Additionally, pulse oximetry is associated with frequent false alarms and parental stress and fatigue. Clinicians may choose not to given additional oxygen to children with bronchiolitis if their oxygen saturation is above 90%. Additionally, clinicians may choose not to use continuous pulse oximetry in these people.When choosing to use oxygen therapy for a child with bronchiolitis, there is evidence that home oxygen may reduce hospitalization rate and length of stay although readmission rates and follow-up visits are increased. Also, the use of humidified, heated, high-flow nasal cannula may be a safe initial therapy to decrease work of breathing and need for intubation. However, evidence is lacking regarding the use of high-flow nasal cannula compared to standard oxygen therapy or continuous positive airway pressure. These practices may still be used in severe cases prior to intubation.Blood gas testing is not recommended for people hospitalized with the disease and is not useful in the routine management of bronchiolitis. People with severe worsening respiratory distress or impending respiratory failure may be considered for capillary blood gas testing. Hypertonic saline
Guidelines recommend against the use of nebulized hypertonic saline in the emergency department for children with bronchiolitis but it may be given to children who are hospitalized.Nebulized hypertonic saline (3%) has limited evidence of benefit and previous studies lack consistency and standardization. A 2017 review found tentative evidence that it reduces the risk of hospitalization, duration of hospital stay, and improved the severity of symptoms.
Hypothenar hammer syndrome (HHS) is a vascular occlusion in humans in the region of the ulna. It is caused by repetitive trauma to the hand or wrist (such as that caused by the use of a hammer) by the vulnerable portion of the ulnar artery as it passes over the hamate bone, which may result in thrombosis, irregularity or aneurysm formation. HHS is a potentially curable cause of Raynauds syndrome, distinct from hand–arm vibration syndrome. Cause
Diagnosis
A physical examination of the hand may show discoloration (blanching, mottling, and/ or cyanosis; gangrene  may be present in advanced cases), unusual tenderness/ a callous over the hypothenar eminence, and fingertip ulcerations and splinter hemorrhages over ulnar digits; if an aneurysm is present, there may also be a pulsatile mass. Allens test will be positive if an occlusion is present and negative if an aneurysm is present. An angiogram may show a "corkscrew" ulnar artery or an occlusion or aneurysm at the hook of the hamate. Treatment
Noninvasive treatments have an 80% success rate; Example: switch jobs, stop smoking, regular finger exercise, surgical options exist for other instances. Epidemiology
HHS, though rare, occurs much more frequently in men than in women (9:1) and principally affects those in their 40s and 50s. == References ==