What Are the Complications of Inhalant Abuse?

Patient Presentation
A 10-year-old male was brought to the Emergency Department because of being unarousable. His 16-year-old sister found him in his bedroom, and couldn’t really arouse him and she called emergency services. Emergency services said that he became more alert during the transport. They described the residence as very messy and unhygienic. In his room they found several cans of various aerosols and e-cigarettes in a bag next to him. There were no adults at home so they also transported the 16-year-old and two other children. The past medical history given by the older sister said he was healthy and there were no significant family history. She denied any substance abuse in the household but said there were other apartments in the building that did.

The pertinent physical exam showed the vital signs were normal except for a heart rate range between 120-140. His respiratory rate was 20 without distress. He had some blue marks on his face, irritated eyes and rhinorrhea. His lungs were clear. His heart was tachycardic without murmurs. Abdomen and extremities were normal. He was awake with normal mentation in the ER but if left alone would want to sleep.

The work-up showed mildly elevated transaminases, but normal electrolytes, BUN, creatinine and urinalysis. Electrocardiogram showed sinus tachycardia. His creatinine kinase was normal. Toxicology eventually was normal. The patient’s clinical course showed he was admitted to the hospital for IV fluids, monitoring and further evaluation. During his hospitalization he said he had been trying various inhalants for a few weeks. He would do this usually late at night. He had tried e-cigarettes and beer as well but denied any other drugs. He and the other children were placed with a family member who lived close to the parents’ home while the Department of Human Services investigated. The Department offered a variety of services under the “child in need of services” pathway which included counseling for the children and parents. Longer term followup was not known.

Hydrocarbons (HC) are organic compounds that are abused because they produce a euphoric effect, usually quickly, are low cost and easily obtained. They are commonly abused by adolescents and use in the US is either stable or increasing.

Volatile HC rapidly distribute throughout the body which produces euphoria in seconds to minutes. There are 3 ways that HC are inhaled:

  • Sniffing – directly inhaling the HC from the container. This has the lowest HC concentration.
  • Huffing – a cloth is saturated with the HC and then the cloth is held to the nose and mouth and inhaled. This has a higher concentration than sniffing and lower than bagging.
  • Bagging – the HC is sprayed into an impermeable bag and then the bag is placed over the nose and mouth and inhaled, or the bag is placed over the entire head and inhaled. This has the highest HC concentration.

Common HC that are abused include:

  • Aliphatic (straight chain) – butane, gasoline, propane
  • Alkyl halides – aerosol cans, freon, paint strippers
  • Aromatic (cyclic) – adhesive, benzene, glues, spray paint, toluene, varnishes
  • Nitrites – air fresheners
  • Ethers/Ketones – adhesive, nail polish remover, paint

Ways to identify potential inhalant abuse includes stains of the substance used (i.e. paint), rashes around the mouth and/or nose, and signs of irritation of the mucous membranes of the head including conjunctivitis, sneezing, rhinitis, epistaxis, and sore throat. The lung is the most commonly affected organ.

Learning Point
Complications with hydrocarbon inhalants includes:

  • Cardiac – HC desensitize the myocardium to catecholamines and can lead to fatal arrhythmias
    • Arrhythmias
    • Myocarditis
    • Myocardial infarction
  • Central nervous system
    • Depression including delirium, obtundation and coma
    • Disinhibition and impulsiveness
    • Headache
    • Nausea
    • Numbness of extremities
    • Seizures
    • Visual changes – nystagmus is common, blurry vision
  • Electrolyte abnormalities
    • Hypokalemia
    • Metabolic acidosis
  • Pulmonary
    • Asphyxia – because of direct displacement of oxygen
    • Pneumonitis
  • Liver failure
  • Kidney failure
  • Rhabdomyolysis
  • Trauma – secondary to CNS affects can cause self-injury or accident
  • Co-morbid conditions – secondary to environment as other drugs may be being used or used in unsafe environments or circumstances, i.e. increased risk for Hepatitis B or HIV with intravenous drug abuse or prostitution

    Other substances can be smoked including various tobacco products, marijuana/THC and cocaine.
    Here the lung again is the most affected organ, as it acts as an important intermediary between the internal and external environments. It acts as a direct barrier and also is a conduit into the circulation.
    Pulmonary problems can include:

    • Cough
    • Bronchospasm
    • Hypersensitivity/allergic reaction
    • Foreign body aspiration
    • Irritation by small particulate matter
    • Pneumonia – aspiration and community acquired
    • Pulmonary edema
    • Acute lung injury/Acute respiratory distress syndrome
    • Barotrauma to the lung
    • Spontaneous pneumothorax or free air in other structures of the chest or spine
    • Pneumoconiosis due to inert substance inhalation such as talc or sand
    • Septic emboli
    • Thermal injury is less common but can occur

    EVALI stands for e-cigarette or vaping product use associated lung injury. There has been a recognized increase in risk of lung injury or death in the United States due to lung complications from these legal products but the underlying cause is not currently unknown. Also recognize that many of these same substances can be an accidental ingestion risk particularly for young children. You can review current EVALI news articles here.

    Questions for Further Discussion
    1. What is the morbidity rate for smoke inhalation? A review can be found here
    2. Describe the clinical and radiographic findings in “crack lung?”
    3. What are the local laws to help prevent inhalant and tobacco product abuse by minors?

    Related Cases

    To Learn More
    To view pediatric review articles on this topic from the past year check PubMed.

    Evidence-based medicine information on this topic can be found at SearchingPediatrics.com and the Cochrane Database of Systematic Reviews.

    Information prescriptions for patients can be found at MedlinePlus for these topics: Inhalants and Drugs and Young People.

    To view current news articles on this topic check Google News.

    To view images related to this topic check Google Images.

    To view videos related to this topic check YouTube Videos.

    Richmond SA, Pike I, Maguire JL, Macpherson A. E-cigarettes: A new hazard for children and adolescents. Paediatr Child Health. 2018;23(4):255-259. doi:10.1093/pch/pxx204

    Megarbane B, Chevillard L. The large spectrum of pulmonary complications following illicit drug use: features and mechanisms. Chem Biol Interact. 2013;206(3):444-451. doi:10.1016/j.cbi.2013.10.011

    Dingle HE, Williams SR. Multi-Organ System Injury from Inhalant Abuse. Prehospital Emergency Care. 2019;23:580-583. https://www.ncbi.nlm.nih.gov/pubmed/30320538. Accessed February 4, 2020.

    Outbreak of Lung Injury Associated with E-cigarette Use, or Vaping. What You Need to Know. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease/healthcare-providers/index.html. Published February 11, 2020. Accessed February 14, 2020.

    New CDC Report Provides First Analysis of Lung Injury Deaths Associated with Use of E-cigarette, or Vaping, Products. CDC. https://www.cdc.gov/media/releases/2019/p1028-first-analysis-lung-injury-deaths.html. Published October 28, 2019. Accessed February 14, 2020.

    Donna M. D’Alessandro, MD
    Professor of Pediatrics, University of Iowa

  • Fragile X in the Family

    Patient Presentation
    A 6-month-old male came to clinic with his mother. She said that he seemed to be developing normally, but was very concerned because her sister’s 3-year-old son had just been diagnosed with Fragile X syndrome during an evaluation for developmental delay. “They really don’t know much, just that they have a reason why he’s not normal. Looking back he’s always seemed a little different to me. He would look at me and other people a little differently and he just hasn’t been doing the things people would expect when he walks or talks. I’m really worried about my son. He’s not the same as my nephew but he’s also still little. Is there something we should do? Does he need to get tested for it,” she asked.

    The pertinent physical exam showed an alert and interactive male with normal vital signs and growth parameters in the 75-95%. His physical examination was normal. Developmentally he had good eye contact, seemed to hear appropriately, would sit without support, would pull a toy to him, change hands and mouth the toy, and would says vowel sounds responsively.

    The diagnosis of a healthy male was made. “At this time, he seems to be growing and developing appropriately and I’ll keep a close eye on him along with you. Fragile X can be passed from parents to their children. The best information is going to come from your sister. Once she knows more about her risks, then that will tell us more about your risks, and that of your son or other children you might have. At this time I don’t think we need to send him to a neurologist or developmental specialist but if he seems to be behind we can do that at any point. Also once we know more about your risks, I can have you talk with someone who will know more about it. Usually the people talking to your sister will also have recommendations for other family members like yourself. When you know more, let me know and we can decide together what to do,” the pediatrician said.

    Fragile X syndrome (FXS) was first clinically described in 1943 by Martin-Bell and in 1969 Lubs found a fragility at the terminal end of the X chromosome. In 1991, three different research groups independently cloned the mutation for the FMR1 gene (Fragile X mental retardation type 1) which has a CGG triplet expansion. The FMR1 gene codes for the FMR protein which is a major regulator of synaptic plasticity and is expressed in the brain and spermatogonia mainly but many other tissues during fetal and early neonatal development. The number of triplets and methylation correlates with clinical expression (increased numbers have increased clinical expression). It is an X-linked dominant gene with reduced penetrance. Overall it has an incidence of 1:4000 for males and 1:7000 in females.

    Learning Point
    FXS occurs from inactivation of the FMR1 gene. FXS is the most common cause of inherited intellectual disability. It is also a leading form of autism spectrum disorders. Patients may also have seizures, abnormal head movements, hyperactive behavior, and poor eye contact.

    FXS is suspected in patients with developmental delays and is diagnosed by polymerase chain reaction which can determine the number of CGG repeats as well as other genetic information that is important for genetic counseling. The number of repeats tends to increase in subsequent generations especially with repeats in the permutation zone. People with 6-44 repeats are considered normal. People with 45-54 are in a gray zone where the alleles can be stable or unstable. From 55-200 repeats is the permutation zone. People with >200 repeats have the full mutation.

    If the person is male, they have FXS. If they are female, 30-50% will be affected because of X-inactivation. FXS physical characteristics include “…elongated face, broad forehead, high palate, prominent ears, hyperextensible finger joints, flat feet and macroorchidism” but this is variable depending on age and ethnicity. Mitral valve prolapse, macrocephaly and scoliosis are also seen.

    Clinical problems seen with the permutation includes women with impaired reproductive systems with decreased fertility and early menopause, psychiatric disorders (anxiety, depression and increased stress), pain syndromes, hypertension, sleep apnea, hypothyroidism, vertigo and olfaction and hearing problems. There also seems to be higher rates of attention deficit hyperactivity disorder, social problems and/or autism spectrum disorder. Fragile X tremor/ataxis syndrome also is an identified clinical problem for certain individuals. All of these problems vary greatly depending on the individual.

    Gene therapy treatments are being evaluated, and medications targeting signal modulations are also being studied. Most treatment is a combination of behavioral, educational and medication to support and treat co-occurring problems.

    Questions for Further Discussion
    1. What is included in the differential diagnosis of intellectual disability?
    2. What can pediatricians do for families affected by rare diseases? A review can be found here
    3. Who can also provide genetic counseling if a genetic counselor is not available?
    4. What should be included in the differential diagnosis of intellectual disability?

    Related Cases

    To Learn More
    To view pediatric review articles on this topic from the past year check PubMed.

    Evidence-based medicine information on this topic can be found at SearchingPediatrics.com and the Cochrane Database of Systematic Reviews.

    Information prescriptions for patients can be found at MedlinePlus for these topics: Fragile X Syndrome and Birth Defects.

    To view current news articles on this topic check Google News.

    To view images related to this topic check Google Images.

    To view videos related to this topic check YouTube Videos.

    Mila M, Alvarez-Mora MI, Madrigal I, Rodriguez-Revenga L. Fragile X syndrome: An overview and update of the FMR1 gene. Clin Genet. 2018;93(2):197-205. doi:10.1111/cge.13075

    Salcedo-Arellano MJ, Dufour B, McLennan Y, Martinez-Cerdeno V, Hagerman R. Fragile X syndrome and associated disorders: Clinical aspects and pathology. Neurobiol Dis. 2020;136:104740. doi:10.1016/j.nbd.2020.104740

    Glasson EJ, Buckley N, Chen W, et al. Systematic Review and Meta-Analysis: Mental Health in Children With Neurogenetic Disorders Associated With Intellectual Disability. J Am Acad Child Adolesc Psychiatry. January 2020. doi:10.1016/j.jaac.2020.01.006

    Donna M. D’Alessandro, MD
    Professor of Pediatrics, University of Iowa

    Are Taste Preferences Genetic?

    Patient Presentation
    A 30-month-old female came to clinic for her health maintenance examination. She was growing well and her mother described her as “head strong.” She was a generally compliant and happy child, but her mother said, “When she doesn’t want to do something, she will whine, cry, scream or just sit there and stare at you.” The mother described that she most often had problems when there was a time constraint such as leaving home in the morning or regarding eating. “She just absolutely refuses any vegetables. She lives on carbohydrates and fruit,” her mother described. The food had to be prepared and presented the same way or the child would refuse the food, and sometimes the entire plate. “I’ve tried to give her other things, or mix them up in the food she likes but she refuses again. She likes to put her macaroni in tomato sauce, but when I put some vegetables in the sauce, she refused the entire plate.”

    The pertinent physical exam showed a smiling toddler. Her growth parameters were 50-75% with normal vital signs.
    Her examination was normal. She did show her “head strong” behavior when a book was moved by the physician and she screamed until it was replaced where she had put it in the room.

    The diagnosis of a healthy toddler was made. Further questioning showed that her diet was not very atypical and she did eat more foods than her mother had originally stated. The physician discussed how it was important to keep offering foods even if they are rejected several times. “It takes at least 8-10 times before they will even try to eat it and then they may not still like it. Just keep offering it, and also show her that you are enjoying the food. That sets a great example for her of how to eat a healthy diet,” he stated. He also encouraged the mother to continue appropriate discipline and ignoring of her behaviors. After the visit, the medical student who had been present was asking about children’s eating habits. The physician noted that eating preferences start young and are very much influenced by experiences with what is offered and how the family reacts. Kids like sweet things and don’t like bitter things. It’s part of our biology. But we all learn to eat more than breast milk or formula over time.
    There’s alot known about the genetics of bitter taste and this is part of the reason some people really don’t like those types of food even as an adult,” he noted.

    Taste or gustation is the sensation of taste and is a primary human sense. There are 5 basic tastes currently accepted including sweet, sour, bitter, salty and umami or savory. There is also some data for distinct tastes of fats (called oleogustus) or complex carbohydrates. Taste buds in the oral cavity are the primary chemoreceptors of whether or not to allow a substance into our bodies. Taste receptors are also found in the gastrointestinal tract and are involved in gut sensing.

    Flavor and taste are not the same although in general everyday language people use them interchangeably. Flavor is “… the integrated sensation that arises from the combined inputs of taste, chemosensation and olfaction.” There are thousands to millions of combinations of these inputs which then allow humans to experience a wide array of flavors.

    Chemesthesis is a group of sensations caused by chemical irritants. It includes the cooling sensation felt from menthol or the warming sensation from capsaicin. This occurs through the trigeminal nerve and is a separately neurological pathway than the chemoreceptors for taste. Metallic is also not a taste itself but an important quality which also has some genetic basis.

    In fetuses and young children, “…flavors are transmitted from the maternal diet to amniotic fluid and breastmilk[. M]others who consume a variety of healthful foods throughout pregnancy and lactation provide infants with an opportunity to learn to like these flavors.” Taste and olfaction receptors are already working in the last trimester of pregnancy. Flavors of maternal foods are in the amniotic fluid and fetuses swallow up 1L of amniotic fluid a day providing the opportunity to experience these flavors. Newborn infants receiving breast milk similarly have the opportunity to experience a variety of flavors and tastes, transmitted from the maternal diet to the infant.

    Learning Point
    Taste preferences are influenced by different factors including genetics, culture, repeated exposures and role models such as parents and siblings, and taste preferences change over time. Sweet tastes are preferred by newborns and bitter taste is disliked by infants. In general humans “… are born with a biological predisposition to prefer sweet and to avoid bitter foods such as green leafy vegetables. It has been hypothesized that this predisposition evolved to attract children to energy-dense foods while discouraging the consumption of toxins.” Bitterness is considered affiliated with toxins. The presence of sugars can effectively mask bitterness (e.g. chocolate). Bitterness can be a desirable taste such as in beer, coffee and chocolate.

    There are at least 25 known genes in the bitter taste receptor family. Sweet has at least 3 genes, and others have been identified for sour and salty foods. Although there are genetics at work, exposures both directly with the food and also within the socio-cultural context of family can and does expand the food choices accepted by children, teens and adults.

    Changes in taste preferences occur over time. Repeated exposures are needed to increase the acceptance of a novel food (at least 8-10 or more). Even with acceptance and ingestion of the novel food, the infant or child may still not like it (e.g. demonstrates negative facial expression) and additional exposures are needed until the infant or child learns to like a novel food. Foods that share similar flavor characteristics to preferred or already accepted foods help to increase the novel food acceptance. This understanding may help parents to continue to offer novel foods to young and older children particularly fruits and vegetables.

    Interestingly, for formula fed infants, families tend to use the same brand and therefore the variety of flavors experienced by the infant may be fewer. Infants do show flavor preferences for the formula they are fed which can be long lasting. Formala fed infants obviously can and do acquire taste and flavor preferences with repeated exposure to complimentary foods.

    Taste sensitivity is the ability to perceive a taste and this also changes over time. One cohort study of 4-6 years olds (N=131) who were followed longitudinally for 3 years, found that for some basic taste sensitivities and preferences changed.

    Taste Sensitivity Preference Preference Type
    Sweet Decreased* Increased Medium or high
    Sour Increased Stable Medium or high
    Bitter Stable Stable variable depending on individual
    Salty Increased* Not evaluated
    Umami Increased Not evaluated

    * Different from previous studies which are mainly cross-sectional studies

    There are also changes in older children and adults where sweet preferences in general have an overall decline.

    Questions for Further Discussion
    1. What advice do you give for starting complimentary foods in infants?
    2. Using the information above, what other parental advice would you give?
    3. How do sensations in the gut affect food and taste preferences?
    4. What parental advice do you give for discipline of young children? A review can be found here.

    Related Cases

    To Learn More
    To view pediatric review articles on this topic from the past year check PubMed.

    Evidence-based medicine information on this topic can be found at SearchingPediatrics.com and the Cochrane Database of Systematic Reviews.

    Information prescriptions for patients can be found at MedlinePlus for this topic: Taste and Smell Disorders

    To view current news articles on this topic check Google News.

    To view images related to this topic check Google Images.

    To view videos related to this topic check YouTube Videos.

    Barlow LA. Progress and renewal in gustation: new insights into taste bud development. Dev Camb Engl. 2015;142(21):3620-3629. doi:10.1242/dev.120394

    Forestell CA. Flavor Perception and Preference Development in Human Infants. Ann Nutr Metab. 2017;70 Suppl 3:17-25. doi:10.1159/000478759

    Fry Vennerod FF, Nicklaus S, Lien N, Almli VL. The development of basic taste sensitivity and preferences in children. Appetite. 2018;127:130-137. doi:10.1016/j.appet.2018.04.027

    Nolden AA, Feeney EL. Genetic Differences in Taste Receptors: Implications for the Food Industry. Annu Rev Food Sci Technol. January 2020. doi:10.1146/annurev-food-032519-051653

    Donna M. D’Alessandro, MD
    Professor of Pediatrics, University of Iowa

    How Good Is Infrared Thermography for Mass Screening for Fever?

    Patient Presentation
    A pediatrician was entering her hospital during the early stages of the recent novel Coronavirus (COVID-19) epidemic and noticed that as part of the government-required employee entrance screening procedure the security guards were starting to set up an infrared technology screening camera. She was curious because her impression was that the technologies had some benefit but weren’t more widely used because of technical issues when used in the field. “I wonder how good they actually are at detecting a fever or more importantly missing one?” she asked herself.

    The purpose of measuring temperature is to monitor the health of the individual and evaluate for a potentially abnormal physiological state such an ambient hyper/hypothermia or infectious disease. Rectal and esophageal temperature are considered the two most reliable measures for the gold standard of core body temperature. Oral, axillary and inguinal temperatures are common alternative measurement sites but do underestimate core body temperature. These sites often use digital/electronic temperature measurements and contact with the patient’s skin which is not helpful for high volume screening locations. Another option is a temperature measuring gun like a tympanic thermometer.

    Infrared thermal imaging (ITI) uses infrared data collection taken from an appropriate body location that then uses a mathematical formula to convert the data into a temperature reading. There is no specific data correlating core body temperature to ITI temperature.

    There are not too many ways to screen people for fever that don’t take a lot of time or that are not invasive. ITI has been used for remote sensing for human body temperature and fever screening since 2006 in international airports and is used in other locations such as hospital entrances and public places for crowd surveillance. While ITI can be accessible and affordable and efficient, it may not be used properly. ITI can be the first step in detection and therefore evaluation and management of individuals.

    “Mass health screening during a pandemic will certainly be influenced by several other factors, including perceived and actual pandemic severity, as well as the potential consequences of illness detection, either negative or positive, which can affect the sensitivity of screening that uses self-report. If being detected as febrile is perceived as harmful, travelers may hide their symptoms. Alternative, during a pandemic with high mortality rates, incentives for reporting symptoms might be present such as access to scarce antiviral medication and medical care. In both situations, a comprehensive screening approach may be necessary, which uses [ITI] for fever screening and a health questionnaire to detect other symptoms or exposures that would increase specificity of the screening process. Finally, the usefulness of any infectious disease screening must take into account temperature fluctuations, use of antipyretic medication, transmission risks, prevalence of infections and asymptomatic infections.”

    A 2015 study of ITI in hospitalized children found that screening of either eye (best location, see below) produced consistent results for children. ITI was also consistent with axillary temperatures for children who were febrile or nonfebrile, but forehead and tympanic measurements were not consistent with axillary temperatures. The error of the temperature measured by ITI was up to 0.4&degC though, which makes it less sensitive for detection of true fever.

    One study of emergency room patients in 3 different US locations using 3 different ITI technologies, found that asking patients if they felt febrile had a sensitivity of only 75% for fever detection, specificity was 84.7% and positive predictive value was 10.1% when compared to oral temperature. The ITI technologies (2 of them) did have higher correlations with oral temperature than self-report though. They also found that there may be gender differences where men had higher ITI temperatures than women which they felt may be because of facial hair, cosmetic use or subcutaneous fat composition.

    Thermal imaging in medicine includes evaluation and management of inflammatory disease, regional pain syndrome, Raynaud’s phenomenon, and general temperature or disease monitoring in at risk populations (e.g. neonates). ITI is used in many other applications such as inspections in the power industry, manufacturing and material and biological research applications.

    Learning Point
    The International Organization for Standardization has documents for standard use of infrared thermal imaging for fever screening.

    The standards for use include:
    The optimal place to measure is the inner canthus of the human eye. The measurement area needs to be at least 9 pixels (pixel is .26 mm) in size. “…[T]he subject should be stationary and close to the camera without angular distortion to optimize the target site, ruling out the common practice of distant surveillance of a moving crowd of subjects.” The camera is best mounted close to the subject, at eye level and the face needs to fill the majority of the ITI image. The camera needs to have clear focus and resolution. The camera needs to be calibrated properly based on the manufacturer’s recommendations which can be several times a day depending on the specific technology used. Calibration is necessary as ambient air temperatures and relative humidity can change the skin surface temperature. An appropriate fever threshold also needs to be determined for what is considered a significant temperature difference A higher threshold has the advantage of detecting fewer false positive fevers, but may have more false negative results.
    For mass screening, the appropriate facial area (i.e. inner canthus) has to be recognized by the technologies which can be difficult to do but is improving with facial recognition technology. Glass and plastic also do not transmit infrared, so wearing eyeglasses can also potentially interfere with the appropriate testing.
    It is possible to have a proven fever without an increase in facial temperature.

    Technologies improve every day. Therefore use of ITI in specific locations or for specific reasons hopefully has improved as some of the data above is older.

    Questions for Further Discussion
    1. What are the elements that you consider when thinking about the accuracy of temperature measurements?
    2. What temperature measurements do you use and how are they affected by your local environment?
    3. What are causes of fever? A review can be found here
    4. How good are masks for preventing infection? A review can be found here

    Related Cases

    To Learn More
    To view pediatric review articles on this topic from the past year check PubMed – Thermography and
    and PubMed – COVID-19.

    Evidence-based medicine information on this topic can be found at SearchingPediatrics.com – Infrared Thermography, and SearchingPediatrics.com – COVID-19 and the Cochrane Database of Systematic Reviews.

    Information prescriptions for patients can be found at MedlinePlus for these topics: Coronavirus Infections and Fever.

    To view current news articles on this topic check Google News – Infrared Thermography.
    and Google News – COVID-19

    To view images related to this topic check Google Images – Infrared Thermagraphy and Google Images – COVID-19.

    To view videos related to this topic check YouTube Videos – Infrared Thermagraphy and YouTube Videos – COVID-19.

    Mercer J, Ring EFJ. Fever screening and infrared thermal imaging: Concerns and guidelines. Thermology. 2009;19:67-69.

    Nguyen AV, Cohen NJ, Lipman H, et al. Comparison of 3 infrared thermal detection systems and self-report for mass fever screening. Emerg Infect Dis. 2010;16(11):1710-1717. doi:10.3201/eid1611.100703

    Ring EFJ, Ammer K. Infrared thermal imaging in medicine. Physiol Meas. 2012;33(3):R33-46. doi:10.1088/0967-3334/33/3/R33

    Ring EFJ, Jung A, Kalicki B, ZUBER J, RUSTECKA A, Vardasca R. New standards for fever screening with thermal imaging systemss. J Mech Med Biol. 2013;13:1350045. doi:10.1142/S0219519413500450

    Dwith Chenna YN, Ghassemi P, Pfefer TJ, Casamento J, Wang Q. Free-Form Deformation Approach for Registration of Visible and Infrared Facial Images in Fever Screening. Sensors. 2018;18(1). doi:10.3390/s18010125

    Topalidou A, Ali N, Sekulic S, Downe S. Thermal imaging applications in neonatal care: a scoping review. BMC Pregnancy Childbirth. 2019;19(1). doi:10.1186/s12884-019-2533-y

    How infrared thermography screens body temperature – cnTechPost. https://cntechpost.com/2020/02/15/how-infrared-thermography-screens-body-temperature/. Accessed April 3, 2020.

    For COVID-19 Coronavirus, How Well Do Thermometer Guns Even Work? https://www.forbes.com/sites/brucelee/2020/02/16/for-covad-19-coronavirus-how-well-do-thermometer-guns-even-work/#65dce7a32af9. Accessed April 3, 2020.

    Donna M. D’Alessandro, MD
    Professor of Pediatrics, University of Iowa