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group_1_presentation_2_-_hiccups [2019/03/08 23:48] chens60 [The Heimlich maneuver] |
group_1_presentation_2_-_hiccups [2019/03/09 00:00] (current) chens60 [The Heimlich maneuver] |
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| - | <box 46% round | > {{ :brain.jpg?450 |}} </box| Figure 4: Components of the brain.> | + | <box 46% round | > {{ :brain.jpg?450 |}} </box| Figure 4: Components of the brain in an individual with a central nervous system disorder.> |
| ===== Metabolic Disorders ===== | ===== Metabolic Disorders ===== | ||
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| ==== Breathing into a bag and breath holding ==== | ==== Breathing into a bag and breath holding ==== | ||
| - | The mechanism behind this is that hiccups most often begin during inspiration and are inhibited by elevations in PaCO2. Breath holding and breathing into a paper bag are thought to restore normal phrenic nervous rhythms (Ropper & Samuels 2009 and Aldrich & Tso 2005). A study done by Morris et al. (2004) tested breath holding as a means to terminate hiccups in 6 pregnant women. Using the technique of supra-supramaximal inspiration, it was postulated that this technique may terminate spasmodic diaphragm contractions by effectively immobilising the diaphragm for 20 seconds, while also increasing PaCO2. Lung expansion may also cause a reflex reduction in phrenic nerve tonicity (Morris et al. 2004). | + | The mechanism behind this is that hiccups most often begin during inspiration and are inhibited by elevations in PaCO2. Breath holding and breathing into a paper bag are thought to restore normal phrenic nervous rhythms (Ropper & Samuels 2009 and Aldrich & Tso 2005). A study done by Morris et al. (2004) tested breath holding as a means to terminate hiccups in 6 pregnant women. Using the technique of supra-supramaximal inspiration, it was postulated that this technique may terminate spasmodic diaphragm contractions by effectively immobilising the diaphragm for 20 seconds, while also increasing PaCO2. Lung expansion may also cause a reflex reduction in phrenic nerve tonicity (Morris et al., 2004). |
| - | <box 40% round | > {{ :bag.jpg?340 |}} </box| Figure 6: Bhild blowing into paper bag.> | + | <box 40% round | > {{ :bag.jpg?340 |}} </box| Figure 6: Child breathing into paper bag.> |
| ==== Eating a lemon wedge saturated in Angostura bitters ==== | ==== Eating a lemon wedge saturated in Angostura bitters ==== | ||
| - | This study included 16 participants, and was only tested on hiccups induced by ethanol (i.e. ingestion of alcohol). A lemon wedge saturated in Angostura bitters was orally administered. There was an 88% success rate (14 out of 16 participants), with the two cases where the treatment failed, the hiccups were overcome after a second treatment. The results confirm “anecdotal success” (Herman & Nolan 1654). | + | This study included 16 participants, and was only tested on hiccups induced by ethanol (i.e. ingestion of alcohol). A lemon wedge saturated in Angostura bitters was orally administered. There was an 88% success rate (14 out of 16 participants), with the two cases where the treatment failed, the hiccups were overcome after a second treatment. The results confirm “anecdotal success” (Herman & Nolan, 1654). |
| ==== Intranasal vinegar ==== | ==== Intranasal vinegar ==== | ||
| Success of intranasal vinegar instillation was seen in a patient with tracheostomy related hiccup. | Success of intranasal vinegar instillation was seen in a patient with tracheostomy related hiccup. | ||
| - | Nose drops of small amounts of vinegar was used to stimulate the dorsal pharynx at the supplied area of afferent branches of the hiccup reflex arc and was seen to be effective. Intranasal vinegar might stimulate dorsal wall of nasopharynx where the pharyngeal branch of the glossopharyngeal nerve, which is thought as an afferent of the reflex arch of hiccup, is distributed. This method is a safe and convenient to stimulate the dorsal wall of the nasopharynx (Iwasaki et al. 2007). | + | Nose drops of small amounts of vinegar was used to stimulate the dorsal pharynx at the supplied area of afferent branches of the hiccup reflex arc and was seen to be effective. Intranasal vinegar might stimulate dorsal wall of nasopharynx where the pharyngeal branch of the glossopharyngeal nerve, which is thought as an afferent of the reflex arch of hiccup, is distributed. This method is a safe and convenient to stimulate the dorsal wall of the nasopharynx (Iwasaki et al., 2007). |
| ==== The Heimlich maneuver ==== | ==== The Heimlich maneuver ==== | ||
| - | This study used the Heimlich maneuver, usually utilized to expel aspirated water, vomitus, debris, and other foreign matter to stabilize the diaphragmatic spasms in hiccups. This procedure elevates the diaphragm, increasing intrathoracic pressure and compressing the lungs (Heimlich & Patrick 1988). A modified Heimlich maneuver with 3 thrusts delivered at 10 second intervals was used and seen to be effective in terminating the hiccup immediately. Presumably, this maneuver caused the cessation of the diaphragmatic contractions responsible for the hiccups (Heymann 2003). | + | This study used the Heimlich maneuver, usually utilized to expel aspirated water, vomitus, debris, and other foreign matter to stabilize the diaphragmatic spasms in hiccups. This procedure elevates the diaphragm, increasing intrathoracic pressure and compressing the lungs (Heimlich & Patrick, 1988). A modified Heimlich maneuver with 3 thrusts delivered at 10-second intervals was used and seen to be effective in terminating the hiccup immediately. Presumably, this maneuver caused the cessation of the diaphragmatic contractions responsible for the hiccups (Heymann, 2003). |
| - | Other approaches with rare reports of effectiveness for intractable hiccups include hypnosis, acupuncture, and even surgery. Two examples surgical procedures are a “nerve block” that stops the phrenic nerve (the major nerve supply for the diaphragm) from sending signals so that the diaphragm stops contracting, and implantation of a pacemaker that results in more rhythmic contractions of the diaphragm (The Myth and Mystery of Hiccups. n.d.). | + | Other approaches with rare reports of effectiveness for intractable hiccups include hypnosis, acupuncture, and even surgery. Two examples surgical procedures are a “nerve block” that stops the phrenic nerve (the major nerve supply for the diaphragm) from sending signals so that the diaphragm stops contracting, and implantation of a pacemaker that results in more rhythmic contractions of the diaphragm (The Myth and Mystery of Hiccups., n.d.). |
| - | These measures seem to be most effective in transient hiccups and are less effective with persistent hiccups, but it is hard to know if the treatments are really effective or not because they typically resolve themselves, and there is not enough scientific evidence or research yet to back up any of these claims (Schuchmann & Browne 2007). With the research already been conducted on some of these treatments, a lot are anecdotal and have small sample sizes. Overall, these treatments are generally safe to use so it can be worth a try. These remedies may be very convenient and less hazardous, however, their effectiveness to treat serious hiccups are usually uncertain (Chang & Lu 2012). | + | These measures seem to be most effective in transient hiccups and are less effective with persistent hiccups, but it is hard to know if the treatments are really effective or not because they typically resolve themselves, and there is not enough scientific evidence or research yet to back up any of these claims (Schuchmann & Browne, 2007). With the research already been conducted on some of these treatments, a lot are anecdotal and have small sample sizes. Overall, these treatments are generally safe to use so it can be worth a try. These remedies may be very convenient and less hazardous, however, their effectiveness to treat serious hiccups are usually uncertain (Chang & Lu, 2012). |
| - | Some treatments that have less merit, and are more superstitious are curing hiccups with hypnosis and the superstition that hiccups are caused by hate (The Myth and Mystery of Hiccups. (n.d.) and Hindy 2014). An old wives’ tale asserts that you only have hiccups when someone is talking about you in a negative way (in Russia, it’s when someone is thinking about you in a good or bad way) and the only way to cure it is to guess the name of the person who is doing it (Hindy 2014). Of course these aren’t true, but again if you’re desperate it’s worth a try. | + | Some treatments that have less merit, and are more superstitious are curing hiccups with hypnosis and the superstition that hiccups are caused by hate (The Myth and Mystery of Hiccups. (n.d.) and Hindy, 2014). An old wives’ tale asserts that you only have hiccups when someone is talking about you in a negative way (in Russia, it’s when someone is thinking about you in a good or bad way) and the only way to cure it is to guess the name of the person who is doing it (Hindy, 2014). Of course these aren’t true, but again if you’re desperate it’s worth a try. |
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| ==== Chlorpromazine ==== | ==== Chlorpromazine ==== | ||
| This is the sole medication that is approved by the US Food and Drug Administration (Woelk, 2011). Because dopamine is a neurotransmitter known to be a part of the hiccup reflex, Chlorpromazine acts by behaving as a dopamine antagonist in the hypothalamus to reduce the effects of dopamine (Woelk, 2011). As a result, Chlorpromazine is evidently an antipsychotic that affects neural activity – impacting your mood, concentration, etc. (Nausheen, Mohsin, & Lakhan, 2016). However, there are many side effects including hypotension, urinary retention, glaucoma, and delirium (Woelk, 2011). The recommended doses necessary for the drug to work is 25 mg four times a day, or 50 mg four times a day if required (Nausheen, Mohsin, & Lakhan, 2016). Additionally, the method of administration is either intravenously, intramuscularly, or taken orally (Nausheen, Mohsin, & Lakhan, 2016). | This is the sole medication that is approved by the US Food and Drug Administration (Woelk, 2011). Because dopamine is a neurotransmitter known to be a part of the hiccup reflex, Chlorpromazine acts by behaving as a dopamine antagonist in the hypothalamus to reduce the effects of dopamine (Woelk, 2011). As a result, Chlorpromazine is evidently an antipsychotic that affects neural activity – impacting your mood, concentration, etc. (Nausheen, Mohsin, & Lakhan, 2016). However, there are many side effects including hypotension, urinary retention, glaucoma, and delirium (Woelk, 2011). The recommended doses necessary for the drug to work is 25 mg four times a day, or 50 mg four times a day if required (Nausheen, Mohsin, & Lakhan, 2016). Additionally, the method of administration is either intravenously, intramuscularly, or taken orally (Nausheen, Mohsin, & Lakhan, 2016). | ||
| - | {{ :chlor.jpg?350 |}} | + | |
| + | <box 35% round | > {{ :chlor.jpg?350 |}} </box| Figure 8: Chlorpromazine. > | ||
| ==== Haloperidol ==== | ==== Haloperidol ==== | ||
| Haloperidol is also shown to be effective in treating hiccups. Similar to Chlorpromazine, researchers assume that it plays a role as a dopamine antagonist (Woelk, 2011). | Haloperidol is also shown to be effective in treating hiccups. Similar to Chlorpromazine, researchers assume that it plays a role as a dopamine antagonist (Woelk, 2011). | ||
| - | {{ :hald.jpg?350 |}} | + | |
| + | <box 35% round | > {{ :hald.jpg?350 |}} </box| Figure 9: Haloperidol. > | ||
| ==== Metoclopramide ==== | ==== Metoclopramide ==== | ||
| Like chlorpromazine and haloperidol, Metoclopramide is a dopamine agonist; however, it is less effective as a dopamine antagonist (Woelk, 2011). | Like chlorpromazine and haloperidol, Metoclopramide is a dopamine agonist; however, it is less effective as a dopamine antagonist (Woelk, 2011). | ||
| - | {{ :meto.png?350 |}} | + | |
| + | <box 35% round | > {{ :meto.png?350 |}} </box| Figure 10: Metoclopramide. > | ||
| ==== Gabapentin ==== | ==== Gabapentin ==== | ||
| This is a drug that is used to decrease pain in individuals with cancer and is also used for neuropathic pain management (Woelk, 2011). The mechanism of Gabapentin in hiccups is not well understood; however researchers believe that it has the ability to block neural calcium channels and promote the release of GABA which modulates the excitability of the diaphragm (Woelk, 2011). There are no major side effects of this drug; however, it can cause temporary sleepiness (Woelk, 2011). | This is a drug that is used to decrease pain in individuals with cancer and is also used for neuropathic pain management (Woelk, 2011). The mechanism of Gabapentin in hiccups is not well understood; however researchers believe that it has the ability to block neural calcium channels and promote the release of GABA which modulates the excitability of the diaphragm (Woelk, 2011). There are no major side effects of this drug; however, it can cause temporary sleepiness (Woelk, 2011). | ||
| - | {{ :gabapen.jpg?350 |}} | + | |
| + | <box 35% round | > {{ :gabapen.jpg?350 |}} </box| Figure 11: Gabapentin. > | ||
| ==== Baclofen ==== | ==== Baclofen ==== | ||
| Baclofen is a structure that is similar to GABA and has the ability to reduce excitability and has the effect of preventing the hiccup reflex (Lee et al., 2010). It is expected that baclofen reduces the synaptic transmission at the spinal cord and has the ability to prevent muscle spasms associated with hiccups (Lee et al., 2010). Baclofen is taken orally and is absorbed quickly. It is eliminated from the body in about 3-4 hours by the kidney (Lee et al., 2010). Side effects of Baclofen include confusion, weakness, insomnia, etc. Researchers have also revealed that individuals get involuntary contractions if one stops using the drug. It is recommended that the dosages should be steadily lowered when one stops using this drug (Lee et al., 2010). | Baclofen is a structure that is similar to GABA and has the ability to reduce excitability and has the effect of preventing the hiccup reflex (Lee et al., 2010). It is expected that baclofen reduces the synaptic transmission at the spinal cord and has the ability to prevent muscle spasms associated with hiccups (Lee et al., 2010). Baclofen is taken orally and is absorbed quickly. It is eliminated from the body in about 3-4 hours by the kidney (Lee et al., 2010). Side effects of Baclofen include confusion, weakness, insomnia, etc. Researchers have also revealed that individuals get involuntary contractions if one stops using the drug. It is recommended that the dosages should be steadily lowered when one stops using this drug (Lee et al., 2010). | ||
| - | {{ :bac.jpg?350 |}} | + | <box 35% round | > {{ :bac.jpg?350 |}} </box| Figure 12: Baclofen. > |
| ====== Case Study ====== | ====== Case Study ====== | ||
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| From this case, it is essential to know that if pharmacological and non-pharmacological interventions have not succeeded in curing hiccups, the source of the hiccups might result from an exceptional case, which should be examined using additional diagnostic processes. | From this case, it is essential to know that if pharmacological and non-pharmacological interventions have not succeeded in curing hiccups, the source of the hiccups might result from an exceptional case, which should be examined using additional diagnostic processes. | ||
| - | {{ :screen_shot_2019-03-08_at_10.50.29_pm.png?400 |}} | + | |
| + | <box 40% round | > {{ :screen_shot_2019-03-08_at_10.50.29_pm.png?400 |}} </box| Figure 13: MRI of German soldier's brain before and after surgery. > | ||
| ====== Presentation Slides ====== | ====== Presentation Slides ====== | ||
