
* [[Oesophageal cancer]]
* [[Ofloxacin]]
* [[Olanzapine]]
* [[Omeprazole]]
* [[Ondansetron]]
* [[Opioid]]
* [[Oprelvekin]]
* [[Oral contraceptives]]
* [[Orellanine]]
* [[Organic acidemia]]
* [[Organophosphates]]
* [[Oritavancin]]
* [[Oseltamivir]]
* [[Osteosarcoma]]
* [[Otitis interna]]
* [[Otitis media]]
* [[Ovarian cancer]]
* [[Ovarian cyst]]
* [[Ovarian hyperstimulation syndrome]]
* [[Ovarian torsion]]
* [[Oxaliplatin]]
* [[Oxamniquine]]
* [[Oxazepam]]
* [[Oxcarbazepine]]
* [[Oxybutynin]]
* [[Oxycodone and aspirin]]
* [[Paclitaxel]]
* [[Pain]]
* [[Palbociclib]]
* [[Pancreatic adenocarcinoma]]
* [[Pancreatitis]]
* [[Panitumumab]]
* [[Pantoprazole]]
* [[Palbociclib]]
* [[Paliperidone]]
* [[Palonosetron]]
* [[Panic attack]]
* [[Paralytic ileus]]
* [[Paraneoplastic syndrome]]
* [[Paraquat]]
* [[Paroxetine]]
* [[Pegaspargase]]
* [[Pemetrexed injection]]
* [[Penicillin]]
* [[Pentamidine]]
* [[Pentavalent antimonial]]
* [[Pentetic acid]]
* [[Pentostatin]]
* [[Peptic ulcer]]
* [[Pergolide]]
* [[Perhexiline]]
* [[Peritonitis]]
* [[Pesticide]]
* [[Pethidine]]
* [[Pfiesteria piscicida]]
* [[PFPP]]
* [[Pharyngeal pouch]]
* [[Pharyngitis]]
* [[Phenelzine]]
* [[Phenoxymethylpenicillin]]
* [[Phentermine]]
* [[Phentolamine]]
* [[Pholcodine]]
* [[Physostigmine]]
* [[Phytohaemagglutinin]]
* [[Pioglitazone]]
* [[Pirfenidone]]
* [[Piribedil]]
* [[Plerixafor]]
* [[Plicamycin]]
* [[Piroxicam]]
* [[PMA]]
* [[Pneumonia]]
* [[Polio]]
* [[Poliomyelitis]]
* [[Porphyria]]
* [[Posaconazole]]
* [[Post-concussion syndrome]]
* [[Post-exposure prophylaxis]]
* [[Ileus|Postoperative ileus]]
* [[Postoperative nausea and vomiting]]
* [[Pain|Postoperative pain]]
* [[Potassium bromide]]
* [[Potassium chloride]]
* [[Potassium citrate]]
* [[Praziquantel]]
* [[Pregabalin]]
* [[Pregnancy]]
* [[Primaquine]]
* [[Procainamide]]
* [[Procarbazine]]
* [[Prochlorperazine]]
* [[Progesterone]]
* [[Prolactinoma]]
* [[Propiram]]
* [[Propylketobemidone]]
* [[Prosidol]]
* [[Protriptyline]]
* [[Pseudotumor cerebri]]
* [[Psychogenic]]
* [[Pulmonary embolism]]
* [[Pyelonephritis]]
* [[Pyloric stenosis]]
* [[Pyrazinamide]]
* [[Pyrantel pamoate]]
* [[Pyridostigmine]]
* [[Pyridoxine deficiency]]
* [[Q fever]]
* [[Quetiapine]]
* [[Quinidine]]
* [[Quinupristin/dalfopristin]]
* [[Radiation poisoning]]
* [[Radiation therapy]]
* [[Raised intracranial pressure]]
* [[Radium chloride]]
* [[Ramelteon]]
* [[Ranolazine]]
* [[Rasagiline]]
* [[Refractive error]]
* [[Renal colic]]
* [[Renal failure]]
* [[Renal insufficiency]]
* [[Reserpine]]
* [[Retroperitoneal fibrosis]]
* [[Reversible cerebral vasoconstriction syndrome]]
* [[Reye's syndrome]]
* [[Ribavirin]]
* [[Rifabutin]]
* [[Riluzole]]
* [[Risedronate]]
* [[Rituximab injection]]
* [[Rivastigmine]]
* [[Rizatriptan]]
* [[Rocky mountain spotted fever]]
* [[Ropinirole]]
* [[Rotavirus]]
* [[Rotigotine]]
* [[Roxithromycin]]
* [[Rubbing alcohol]]
* [[Rumination disorder]]
* [[Salicylate poisoning]]
* [[Salmonella]]
* [[Salpingitis]]
* [[Salsalate]]
* [[Saquinavir mesylate]]
* [[Sargramostim]]
* [[Sarin]]
* [[Sativex]]
* [[Scarlet fever]]
* [[Scleroderma]]
* [[Seasickness]]
* [[Secobarbital]]
* [[second-hand smoke]]
* [[Secretin human]]
* [[Seizure disorders]]
* [[Selective serotonin reuptake inhibitor]]
* [[Selegiline]]
* [[Seliciclib]]
* [[Sepsis]]
* [[Sexual fetish]]
* [[Shigella]]
* [[Sibutramine]]
* [[Sipuleucel-T]]
* [[Ski sickness]]
* [[Sleep deprivation]]
* [[Slone's disease]]
* [[Small bowel bacterial overgrowth syndrome]]
* [[Small bowel lymphoma]]
* [[Small bowel obstruction]]
* [[Small intestine cancer]]
* [[Smoke inhalation]]
* [[Snakebites]]
* [[Soapwort]]
* [[Sodium oxybate]]
* [[Sodium polystyrene sulfonate]]
* [[Sodium stibogluconate]]
* [[Sofosbuvir]]
* [[Solanine]]
* [[Somatization]]
* [[Spider bite]]
* [[Spironolactone]]
* [[Splenic infarction]]
* [[Sporotrichosis]]
* [[Spotted fever]]
* [[SSRI discontinuation syndrome]]
* [[Staphylococcal enteritis]]
* [[Starvation]]
* [[Stavudine]]
* [[Stomach cancer]]
* [[Streptococcal pharyngitis]]
* [[Stribild]] ([[Elvitegravir, Cobicistat, Emtricitabine, And Tenofovir Disoproxil Fumarate]])
* [[Strongyloidiasis]]
* [[Stiripentol]]
* [[Strep throat]]
* [[Streptozocin]]
* [[Subdural hematoma]]
* [[Sufentanil]]
* [[Sulfasalazine]]
* [[Sulfonamides]]
* [[Sulprostone]]
* [[Suicide attempt]]
* [[Sultiame]]
* [[Sumatriptan injection]]
* [[Sunitinib]]
* [[Suramin]]
* [[Syndrome of inappropriate antidiuretic hormone]] [[SIADH]]
* [[Tabes dorsalis]]
* [[Tacrine]]
* [[Tacrolimus]]
* [[Tamoxifen]]
* [[Tapentadol]]
* [[Telavancin hydrochloride]]
* [[Telbivudine]]
* [[Telithromycin]]
* [[Tetracycline]]
* [[Temik]]
* [[Temozolomide]]
* [[Teniposide]]
* [[Testicular rupture]]
* [[Testicular torsion]]
* [[Tetanus, Diphtheria, and Pertussis (Tdap) Vaccine]]
* [[Tetracaine]]
* [[Tetrahydrocannabinol]]
* [[Tetrahydrozoline]]
* [[Tetramethylsuccinonitrile]]
* [[Tetrodotoxin]]
* [[Thallium]]
* [[Theobromine]]
* [[Theophylline]]
* [[Thiabendazole]]
* [[Thiethylperazine]]
* [[Thioguanine]]
* [[Thiotepa]]
* [[Thrombotic thrombocytopenic purpura]]
* [[Thyroid Medication (patient information)|Thyroid medication]]
* [[Thyrotoxicosis]]
* [[Tigecycline]]
* [[smoking|Tobacco smoking]]
* [[Tocopherol]]
* [[Tolmetin]]
* [[Topiramate]]
* [[Topotecan Hydrochloride|Topotecan Hydrochloride]]
* [[Toxic ingestion]]
* [[Toxidrome]]
* [[Tralomethrin]]
* [[Tramadol]]
* [[Trametinib dimethyl sulfoxide]]
* [[Trandolapril]]
* [[Tranexamic acid]]
* [[Trastuzumab]]
* [[Traumatic brain injury]]
* [[Traveler's diarrhea]]
* [[Trazodone]]
* [[Tretinoin]]
* [[Triamterene]]
* [[Triazolam]]
* [[Trichuriasis]]
* [[Triclofos]]
* [[Tricyclic antidepressant]]
* [[Trifluoperazine]]
* [[Trifluoromethylphenylpiperazine]]
* [[Trimeperidine]]
* [[Trimethobenzamide]]
* [[Trimetrexate glucuronate]]
* [[Tropisetron]]
* [[Trovafloxacin mesylate]]
* [[Tularemia]]
* [[Tumors]]
* [[Twisted ovarian cyst]]
* [[Typhoid Vaccine (patient information)|Typhoid Vaccine]]
* [[Typhus]]
* [[Ulcers]]
* [[Urea cycle disorders]]
* [[Uremia]]
* [[Urinary tract infection]]
* [[Urofollitropin]]
* [[Urolithiasis]]
* [[Vagotomy]]
* [[Valaciclovir]]
* [[Valganciclovir hydrochloride]]
* [[Valproic Acid]]
* [[Varenicline]]
* [[Vasovagal syncope]]
* [[Venlafaxine]]
* [[Verapamil]]
* [[Vertebro-basilar syndrome]]
* [[Vertigo]]
* [[Vestibular balance disorder]]
* [[Vestibular neuronitis]]
* [[Vibrio parahaemolyticus]]
* [[Vicodin]]
* [[Vidarabine]]
* [[Vigabatrin]]
* [[Vilazodone]]
* [[Viloxazine]]
* [[Vinblastine]]
* [[Vinorelbine Tartrate]]
* [[Viral gastroenteritis]]
* [[emotion|Violent emotions]]
* [[Cough|Violent fits of coughing]]
* [[hiccups|Violent fits of coughing]]
* [[Vitamin A]]
* [[Vitamin C]]
* [[Vitamin D]]
* [[Volvulus]]
* [[Von Willebrand factor]]
* [[Voriconazole]]
* [[Vorinostat]]
* [[Vortioxetine]]
* [[Water intoxication]]
* [[Waterborne diseases]]
* [[West Nile virus]]
* [[Yellow fever]]
* [[Zanamivir Inhalation]]
* [[Zidovudine]]
* [[Ziprasidone]]
* [[Zollinger-Ellison Syndrome]]
* [[Zolpidem]]
* [[Zopiclone]]

}}

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Emergency medicine]]
[[Category:Gastroenterology]]
[[Category:Obstetrics]]
[[Category:Crowdiagnosis]]

Nausea and vomiting classification

2021-01-28T02:54:14Z

Shaik Aisha sultana: /* Classification */

__NOTOC__
{{Nausea and vomiting}}
==Overview==
Nausea and vomiting can be classified into acute or chronic

====[[Acute nausea and vomiting]]====
[[Acute vomiting]] which typically lasts from a few hours to few days is the most common presentation in the emergency department. [[Acute vomiting ]]needs an extensive workup to exclude life-threatening conditions like [[bowel obstruction]], [[mesenteric ischemia]], [[acute pancreatitis]], and possibly [[myocardial infarction]].

====[[Chronic nausea and vomiting]]====
[[Chronic vomiting]] which lasts from weeks to months is initially evaluated in an outpatient setting. [[Cyclical vomiting syndrome ]]is the most common cause of chronic nausea and vomiting.

==Classification==
Based on the duration of symptoms it can be classified as

====Acute:====
[[Acute nausea and vomiting]] can be caused by food allergies,[[ viral gastroenteritis | viral gastroenteritis etc]]

It typically lasts from few hours to few days

====Chronic:====
[[Chronic nausea, vomiting]] can last from weeks to months. <ref name="pmid29545633">{{cite journal |vauthors=Lacy BE, Parkman HP, Camilleri M |title=Chronic nausea and vomiting: evaluation and treatment |journal=Am J Gastroenterol |volume=113 |issue=5 |pages=647–659 |date=May 2018 |pmid=29545633 |doi=10.1038/s41395-018-0039-2 |url=}}</ref>

Chemotherapy is one of the most common cause of nausea and vomiting, and

===Chemotherapy induced nausea and vomiting can be classified as===

====Acute:====
Acute [[Chemotherapy induced nausea and vomiting]] (CINV) occur with in 24 hours of [[chemotherapy]] administration

====Delayed:====
Delayed CINV can occur at least 24 hours after chemotherapy and peaks between 48-72 hours <ref name="pmid15352652">{{cite journal |vauthors=Navari RM |title=Pathogenesis-based treatment of chemotherapy-induced nausea and vomiting--two new agents |journal=J Support Oncol |volume=1 |issue=2 |pages=89–103 |date=2003 |pmid=15352652 |doi= |url=}}</ref>

====Anticipatory:====
Nausea and vomiting that is triggered by stimuli associated with[[ chemotherapy]] and can be due to prior poor control of nausea and vomiting during chemotherapy <ref>{{cite journal|doi=10.1002/j.1875-9114.1990.tb02560.x}}</ref>
<ref name="pmid15661543">{{cite journal |vauthors=Jordan K, Kasper C, Schmoll HJ |title=Chemotherapy-induced nausea and vomiting: current and new standards in the antiemetic prophylaxis and treatment |journal=Eur J Cancer |volume=41 |issue=2 |pages=199–205 |date=January 2005 |pmid=15661543 |doi=10.1016/j.ejca.2004.09.026 |url=}}</ref>

====Refractory:====
[[CINV]] that occurs despite maximum [[antiemetics]]

====Breakthrough:====
CINV that occurs within 5 days of chemotherapy despite of [[antiemetics]]. May require [[rescue therapy]] 

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Emergency medicine]]
[[Category:Gastroenterology]]
[[Category:Obstetrics]]
[[Category:Needs content]]

Nausea and vomiting differential diagnosis

2021-01-28T02:48:04Z

Shaik Aisha sultana: /* Differential diagnosis */

__NOTOC__
{{Nausea and vomiting}}
==Overview==
Differential diagnosis of vomiting may be a result of a range of causes, including GI (obstructive and inflammatory) etiologies, CNS disease, pulmonary problems, renal disease, endocrine/metabolic disorders, drugs (either as side effects or in over dosages), psychiatric disorders, strep throat, pregnancy or stress.

==Differential diagnosis==
The causes of nausea and vomiting can be differentiated as GI and Non GI causes:

===GI causes===

====[[Inflammatory]]:====
[[Esophagitis]]

[[Gastritis]]

[[Hepatitis]]

[[Enteritis]]

[[Pancreatitis]]

====[[Obstructive]]:====
Esophageal [[malignancies]]

[[Gastric outlet obstruction ]] , may be due to[[ malignancy]]

[[Pyloric stenosis]]

Strangulated [[hernia]]s

Small bowel obstruction due to[[ adhesion]],[[ intussusception]] or[[ volvulus]]

[[Diverticulitis]]

====Functional:====
[[Esophageal dysmotility]]

[[Achalasia Cardia]]

[[Gastroparesis]] due to [[autonomic dysfunction]]

[[Ileus]]-[[ Hypokalemia]]

[[Ogilvie Syndrome]]

===Non GI causes can be===

====CNS causes:====
[[Migraine]]

[[Pseudotumor cerebri]]

[[Meningitis]]

Space occupying lesions

[[Labrynthitis]]

====Metabolic:====
Acidosis- [[DK]]A, [[Lactic acidosis]]

====Others:====
[[Alcoholism]]

[[Chemotherapy]]

[[Opiate]] therapy

[[Antibiotics]]

[[Pregnancy]]

[[Sea sickness]]

 

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Emergency medicine]]
[[Category:Gastroenterology]]
[[Category:Obstetrics]]
[[Category:Needs content]]

Nausea and vomiting differential diagnosis

2021-01-28T02:47:36Z

Shaik Aisha sultana: /* Others: */

__NOTOC__
{{Nausea and vomiting}}
==Overview==
Differential diagnosis of vomiting may be a result of a range of causes, including GI (obstructive and inflammatory) etiologies, CNS disease, pulmonary problems, renal disease, endocrine/metabolic disorders, drugs (either as side effects or in over dosages), psychiatric disorders, strep throat, pregnancy or stress.

==Differential diagnosis==
The causes of nausea and vomiting can be differentiated as GI and Non GI causes:

===GI causes===

====[[Inflammatory]]:====
[[Esophagitis]]

[[Gastritis]]

[[Hepatitis]]

[[Enteritis]]

[[Pancreatitis]]

====[[Obstructive]]:====
Esophageal [[malignancies]]

[[Gastric outlet obstruction ]] , may be due to[[ malignancy]]

[[Pyloric stenosis]]

Strangulated [[hernia]]s

Small bowel obstruction due to[[ adhesion]],[[ intussusception]] or[[ volvulus]]

[[Diverticulitis]]

====Functional:====
[[Esophageal dysmotility]]

[[Achalasia Cardia]]

[[Gastroparesis]] due to [[autonomic dysfunction]]

[[Ileus]]-[[ Hypokalemia]]

[[Ogilvie Syndrome]]

===Non GI causes can be===

====CNS causes:====
[[Migraine]]

[[Pseudotumor cerebri]]

[[Meningitis]]

Space occupying lesions

[[Labrynthitis]]

====Metabolic:====
Acidosis- [[DK]]A, [[Lactic acidosis]]

====Others:====
[[Alcoholism]]

[[Chemotherapy]]

[[Opiate]] therapy

[[Antibiotics]]

[[Pregnancy]]

Sea sickness

 

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Emergency medicine]]
[[Category:Gastroenterology]]
[[Category:Obstetrics]]
[[Category:Needs content]]

Nausea and vomiting differential diagnosis

2021-01-28T02:47:05Z

Shaik Aisha sultana: /* Non GI causes can be */

__NOTOC__
{{Nausea and vomiting}}
==Overview==
Differential diagnosis of vomiting may be a result of a range of causes, including GI (obstructive and inflammatory) etiologies, CNS disease, pulmonary problems, renal disease, endocrine/metabolic disorders, drugs (either as side effects or in over dosages), psychiatric disorders, strep throat, pregnancy or stress.

==Differential diagnosis==
The causes of nausea and vomiting can be differentiated as GI and Non GI causes:

===GI causes===

====[[Inflammatory]]:====
[[Esophagitis]]

[[Gastritis]]

[[Hepatitis]]

[[Enteritis]]

[[Pancreatitis]]

====[[Obstructive]]:====
Esophageal [[malignancies]]

[[Gastric outlet obstruction ]] , may be due to[[ malignancy]]

[[Pyloric stenosis]]

Strangulated [[hernia]]s

Small bowel obstruction due to[[ adhesion]],[[ intussusception]] or[[ volvulus]]

[[Diverticulitis]]

====Functional:====
[[Esophageal dysmotility]]

[[Achalasia Cardia]]

[[Gastroparesis]] due to [[autonomic dysfunction]]

[[Ileus]]-[[ Hypokalemia]]

[[Ogilvie Syndrome]]

===Non GI causes can be===

====CNS causes:====
[[Migraine]]

[[Pseudotumor cerebri]]

[[Meningitis]]

Space occupying lesions

[[Labrynthitis]]

====Metabolic:====
Acidosis- [[DK]]A, [[Lactic acidosis]]

====Others:====
[[Alcoholism]]

[[Chemotherapy]]

[[Opiate]] therapy

[[Antibiotics]]

Pregnancy

Sea sickness

 

==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Emergency medicine]]
[[Category:Gastroenterology]]
[[Category:Obstetrics]]
[[Category:Needs content]]

Nausea and vomiting classification

2021-01-28T02:34:16Z

Shaik Aisha sultana: /* Acute: */

__NOTOC__
{{Nausea and vomiting}}
==Overview==
Nausea and vomiting can be classified into acute or chronic

====[[Acute nausea and vomiting]]====
[[Acute vomiting]] which typically lasts from a few hours to few days is the most common presentation in the emergency department. [[Acute vomiting ]]needs an extensive workup to exclude life-threatening conditions like [[bowel obstruction]], [[mesenteric ischemia]], [[acute pancreatitis]], and possibly [[myocardial infarction]].

====[[Chronic nausea and vomiting]]====
[[Chronic vomiting]] which lasts from weeks to months is initially evaluated in an outpatient setting. [[Cyclical vomiting syndrome ]]is the most common cause of chronic nausea and vomiting.

==Classification==
Based on the duration of symptoms it can be classified as

====Acute:====
[[Acute nausea and vomiting]] can be caused by food allergies,[[ viral gastroenteritis | viral gastroenteritis etc]]

It typically lasts from few hours to few days

====Chronic:====
[[Chronic nausea, vomiting]] can last from weeks to months. <ref name="pmid29545633">{{cite journal |vauthors=Lacy BE, Parkman HP, Camilleri M |title=Chronic nausea and vomiting: evaluation and treatment |journal=Am J Gastroenterol |volume=113 |issue=5 |pages=647–659 |date=May 2018 |pmid=29545633 |doi=10.1038/s41395-018-0039-2 |url=}}</ref>

Chemotherapy is one of the most common cause of nausea and vomiting, and

===Chemotherapy induced nausea and vomiting can be classified as===

====Acute:====
Acute [[Chemotherapy induced nausea and vomiting]] (CINV) occur with in 24 hours of [[chemotherapy]] administration

====Delayed:====
Delayed CINV can occur at least 24 hours after chemotherapy and peaks between 48-72 hours <ref name="pmid15352652">{{cite journal |vauthors=Navari RM |title=Pathogenesis-based treatment of chemotherapy-induced nausea and vomiting--two new agents |journal=J Support Oncol |volume=1 |issue=2 |pages=89–103 |date=2003 |pmid=15352652 |doi= |url=}}</ref>

====Anticipatory:====
Nausea and vomiting that is triggered by stimuli associated with[[ chemotherapy]] and can be due to prior poor control of nausea and vomiting during chemotherapy <ref name="pmid15661543">{{cite journal |vauthors=Jordan K, Kasper C, Schmoll HJ |title=Chemotherapy-induced nausea and vomiting: current and new standards in the antiemetic prophylaxis and treatment |journal=Eur J Cancer |volume=41 |issue=2 |pages=199–205 |date=January 2005 |pmid=15661543 |doi=10.1016/j.ejca.2004.09.026 |url=}}</ref>

====Refractory:====
[[CINV]] that occurs despite maximum [[antiemetics]]

====Breakthrough:====
CINV that occurs within 5 days of chemotherapy despite of [[antiemetics]]. May require [[rescue therapy]] 
==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Emergency medicine]]
[[Category:Gastroenterology]]
[[Category:Obstetrics]]
[[Category:Needs content]]

Nausea and vomiting classification

2021-01-28T02:32:53Z

Shaik Aisha sultana:

__NOTOC__
{{Nausea and vomiting}}
==Overview==
Nausea and vomiting can be classified into acute or chronic

====[[Acute nausea and vomiting]]====
[[Acute vomiting]] which typically lasts from a few hours to few days is the most common presentation in the emergency department. [[Acute vomiting ]]needs an extensive workup to exclude life-threatening conditions like [[bowel obstruction]], [[mesenteric ischemia]], [[acute pancreatitis]], and possibly [[myocardial infarction]].

====[[Chronic nausea and vomiting]]====
[[Chronic vomiting]] which lasts from weeks to months is initially evaluated in an outpatient setting. [[Cyclical vomiting syndrome ]]is the most common cause of chronic nausea and vomiting.

==Classification==
Based on the duration of symptoms it can be classified as

====Acute:====
[[Acute nausea and vomiting]] can be caused by food allergies,[[ viral gastroenteritis ]]et.

It typically lasts from few hours to few days

====Chronic:====
[[Chronic nausea, vomiting]] can last from weeks to months. <ref name="pmid29545633">{{cite journal |vauthors=Lacy BE, Parkman HP, Camilleri M |title=Chronic nausea and vomiting: evaluation and treatment |journal=Am J Gastroenterol |volume=113 |issue=5 |pages=647–659 |date=May 2018 |pmid=29545633 |doi=10.1038/s41395-018-0039-2 |url=}}</ref>

Chemotherapy is one of the most common cause of nausea and vomiting, and

===Chemotherapy induced nausea and vomiting can be classified as===

====Acute:====
Acute [[Chemotherapy induced nausea and vomiting]] (CINV) occur with in 24 hours of [[chemotherapy]] administration

====Delayed:====
Delayed CINV can occur at least 24 hours after chemotherapy and peaks between 48-72 hours <ref name="pmid15352652">{{cite journal |vauthors=Navari RM |title=Pathogenesis-based treatment of chemotherapy-induced nausea and vomiting--two new agents |journal=J Support Oncol |volume=1 |issue=2 |pages=89–103 |date=2003 |pmid=15352652 |doi= |url=}}</ref>

====Anticipatory:====
Nausea and vomiting that is triggered by stimuli associated with[[ chemotherapy]] and can be due to prior poor control of nausea and vomiting during chemotherapy <ref name="pmid15661543">{{cite journal |vauthors=Jordan K, Kasper C, Schmoll HJ |title=Chemotherapy-induced nausea and vomiting: current and new standards in the antiemetic prophylaxis and treatment |journal=Eur J Cancer |volume=41 |issue=2 |pages=199–205 |date=January 2005 |pmid=15661543 |doi=10.1016/j.ejca.2004.09.026 |url=}}</ref>

==== Refractory: ====
[[CINV]] that occurs despite maximum [[antiemetics]]

==== Breakthrough: ====
CINV that occurs within 5 days of chemotherapy despite of [[antiemetics]]. May require [[rescue therapy]] 
==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Emergency medicine]]
[[Category:Gastroenterology]]
[[Category:Obstetrics]]
[[Category:Needs content]]

Nausea and vomiting classification

2021-01-28T02:29:14Z

Shaik Aisha sultana: /* Classification */

__NOTOC__
{{Nausea and vomiting}}
==Overview==
Nausea and vomiting can be classified into acute or chronic

====Acute nausea and vomiting====
Acute vomiting which typically lasts from a few hours to few days is the most common presentation in the emergency department. Acute vomiting needs an extensive workup to exclude life-threatening conditions like bowel obstruction, mesenteric ischemia, acute pancreatitis, and possibly myocardial infarction.

====Chronic nausea and vomiting====
Chronic vomiting which lasts from weeks to months is initially evaluated in an outpatient setting. Cyclical vomiting syndrome is the most common cause of chronic nausea and vomiting.

==Classification==
Based on the duration of symptoms it can be classified as

====Acute:====
Acute nausea and vomiting can be caused by food allergies, viral gastroenteritis et.

It typically lasts from few hours to few days

====Chronic:====
Chronic nausea vomiting can last from weeks to months. <ref name="pmid29545633">{{cite journal |vauthors=Lacy BE, Parkman HP, Camilleri M |title=Chronic nausea and vomiting: evaluation and treatment |journal=Am J Gastroenterol |volume=113 |issue=5 |pages=647–659 |date=May 2018 |pmid=29545633 |doi=10.1038/s41395-018-0039-2 |url=}}</ref>

Chemotherapy is one of the most common cause of nausea and vomiting, and

===Chemotherapy induced nausea and vomiting can be classified as===

====Acute:====
Acute Chemotherapy induced nausea and vomiting (CINV) occur with in 24 hours of chemotherapy administration

====Delayed:====
Delayed CINV can occur at least 24 hours after chemotherapy and peaks between 48-72 hours <ref name="pmid15352652">{{cite journal |vauthors=Navari RM |title=Pathogenesis-based treatment of chemotherapy-induced nausea and vomiting--two new agents |journal=J Support Oncol |volume=1 |issue=2 |pages=89–103 |date=2003 |pmid=15352652 |doi= |url=}}</ref>

====Anticipatory:====
Nausea and vomiting that is triggered by stimuli associated with chemotherapy and can be due to prior poor control of nausea and vomiting during chemotherapy <ref name="pmid15661543">{{cite journal |vauthors=Jordan K, Kasper C, Schmoll HJ |title=Chemotherapy-induced nausea and vomiting: current and new standards in the antiemetic prophylaxis and treatment |journal=Eur J Cancer |volume=41 |issue=2 |pages=199–205 |date=January 2005 |pmid=15661543 |doi=10.1016/j.ejca.2004.09.026 |url=}}</ref>

==== Refractory: ====
CINV that occurs despite maximum antiemetics

==== Breakthrough: ====
CINV that occurs within 5 days of chemotherapy despite of antiemetics. May require rescue therapy 
==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Emergency medicine]]
[[Category:Gastroenterology]]
[[Category:Obstetrics]]
[[Category:Needs content]]

Nausea and vomiting classification

2021-01-28T02:15:41Z

Shaik Aisha sultana:

__NOTOC__
{{Nausea and vomiting}}
==Overview==
Nausea and vomiting can be classified into acute or chronic

====Acute nausea and vomiting====
Acute vomiting which typically lasts from a few hours to few days is the most common presentation in the emergency department. Acute vomiting needs an extensive workup to exclude life-threatening conditions like bowel obstruction, mesenteric ischemia, acute pancreatitis, and possibly myocardial infarction.

====Chronic nausea and vomiting====
Chronic vomiting which lasts from weeks to months is initially evaluated in an outpatient setting. Cyclical vomiting syndrome is the most common cause of chronic nausea and vomiting.

==Classification==
Based on the duration of symptoms it can be classified as

==== Acute ====

==== Chronic ====
<ref name="pmid29545633">{{cite journal |vauthors=Lacy BE, Parkman HP, Camilleri M |title=Chronic nausea and vomiting: evaluation and treatment |journal=Am J Gastroenterol |volume=113 |issue=5 |pages=647–659 |date=May 2018 |pmid=29545633 |doi=10.1038/s41395-018-0039-2 |url=}}</ref>
Chemotherapy is one of the most common cause of nausea and vomiting, and

=== Chemotherapy induced nausea and vomiting can be classified as ===

==== Acute ====

==== Delayed ====
<ref name="pmid15352652">{{cite journal |vauthors=Navari RM |title=Pathogenesis-based treatment of chemotherapy-induced nausea and vomiting--two new agents |journal=J Support Oncol |volume=1 |issue=2 |pages=89–103 |date=2003 |pmid=15352652 |doi= |url=}}</ref>

==== Anticipatory ====
<ref name="pmid15661543">{{cite journal |vauthors=Jordan K, Kasper C, Schmoll HJ |title=Chemotherapy-induced nausea and vomiting: current and new standards in the antiemetic prophylaxis and treatment |journal=Eur J Cancer |volume=41 |issue=2 |pages=199–205 |date=January 2005 |pmid=15661543 |doi=10.1016/j.ejca.2004.09.026 |url=}}</ref>
 
==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Emergency medicine]]
[[Category:Gastroenterology]]
[[Category:Obstetrics]]
[[Category:Needs content]]

Nausea and vomiting classification

2021-01-28T02:15:06Z

Shaik Aisha sultana:

__NOTOC__
{{Nausea and vomiting}}
==Overview==
Nausea and vomiting can be classified into acute or chronic

====Acute nausea and vomiting====
Acute vomiting which typically lasts from a few hours to few days is the most common presentation in the emergency department. Acute vomiting needs an extensive workup to exclude life-threatening conditions like bowel obstruction, mesenteric ischemia, acute pancreatitis, and possibly myocardial infarction.

====Chronic nausea and vomiting====
Chronic vomiting which lasts from weeks to months is initially evaluated in an outpatient setting. Cyclical vomiting syndrome is the most common cause of chronic nausea and vomiting.

==Classification==
Based on the duration of symptoms it can be classified as

==== Acute ====

==== Chronic ==== <ref name="pmid29545633">{{cite journal |vauthors=Lacy BE, Parkman HP, Camilleri M |title=Chronic nausea and vomiting: evaluation and treatment |journal=Am J Gastroenterol |volume=113 |issue=5 |pages=647–659 |date=May 2018 |pmid=29545633 |doi=10.1038/s41395-018-0039-2 |url=}}</ref>
Chemotherapy is one of the most common cause of nausea and vomiting, and

=== Chemotherapy induced nausea and vomiting can be classified as ===

==== Acute ====

==== Delayed ==== <ref name="pmid15352652">{{cite journal |vauthors=Navari RM |title=Pathogenesis-based treatment of chemotherapy-induced nausea and vomiting--two new agents |journal=J Support Oncol |volume=1 |issue=2 |pages=89–103 |date=2003 |pmid=15352652 |doi= |url=}}</ref>

==== Anticipatory ==== <ref name="pmid15661543">{{cite journal |vauthors=Jordan K, Kasper C, Schmoll HJ |title=Chemotherapy-induced nausea and vomiting: current and new standards in the antiemetic prophylaxis and treatment |journal=Eur J Cancer |volume=41 |issue=2 |pages=199–205 |date=January 2005 |pmid=15661543 |doi=10.1016/j.ejca.2004.09.026 |url=}}</ref>
 
==References==
{{reflist|2}}
{{WH}}
{{WS}}

[[Category:Emergency medicine]]
[[Category:Gastroenterology]]
[[Category:Obstetrics]]
[[Category:Needs content]]

Nausea and vomiting classification

2021-01-28T02:13:39Z

Shaik Aisha sultana: references

__NOTOC__
{{Nausea and vomiting}}
==Overview==
Nausea and vomiting can be classified into acute or chronic

====Acute nausea and vomiting====
Acute vomiting which typically lasts from a few hours to few days is the most common presentation in the emergency department. Acute vomiting needs an extensive workup to exclude life-threatening conditions like bowel obstruction, mesenteric ischemia, acute pancreatitis, and possibly myocardial infarction.

====Chronic nausea and vomiting====
Chronic vomiting which lasts from weeks to months is initially evaluated in an outpatient setting. Cyclical vomiting syndrome is the most common cause of chronic nausea and vomiting.

==Classification==
Based on the duration of symptoms it can be classified as

==== Acute ====

==== Chronic ====<ref name="pmid29545633">{{cite journal |vauthors=Lacy BE, Parkman HP, Camilleri M |title=Chronic nausea and vomiting: evaluation and treatment |journal=Am J Gastroenterol |volume=113 |issue=5 |pages=647–659 |date=May 2018 |pmid=29545633 |doi=10.1038/s41395-018-0039-2 |url=}}</ref>
Chemotherapy is one of the most common cause of nausea and vomiting, and

=== Chemotherapy induced nausea and vomiting can be classified as ===

==== Acute ====

==== Delayed ====<ref name="pmid15352652">{{cite journal |vauthors=Navari RM |title=Pathogenesis-based treatment of chemotherapy-induced nausea and vomiting--two new agents |journal=J Support Oncol |volume=1 |issue=2 |pages=89–103 |date=2003 |pmid=15352652 |doi= |url=}}</ref>

==== Anticipatory ====<ref name="pmid15661543">{{cite journal |vauthors=Jordan K, Kasper C, Schmoll HJ |title=Chemotherapy-induced nausea and vomiting: current and new standards in the antiemetic prophylaxis and treatment |journal=Eur J Cancer |volume=41 |issue=2 |pages=199–205 |date=January 2005 |pmid=15661543 |doi=10.1016/j.ejca.2004.09.026 |url=}}</ref>
 
==References==
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[[Category:Emergency medicine]]
[[Category:Gastroenterology]]
[[Category:Obstetrics]]
[[Category:Needs content]]

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