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Alcohol Tremor

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101. Alcohol Toxicity and Withdrawal

physical activity (LTPA)... SOCIAL MEDIA Add to Any Platform Loading Topic Resources Alcohol (ethanol) is a CNS depressant. Large amounts consumed rapidly can cause respiratory depression, coma, and death. Large amounts chronically consumed damage the liver and many other organs. Alcohol withdrawal manifests as a continuum, ranging from tremor to seizures, hallucinations, and life-threatening autonomic instability in severe withdrawal (delirium tremens). Diagnosis is clinical. (See also .) About half (...) intake. A mild alcohol withdrawal syndrome includes tremor, weakness, headache, sweating, hyperreflexia, and GI symptoms. Tachycardia may be present and blood pressure can be slightly elevated. Symptoms usually begin within about 6 h of cessation. Some patients have generalized tonic-clonic seizures (called alcoholic epilepsy, or rum fits) but usually not > 2 in short succession. Seizures generally occur 6-48 h after cessation of alcohol. Alcoholic hallucinosis (hallucinations without other

2013 Merck Manual (19th Edition)

102. Suspected neurological conditions: recognition and referral

. 1.15.3 In adults with suspected essential tremor: Suspected neurological conditions: recognition and referral (NG127) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 23 of 73review regular medication check thyroid function assess alcohol consumption using a tool such as AUDIT (Alcohol Use Disorders Identification T est), in line with the NICE guideline on alcohol-use disorders: diagnosis, assessment and management (...) of harmful drinking and alcohol dependence. Refer for neurological assessment only if the symptoms are disabling and first-line treatment as specified in the BNF is ineffective or not tolerated. 1.15.4 Consider referring adults with troublesome tremor of the head to a movement disorder clinic. T o find out why the committee made the recommendations on tremor in adults, see rationale. 1.16 Information and support 1.16.1 Follow the principles in the NICE guideline on patient experience in adult NHS

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

103. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version)

immediately; (2) call the doctor about his/her recent trips and symptoms before going to the doctor’s office or emergency room; (3) avoid contact with others; (4) not to travel around; (5) covermouthandnosewithatissueorsleeve(nothands) when coughing or sneezing; and (6) wash hands with soap and water for at least 20s. If soap and water are not avail- able, use alcohol-based hand sanitizers [24]. 5 Diagnosis of the 2019-nCoV cases 5.1 Clinical manifestation The 2019-nCoV infected cases have symptoms like (...) may have shortness of breath, moist rales in lungs, weakened breath sounds, dullness in percussion, and increased or decreased tactile speech tremor, etc. 5.3 Imaging examination 5.3.1 CT imaging (strong recommendation) The imaging findings vary with the patient’s age, immun- ity status, disease stage at the time of scanning, underlying diseases, and druginterventions. Table 3 Recommendations for those with close contacts and suspicious exposures No. Recommendation items Recommendation strength 1

2020 Covid-19 Ad hoc guidelines

104. Recommendations: Prehospital Emergency Medical Services (EMS) COVID-19

and PPE Pilots should wear properly fitted N95 masks on any call with a PUI. Diligent hand hygiene should be practiced, and eye protection should be worn by aircraft personnel regardless of patient contact status. If soap and water are not available, you may use alcohol-based hand rub (containing at least 60% alcohol). Designation of an “isolation area” is highly recommended where possible, with the perimeter establishing “clean” and “dirty” areas when donning and doffing of PPE should occur (...) and Disinfection: Following patient transfer, the back doors of the ambulance should be left open so that sufficient air exchange may occur. Appropriate supplies must be available. 1. Yellow caution tape or alternative system for marking off the decontamination area 2. PPE for personnel performing decontamination 3. Leak proof biohazard bags 4. Garbage bags 5. Spray bottles 6. Disposable rags 7. Alcohol based hand sanitizer 8. Absorbent towels 9. Bleach or alcohol-based cleaning solution or disinfectant wipes

2020 WHO Coronavirus disease (COVID-19) Pandemic

106. Depression: Perinatal

the first year of the baby’s life. • Women who are already taking antidepressant medications and are considering becoming pregnant. Behavioral Health Integration/Maternal Behavioral Health Kaiser Permanente Washington has integrated behavioral health into all primary care clinics. The goal of Behavioral Health Integration (BHI) is to create a welcoming environment for patients to address common problems—alcohol and substance use disorders as well as depression—with their primary care teams. A major (...) element of BHI has been transitioning primary care social workers to a new role of integrated behavioral health specialist, in which they work as “provider extenders” to address patient needs without disrupting patient flow and team cycle time. Social workers offer consultation to providers, brief interventions, or short-term (4–6 visits) counseling for individuals with mild to moderate depression and alcohol or substance use disorders. Maternal Behavioral Health (MBH) Screening is part of the BHI

2020 Kaiser Permanente Clinical Guidelines

107. Canadian guideline for Parkinson disease

and written form. n Discussions should aim to achieve a balance between providing realistic information and promoting optimism. n Families and caregivers should be informed about the condition and available support services. DIAGNOSIS AND PROGRESSION n Parkinson disease should be suspected in anyone with tremor, stiness, slowness, balance problems or gait disorders. n CT or MRI brain scanning should not be routinely used to diagnose Parkinson disease. n Patients, especially young, who request genetic (...) to achieve a balance between providing realistic information and promoting optimism. n Families and caregivers should be informed about the condition and available support services. DIAGNOSIS AND PROGRESSION n Parkinson disease should be suspected in anyone with tremor, stiness, slowness, balance problems or gait disorders. n CT or MRI brain scanning should not be routinely used to diagnose Parkinson disease. n Patients, especially young, who request genetic testing should be assessed by a movement

2019 CPG Infobase

108. Managing opioid use disorder in primary care: PEER simplified guideline

Ondanestron 4mg PO Q6H PRN Diarrhea Loperamide 4mg, followed by 2mg after each loose stool (max:16mg/day) &OLQLFDO2SLDWH:LWKGUDZDO6FDOH &2:6 6FRUH † Category (Points), Clinician Administered WORSE Resting Pulse Rate 0 1 2 4 Sweating 0 1 2 3 4 Observed Restlessness 0 1 3 5 Pupil Size 0 1 2 5 Bone or Joint Aches 0 1 2 4 Runny Nose or Tearing 0 1 2 4 Gastrointestinal Upset 0 1 2 3 5 Observed Tremor of Outreached Hands 0 1 2 4 Observed Yawning 0 1 2 4 Anxiety or Irritability 0 1 2 4 Goose?esh Skin 0 2 3 4 (...) 2018;362:k3207. 3. Gomes T, Khuu W, Craiovan D, Martins D, Hunt J, Lee K, et al. Comparing the contribution of prescribed opioids to opioid-related hospitalizations across Canada: a multi-jurisdictional cross-sectional study. Drug Alcohol Depend 2018;191:86-90. Epub 2018 Jul 31. 4. Canadian Institute for Health Information. Pan-Canadian trends in the prescription of opioids, 2012 to 2016. Ottawa, ON: Canadian Institute for Health Information; 2017. Available from: https://secure.cihi.ca/free_products

2019 CPG Infobase

109. Assessment of ataxia

in the prevalence of many mutations. Schöls L, Bauer P, Schmidt T, et al. Autosomal dominant cerebellar ataxias: clinical features, genetics, and pathogenesis. Lancet Neurol. 2004 May;3(5):291-304. http://www.ncbi.nlm.nih.gov/pubmed/15099544?tool=bestpractice.com Differentials Alcoholic cerebellar degeneration Ischaemic stroke (cerebellum) Ischaemic stroke (brain stem) Haemorrhage in the cerebellum Multiple sclerosis (MS) Wernicke-Korsakoff syndrome Drug-induced ataxia Toxic neuropathies Von Hippel-Lindau (...) ) Spinocerebellar ataxia 37 (SCA 37) Spinocerebellar ataxia 38 (SCA 38) Spinocerebellar ataxia 40 (SCA 40) Dentatorubral-pallido-luysian atrophy (DRPLA) Episodic ataxia type 1 Episodic ataxia type 2 Fragile-X tremor-ataxia syndrome (FXTAS) Mitochondrial cytopathy Niemann-Pick disease type C (NP-C) Contributors Authors Assistant Professor of Neurology The Ohio State University Columbus OH Disclosures BKC declares that she has no competing interests. Dr Barbara Kelly Changizi would like to gratefully acknowledge

2019 BMJ Best Practice

110. Canadian guidelines on benzodiazepine receptor agonist use disorder among older adults

the drug under medical supervision) . ? Withdrawal as manifested by either characteristic withdrawal symptoms (i .e ., autonomic hyperactivity, hand tremor, insomnia, nausea or vomiting, transient sensory hallucinations or illusions, psychomotor agitation, anxiety, and/or seizures) OR the BZRA (or a closely related substance such as alcohol) is taken to relieve or avoid withdrawal symptoms . Diagnosis ? 1 symptom or less, no diagnosis ? 2–3 symptoms, mild BZRA Use Disorder ? 4–5 symptoms, moderate BZRA (...) of Psychiatry Dalhousie University Dr. Peter Cordell PGY 4 Psychiatry Resident Department of Psychiatry, McMaster University Chair, CCSMH: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Dr. David Conn Co-Chair, CCSMH: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dr. Kiran Rabheru Director, CCSMH: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Claire Checkland Co-Leads, Alcohol Use Disorder Among Older Adults . . . . . . . . . Dr. Peter Butt and Marilyn

2019 CPG Infobase

111. Parkinson?s disease in adults

Parkinson's disease in people presenting with tremor, stiffness, slowness, balance problems and/or gait disorders. [2006] [2006] 1.2.2 If Parkinson's disease is suspected, refer people quickly and untreated to a specialist with expertise in the differential diagnosis of this condition. [2006, [2006, amended 2017] amended 2017] Clinical and post-mortem diagnosis Clinical and post-mortem diagnosis 1.2.3 Diagnose Parkinson's disease clinically, based on the UK Parkinson's Disease Society Brain Bank Clinical (...) .) [2006] [2006] Single photon emission computed tomogr Single photon emission computed tomograph aphy y 1.2.6 Consider 123 I-FP-CIT single photon emission computed tomography (SPECT) for people with tremor if essential tremor cannot be clinically differentiated from parkinsonism. [2006, amended 2017] [2006, amended 2017] 1.2.7 123 I-FP-CIT SPECT should be available to specialists with expertise in its use and interpretation. [2006] [2006] Parkinson’s disease in adults (NG71) © NICE 2019. All rights

2017 National Institute for Health and Clinical Excellence - Clinical Guidelines

112. Guidelines on Chronic Coronary Syndromes Full Text available with Trip Pro

test 18 3.1.5.6 Invasive testing 19 3.1.6 Step 6: assess event risk 21 3.1.6.1 Definition of levels of risk 22 3.2 Lifestyle management 23 3.2.1 General management of patients with coronary artery disease 23 3.2.2 Lifestyle modification and control of risk factors 23 3.2.2.1 Smoking 23 3.2.2.2 Diet and alcohol 24 3.2.2.3 Weight management 24 3.2.2.4 Physical activity 24 3.2.2.5 Cardiac rehabilitation 24 3.2.2.6 Psychosocial factors 24 3.2.2.7 Environmental factors 25 3.2.2.8 Sexual activity 25

2019 European Society of Cardiology

114. Staff and associate specialist (SAS) grade handbook

that addiction is multifactorial and can be regarded as having genetic, psychological, social and environmental components. There is frequently an alcoholic parent or history of child abuse. Addiction becomes an active and serious problem when those individuals with predisposing factors discover which drug or drink (or behaviour such as gambling) fixes the way they feel. Access then often dictates which substances someone will try until they find ‘the one’. Since the early 1990s, it has been recognised (...) as an actual disease, and is classified accordingly with other chronic illnesses. It therefore often involves cycles of relapse and remission. Unfortunately, society’s attitude has not changed significantly and addiction is still a rather taboo subject. Definitions [1] The simplest definition of alcoholism is from the American Society of Addiction Medicine (ASAM): ‘(Alcoholism) is characterised by continuous or periodic impaired control over drinking, preoccupation with alcohol, use of alcohol despite

2020 Association of Anaesthetists of GB and Ireland

115. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS) Society and the European Society of Thoracic Surgeons (ESTS) Full Text available with Trip Pro

nutrition may have a role in the malnourished patient postoperatively Low Weak Smoking cessation Smoking should be stopped at least 4 weeks before surgery High Strong Alcohol dependency management Alcohol consumption (in alcohol abusers) should be avoided for at least 4 weeks before surgery Moderate Strong Anaemia management Anaemia should be identified, investigated and corrected preoperatively High Strong Pulmonary rehabilitation and prehabilitation Prehabilitation should be considered for patients (...) Strong Chlorhexidine–alcohol is preferred to povidone-iodine solution for skin preparation High Strong Preventing intraoperative hypothermia Maintenance of normothermia with convective active warming devices should be used perioperatively High Strong Continuous measurement of core temperature for efficacy and compliance is recommended High Strong Standard anaesthetic protocol Lung-protective strategies should be used during one-lung ventilation Moderate Strong A combination of regional and general

2020 ERAS Society

116. Treatment of Patients with Schizophrenia

) and attempts that were aborted or interrupted o Intentional self-injury in which there was no suicide intent Substance Use History • Use of tobacco, alcohol, and other substances (e.g., vaping, marijuana, cocaine, heroin, hallucinogens) and any misuse of prescribed or over-the-counter medications or supplements • Current or recent substance use disorder or change in use of alcohol or other substances Medical History • Whether or not the patient has an ongoing relationship with a primary care health (...) or emergency circumstances. Examples of such circumstances are not limited to unconsciousness but may also include circumstances such as temporary psychosis or intoxication with alcohol or other substances (U.S. Department of Health and Human Services; Office for Civil Rights 2017b). Although it is beyond the scope of this guideline to discuss the differential diagnosis of psychotic disorders and their evaluation, many features and aspects of clinical course will enter into such a determination in addition

2020 American Psychiatric Association

117. Istradefylline (Nourianz) - Parkinson's disease

involved accidental overdoses. One case (6002-US- (b) (6) (b) (6) , formerly Podskalny at the time of the original submission and involved an accidental overdose of six tablets of istradefylline along with alcohol. The patient experienced hallucinations, agitation, and dyskinesia. The second case (6002-US- (b) (6) /formerly (b) (6) ) involved a 72­ year-old male subject who reported an accidental overdose on Study Day 206 without any associated TEAEs. The subject continued on in the study (...) of Istradefylline Chemical Name (IUPAC) (E)-8-(3,4-Dimethoxystyryl)-1,3-diethyl-7-methyl-3,7-dihydro-1H-purine-2,6-dione Molecular Formula: C20H24N4O4 Molecular Weight: 384.43 (b) (4) The investigational drug product consists of 20 mg and 40 mg tablets of Istradefylline Lactose, (b) (4) crospovidone, polyvinyl alcohol and . They are biconvex shaped, peach colored, film coated tablets. Storage at 20°C to 25°C (68°F-77°F) is recommend; excursions permitted between 15°C and 30°C (59°F-86°F) [see USP Controlled

2019 FDA - Drug Approval Package

119. Obstetric Management of Patients with Spinal Cord Injuries

transections. Afferent stimuli come from distention of a hollow viscus (eg, the bladder, bowel, or uterus) and from the skin below the level of the lesion or of the genital areas. Signs and Symptoms The inhibitory response from cerebral vasomotor centers causes vasodilation above the level of injury, with symptoms including pounding headache, flushing, nasal congestion, nausea, anxiety, malaise, and a prickling sensation in the skull; signs include sweating, blushing, skin blotching, piloerection, tremor (...) distension and fundal massage, which may increase the risk of autonomic dysreflexia. Although breastfeeding may be possible, data suggest that SCI, particularly at or above T6, can disrupt lactation and is associated with shorter breastfeeding duration . Additional support may be needed to facilitate breastfeeding in women with SCIs who desire to breastfeed and are physiologically capable of doing so. Depression, suicide, alcoholism, and a wide variety of other mental health problems all occur at higher

2020 American College of Obstetricians and Gynecologists

120. Adult liver transplantation: UK clinical guideline – part 2: surgery and post-operation

immunosuppression immunosuppressant Side effects Calcineurin inhibitors Renal impairment Infections (viral, bacterial and fungal) increased risk Hyperuricaemia Gout Hypertension Hypercholesterolaemia Glucose intolerance Hypomagnesaemia Hyperkalaemia Headaches/migraines Insomnia Tremor Hirsuitism Gum hypertrophy Mycophenolate Diarrhoea Leucopenia Teratogenic (should be avoided by mother prior to and during pregnancy and male patients planning to father children. Men should use condoms during treatment (...) the associated catabolic state. The cardiovas- cular mortality and morbidity rise, along with renal disease and non alcoholic fatty liver disease (NAFLD), in the recipient’s graft. 38 post-transplant smoking Up to a quarter of patients in centres around the world will be regularly smoking tobacco at the time of their LT. 39 While the European Association for the Study of the Liver (EASL) recommends abstinence before listing, UK transplant centres do not take an ‘absolutist’ view. 40 Cigarette smoking

2020 British Society of Gastroenterology

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