Emergency Strategy - How to treat hiccups
Emergency Strategy - How to treat hiccups
The initial steps of treatment include assessment of the airway, breathing and circulation. Any underlying causes are treated if known. Nasogastric tube is considered to relieve distention of the gastric. Other treatments include carotid sinus massage, removal of foreign bodies from the ear, stimulation of the posterior pharynx by catheter,digital rectal massage, application of the supraorbital pressure and use of the cotton swab for direct stimulation of the uvula. Medication such as haloperidol, metoclopramide, chlorpromazine, gabapentin, baclofen, phenytoin, amitriptylline and lidocaine nebulizer. Alternative therapies include accupuncture,behavioral modification, psychiatric evaluation, hypnosis and phrenic nerve crush, phrenic nerve block and phrenic nerve transection.
Natural remedies may also applied and include rebreathing into a paper bag, fright, lemon bitting, valsalva maneuver, breath holding, traction of the tongue, noxious stimuli, drinking from the side of the glass. using cols spoon to lift the uvula, swallowing peanut butter, swallowing spoon of sugar and sucking the hard candy.
Patient is admitted to the hospital if hiccups interfere with daily life and lead to aspiration, loss of weight, malnutrition, decrease intake of fluid, sleep disturbance ( insomnia) , and dehiscence of the wound. Underlying organic disorders are associated with cases of protracted hiccups.
Hiccups usually last for few minutes or seconds and occur at a brief intervals. Organic disorders are suspected if hiccups last more than 48 hours. Hiccups are sounds abruptly present at the end of the inspiration phase. It is important to elicit previous episodes of hiccups and how to treat it in the past. Complete examination of the cardio, respiratory, gastrointestinal, neurological, head, throat, and neck are performed. Eructation remain the sole differential diagnosis of hiccups.
The investigation require are full blood count, urea and electrolytes and chest radiography.
What is hiccups? Hiccups is a sudden involuntary contraction of unilateral diaphragm and other muscle of inspiration. Closure of the glottis is abruptly terminate the contraction. Hiccups most commonly affect male than female. The frequency of hiccups are 40- 60 per minutes . Hiccups are classified into hiccup bout which last less than 48 hours, persistent hiccup which last for 48 hours to 1 months, intractable hiccups last more than 1 months. Hiccups occur due to stimulation of the reflex arc.In the upper spinal cord and brainstem located the hiccup center. Hiccups may occur due to irritation of phrenic nerves and vagus nerves.
The causes of hiccups are drugs ( narcotics, barbiturates, alcohol, chemotherapeutic agent, steroid, benzodiazepine, alpha methyl dopa, general anesthesia, antibiotics and tobacco), irritation of the diaphragm ( peritonitis, hepatomegaly, hiatal hernia, splenomegaly, pericarditis and intra abdominal mass) , cardio respiratory condition ( carcinoma ,tuberculosis, pneumonia, pericarditis, myocardial infarction, mediastinal lymphadenopathy and aortic aneurysm), psychological disorders ( malingering, excitement, conversion disorders, grief and stress), ENT ( mass on the neck, pharyngitis, foreign bodies in the tympanic membrane , retropharyngeal abscess, peritonsillar abscess, goiter and laryngitis ), gastrointestinal causes ( hepatoma, abdominal aortic aneurysm, cholecystitis, hepatitis, cholelithiasis, appendicitis, inflammatory bowel disorders, obstruction of the bowel, pancreatic carcinoma, pseudocyst, pancreatitis, gastric carcinoma, gastric ulcer, eating too fast, esophageal cancer, achalasia, esophageal candidiasis, gastroesophageal reflux and overeating), and CNS disorders ( ventriculoperitoneal shunt, Parkinson disease, hydrocephalus, multiple sclerosis, meningitis, encephalitis, abscess and arteriovenous malformations, hemorrhagic and ischemic stroke or head trauma ) as well as metabolic causes such as uremia,diabetes mellitus , gout, hypocalcemia and hyponatremia.
References
1.Kolodzik, Paul W., and Mark A. Filers. “Hiccups (Singultus): Review and Approach to Management.” Annals of Emergency Medicine 20, no. 5 (May 1991): 565–573.
2.Friedman, Nancy L. “Hiccups: A Treatment Review.” Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy 16, no. 6 (1996): 986–995. doi:10.1002/j.1875-9114.1996.tb03023.x.
3.Salem M, Baraka A, Rattenborg CC, and Holaday DA. “TReatment of Hiccups by Pharyngeal Stimulation in Anesthetized and Conscious Subjects.” JAMA 202, no. 1 (October 2, 1967): 32–36. doi:10.1001/jama.1967.03130140090014.
The initial steps of treatment include assessment of the airway, breathing and circulation. Any underlying causes are treated if known. Nasogastric tube is considered to relieve distention of the gastric. Other treatments include carotid sinus massage, removal of foreign bodies from the ear, stimulation of the posterior pharynx by catheter,digital rectal massage, application of the supraorbital pressure and use of the cotton swab for direct stimulation of the uvula. Medication such as haloperidol, metoclopramide, chlorpromazine, gabapentin, baclofen, phenytoin, amitriptylline and lidocaine nebulizer. Alternative therapies include accupuncture,behavioral modification, psychiatric evaluation, hypnosis and phrenic nerve crush, phrenic nerve block and phrenic nerve transection.
Natural remedies may also applied and include rebreathing into a paper bag, fright, lemon bitting, valsalva maneuver, breath holding, traction of the tongue, noxious stimuli, drinking from the side of the glass. using cols spoon to lift the uvula, swallowing peanut butter, swallowing spoon of sugar and sucking the hard candy.
Patient is admitted to the hospital if hiccups interfere with daily life and lead to aspiration, loss of weight, malnutrition, decrease intake of fluid, sleep disturbance ( insomnia) , and dehiscence of the wound. Underlying organic disorders are associated with cases of protracted hiccups.
Hiccups usually last for few minutes or seconds and occur at a brief intervals. Organic disorders are suspected if hiccups last more than 48 hours. Hiccups are sounds abruptly present at the end of the inspiration phase. It is important to elicit previous episodes of hiccups and how to treat it in the past. Complete examination of the cardio, respiratory, gastrointestinal, neurological, head, throat, and neck are performed. Eructation remain the sole differential diagnosis of hiccups.
The investigation require are full blood count, urea and electrolytes and chest radiography.
What is hiccups? Hiccups is a sudden involuntary contraction of unilateral diaphragm and other muscle of inspiration. Closure of the glottis is abruptly terminate the contraction. Hiccups most commonly affect male than female. The frequency of hiccups are 40- 60 per minutes . Hiccups are classified into hiccup bout which last less than 48 hours, persistent hiccup which last for 48 hours to 1 months, intractable hiccups last more than 1 months. Hiccups occur due to stimulation of the reflex arc.In the upper spinal cord and brainstem located the hiccup center. Hiccups may occur due to irritation of phrenic nerves and vagus nerves.
The causes of hiccups are drugs ( narcotics, barbiturates, alcohol, chemotherapeutic agent, steroid, benzodiazepine, alpha methyl dopa, general anesthesia, antibiotics and tobacco), irritation of the diaphragm ( peritonitis, hepatomegaly, hiatal hernia, splenomegaly, pericarditis and intra abdominal mass) , cardio respiratory condition ( carcinoma ,tuberculosis, pneumonia, pericarditis, myocardial infarction, mediastinal lymphadenopathy and aortic aneurysm), psychological disorders ( malingering, excitement, conversion disorders, grief and stress), ENT ( mass on the neck, pharyngitis, foreign bodies in the tympanic membrane , retropharyngeal abscess, peritonsillar abscess, goiter and laryngitis ), gastrointestinal causes ( hepatoma, abdominal aortic aneurysm, cholecystitis, hepatitis, cholelithiasis, appendicitis, inflammatory bowel disorders, obstruction of the bowel, pancreatic carcinoma, pseudocyst, pancreatitis, gastric carcinoma, gastric ulcer, eating too fast, esophageal cancer, achalasia, esophageal candidiasis, gastroesophageal reflux and overeating), and CNS disorders ( ventriculoperitoneal shunt, Parkinson disease, hydrocephalus, multiple sclerosis, meningitis, encephalitis, abscess and arteriovenous malformations, hemorrhagic and ischemic stroke or head trauma ) as well as metabolic causes such as uremia,diabetes mellitus , gout, hypocalcemia and hyponatremia.
References
1.Kolodzik, Paul W., and Mark A. Filers. “Hiccups (Singultus): Review and Approach to Management.” Annals of Emergency Medicine 20, no. 5 (May 1991): 565–573.
2.Friedman, Nancy L. “Hiccups: A Treatment Review.” Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy 16, no. 6 (1996): 986–995. doi:10.1002/j.1875-9114.1996.tb03023.x.
3.Salem M, Baraka A, Rattenborg CC, and Holaday DA. “TReatment of Hiccups by Pharyngeal Stimulation in Anesthetized and Conscious Subjects.” JAMA 202, no. 1 (October 2, 1967): 32–36. doi:10.1001/jama.1967.03130140090014.
