Re: Case H3.98

[ Follow Ups ] [ Post Followup ] [ SSM Part 2 Forum ] [ FAQ ]

Posted by Dr. Wexler on March 05, 1998 at 19:20:08:

In Reply to: Case H3.98 posted by Stuart Holtby MD ABSM on March 03, 1998 at 19:33:24:

Nice challenge, Stuart!

In general, patient needs counceling on OSA,
treatment options, emphasis on CPAP for first-
line stabilization, and completion of the upper
airway physical exam to rule out localized sites
of obstruction. Weight loss and attention to
good sleep hygiene; avoid supine position. Pointed
discussion of safety issues (driving, etc) is
necessary.
RE: CPAP/BIPAP failure --> try other masks, refit,
so-on; serial desensitization
measures; start with getting used to mask awake
watching TV, etc. Consider Auto-PAP which may
afford a lower overall pressure profile across
the night. If PAP just wont fly --> supplemental
O2 at night as palliative measure. Consider UPPP
to (probably) lower the AHI unless patient has
multiple negative risk factors for failure (such
as severe retrognathia). Also consider oral
appliance to help, if not elminate, SDB. If
patient fails all, talk about trach especially
if CHF develops or if the condition is ruining
his life.

P.S. What's the right answer (ha-ha)?

Follow Ups:


Post a Followup

Name    : 
E-Mail  : 

Subject : 

Comments:

[ Follow Ups ] [ Post Followup ] [ SSM Part 2 Forum ] [ FAQ ]

WWWBoard 2.0a and WWWAdmin 2.0a © 1997, All Rights Reserved.
Matt Wright and DBasics Software Company