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Coma Exam

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181. Oral anticoagulation with warfarin - 4th edition (Full text)

presentations to Accident and Emergency departments and although national guidelines on the management of head injury exist ( ), these only very briefly deal with the particular problem of patients on warfarin ( ). All patients on warfarin presenting to accident and emergency departments with head injuries, however minor, should have their INR measured. Individuals with loss of consciousness, amnesia or reduced Glasgow Coma scale should have an immediate head computerized tomography (CT) scan. Patients

2011 British Committee for Standards in Haematology PubMed

182. Treatment and recommendations for homeless people with Chronic Non-Malignant Pain

be the only opportunity to engage a homeless patient in ongoing care. Use the initial visit as a critical opportunity to engage the patient and establish trust. ? Ask about physical and mental health (including history of traumatic brain injury/ substance use), history of chronic pain, and living situation (including residential stability). PHYSICAL EXAMINATION ? Defer the physical examination to the second visit, if needed; or keep the initial exam focused on the area of concern. Perform serial focused (...) exams (as tolerated), if needed. Look for evidence of occult alcoholism or addiction. ? Practice Trauma-Informed Care during the physical examination and in all patient encounters, recognizing that individuals who are homeless are likely to have experienced some form of previous trauma. ASSESSMENT, SCREENING & DIAGNOSTIC TESTING ? Assess every chronic pain patient for substance use and mental health issues. Based on prevalence of behavioral health issues in the patient population served as well

2011 National Health Care for the Homeless Council

183. Vegetative State 2.0

Grieco COMMENTARY There are many neurologic disorders diagnosed exclusively, or nearly so, based on clinical criteria. These disorders include the vegetative state, the minimally conscious state, coma and generalized motor seizures. In many cases, the diagnosis can be arrived at only with great care and deliberation. It is unfortunately all too common to find these diagnoses entered in medical charts as if they were physical exam findings. These are no more exam findings than myocardial infarction (...) or acute appendicitis are considered exam findings. “Coma,” “vegetative” and “unresponsive” are even entered as reasons for not performing some or any part of a neurologic examination (“Cr Ns: unable to perform, pt comatose/vegetative”). It is incumbent on the physician to carefully examine the patient with disordered consciousness, and accurately record the findings. The diagnosis is then usually straightforward. If not, special tests or evaluation by an expert may be required. How can you approach

2011 Clinical Correlations

186. Artemether-lumefantrine Resistance Monitoring in Children With Uncomplicated Plasmodium Falciparum Malaria in Mali

will have blood taken up to 6 times a year. Study participants will be screened with 1 finger-prick blood sample. Girls may have a pregnancy test. Baseline visit: Participants will have a physical exam. Their vital signs and temperature will be measured. They will answer questions about their symptoms. They will give a blood sample. Participants will get 6 doses of AL over 3 days. They will take it in tablet form with milk. Some participants will also stay at the clinic for 2 days. They will have (...) a catheter placed in a vein. They will have blood taken frequently. Participants will have follow-up visits for about 1 month. They may have: Physical exam performed Vital signs and temperature measured Symptom questionnaire administered Finger-prick blood sample and/or a regular blood sample taken Pregnancy test given Antimalarial medications other than AL provided. Condition or disease Accute Falciparum Malaria Detailed Description: Artemether-lumefantrine (AL) has replaced artesunate + amodiaquine

2016 Clinical Trials

187. Phase 3 Alogliptin Pediatric Study

as a percent of the absolute maximum that can be bound) collected at Week 26 relative to Baseline. Secondary Outcome Measures : Change From Baseline in HbA1c at Weeks 12, 18, 39 and 52 [ Time Frame: Baseline and Weeks 12, 18, 39 and 52 ] The change in the value of glycosylated hemoglobin (the concentration of glucose bound to hemoglobin as a percent of the absolute maximum that can be bound) collected at Weeks 12, 18, 39 and 52 relative to Baseline. Percentage of Participants with Abnormal Physical Exam (...) (3.33 mmol/L) (unless the clinical situation makes obtaining a blood glucose difficult [eg, it involves coma or seizure]). Percentage of Participants with Abnormal Safety Laboratory Findings [ Time Frame: From Day 1 to end of treatment period (up to 52 weeks) ] The number of participants with any abnormal standard safety laboratory values (hematology, serum chemistry, and urinalysis) collected throughout study. Change from Baseline in Bone Mineral Density at Weeks 26 and 52 [ Time Frame: Baseline

2016 Clinical Trials

188. Helping Older Persons Emerge Stronger

months ] As measured by Clinical Institute Withdrawal Assessment Scale-Benzodiazepines Delirium/Coma free days [ Time Frame: 9 months ] As measured by CAM ICU and RASS Weaning duration [ Time Frame: 9 months ] New Pneumonia [ Time Frame: 9 months ] Device self-removal [ Time Frame: 9 months ] Tracheostomy removal [ Time Frame: 90 months ] Depression [ Time Frame: 90 months ] As measured by Hospital Anxiety and Depression Scale Post Traumatic Stress Disorder [ Time Frame: 9 months ] As measured (...) by Impact of Event Scale Functional ability [ Time Frame: 9 months ] As measured by Functional Status Score ICU, KATZ ADL, LAWTON IADL Cognitive ability [ Time Frame: 9 months ] As measure by Mini Mental State Exam Quality of Life [ Time Frame: 9 months ] As measured by SF 36 Eligibility Criteria Go to Information from the National Library of Medicine Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study

2016 Clinical Trials

189. Role of Rehabilitation in Concussion Management: A Randomized Controlled Trial

oculomotor exam that defines the amplitude of convergence or the closest point in space where the patient can hold fusion, and therefore, see one target. Participants complete 3 trials assessing near-point convergence: the average of the three trials is recorded. Change in Dual-Task Ability using a Gait + Digit Span Dual-Task from Baseline to 1 Month Post Return to Play [ Time Frame: 24-48 hrs post injury, asymptomatic, (1 to approximately 240 days) 1 month post return to play ] The Gait + Digit Span (...) emotional, irritability, sadness, nervous/anxious. These symptoms are from the international consensus document on concussion in sport and represent the most common 22 symptoms of concussion (McCroy & Concussion in Sport Group, 2013). All concussions are, by general definition, mild TBIs with Glasgow Coma Score (GCS) scores of 13-15 (with the majority being 14-15). No athlete with a GCS <13 will be started in the intervention progression of either arm. Exclusion criteria: Individuals with any positive

2016 Clinical Trials

190. Virtual Reality for Pain Management Study

, and toothaches). Scores a 15 on the Glasgow Coma Scale and a 7 or above on the abbreviated Mini Mental Status Exam. Patient in the acute and critical palliative care units, post surgical units, or acute care orthopedic units at University Medical Center Brackenridge in Austin, TX. Willing and able to provide informed consent and participate in the study visit and study follow-up questionnaire. Exclusion Criteria: Hearing or visually impaired where participant cannot use the Samsung Gear VR. Does not report (...) experiencing current pain during Pre-Treatment Pain Questionnaire at the onset of study visit. Scores below a 15 on the Glasgow Coma Scale and/or below a 7 on the abbreviated Mini Mental Status Exam Limited mental competency and the inability to give informed, voluntary, written consent to participate. Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information provided

2016 Clinical Trials

191. Neurological Outcomes After In-Hospital Cardiac Arrest

score is classified according to the point. Good neurological outcome is defined as CPC 1-2 and poor is CPC 3-5. CPC score will be evaluated by neurological examination and the results of other exam. Neurological examination: Neurologist will perform directly until the point of CPC score 1 is confirmed. mental status: ACDU score, FOUR score and Glasgow Coma Scale brain stem reflex: Light reflexes by pupillometer(the NeurOptics® NPi™-100 (Neuroptics Inc., Irvine, CA, USA)) and corneal reflexes motor (...) following cardiac arrest. CPC score is classified according to the point. Good neurological outcome is defined as CPC 1-2 and poor is CPC 3-5. CPC score will be evaluated by neurological examination and the results of other exam. Neurological examination: Neurologist will perform directly until the point of CPC score 1 is confirmed. mental status: ACDU score, FOUR score and Glasgow Coma Scale brain stem reflex: Light reflexes by pupillometer(the NeurOptics® NPi™-100 (Neuroptics Inc., Irvine, CA, USA

2016 Clinical Trials

192. The ENRGISE Pilot Study

-Mental State Exam (MMSE) score <24 (<23 for racial/ethnic minorities or participants with less than 9 years of education) Unable to communicate because of severe hearing loss or speech disorder Neurological conditions that are causing impaired muscle function or mobility (may include stroke with residual paresis, paralysis, neuropathy, Parkinson disease, or multiple sclerosis) Severe rheumatologic or orthopedic diseases, e.g., awaiting joint replacement, known active inflammatory or autoimmune (...) replacement within past 6 months; Pulmonary embolism or deep venous thrombosis within past 6 months; Uncontrolled diabetes with recent weight loss, diabetic coma, or frequent insulin reactions; Stroke, hip fracture, hip or knee replacement, or spinal surgery within past 4 months; Physical therapy for gait, balance, or other lower extremity training within the past 2 months; Severe hypertension, e.g., Systolic Blood Pressure > 200, or Diastolic Blood Pressure> 110 mmHg; Hemoglobin <10 g/dL Participation

2016 Clinical Trials

193. The Effect of Hypocaloric Diet Associated With tDCS on Weight Loss and Metabolic Profile

, or referred by a doctor or nutritionist, from external to HCPA services. After screening and selection, patients will undergo a clinical, laboratory and nutritional evaluation. There will be a standard assessment protocol that includes: a complete clinical evaluation and socioeconomic status, assessment of physical activity, questionnaires of quality of life, sleep, depression and anxiety and body composition assessment. In the laboratory evaluation the biochemistry exams include an oral glucose tolerance (...) . During all of tDCS sessions, a film with images of food that usually elicit craving will be presented and after the end of each session, visual analog scales will be applied to assess hunger, satiety and presence of food craving. Finally, attention and mood scales will be applied periodically in addition to a questionnaire of adverse effects and use of tDCS. At the end of the 4-week diet and tDCS, all patients will be submitted to the same clinical, laboratory, nutrition and feeding behavior exams

2016 Clinical Trials

194. Families Expectations and Hope Raised by an Evaluation of Consciousness in Patients in a Vegetative State

brain injury. More and more patients with severe cerebral damages are resuscitated but upon awakening from coma, some patients remain in a state which cannot be qualified as conscious and is now known as an unresponsive wakefulness syndrome (UWS; formerly known as vegetative state). This condition can be transitory and evolve towards recovery, or remain chronic and lasting for years. To improve the diagnosis of patients with disorders of consciousness, recent advances in brain imaging have led (...) the impact of a neuroimaging evaluation of consciousness in institutionalized UWS patients: interviews of professional caregivers and families about their hopes concerning the evaluation of consciousness of UWS patients, interviews of professional caregivers and families about the impact of evaluating consciousness on their beliefs Condition or disease Intervention/treatment Phase Disorders of Consciousness Qualitative Research Ethics Neuroimaging Other: Semi structured interviews + EEG exams

2016 Clinical Trials

195. Efficacy and Safety of Young Health Plasma on Acute Stroke

Rankin Scale [ Time Frame: up to 90 days ] describe the clinical improvement at baseline, 7 days, 14 days, 30 days and 90 days Changes in Glasgow coma scale [ Time Frame: up to 90 days ] describe the clinical improvement at baseline, 7 days, 14 days, 30 days and 90 days Secondary Outcome Measures : Changes in hematoma volume [ Time Frame: At baseline, 7 days, 14 days and 30 days after the onset ] Change in peripheral edema volume [ Time Frame: At baseline, 7 days, 14 days and 30 days after the onset (...) Accepts Healthy Volunteers: No Criteria Inclusion Criteria: Age 65-80 years Clinical presentation of spontaneous intracerebral hemorrhage/ischemic stroke CT/MRI/MRA scan compatible with spontaneous intracerebral hemorrhage/ ischemic stroke Time to young plasma treatment < 72 h from symptom onset Glasgow Coma Score > 6 on initial presentation or improvement to a Glasgow Coma Score > 6 within the time frame for enrollment The first-ever primary supratentorial intracerebral basal ganglia hemorrhage 5

2016 Clinical Trials

196. Neuroimaging and Neuropsychological Outcomes in Urea Cycle Disorders

, impairments, and diet history; a physical exam; a full neurological exam; and cognitive and motor testing. During this visit, participants will undergo imaging studies and additional cognitive and motor testing over a 1-2-day period. This will include standard MRI studies and four sessions consisting of functional MRI (fMRI) (CNMC only), diffusion tensor imaging, and 1H magnetic resonance spectroscopy. For the fMRI study, participants perform various motor and behavioral tasks while in the imaging scanner (...) conditions contra-indicated in MRI Medically unstable at time of scheduled research visit Unable to provide informed consent or assent to the procedures Exclusion criteria for group 2: Ammonia level > 300 µM, or <100 µM Presence of coma and/or inability to maintain a patent airway Age <7 or >30 years Subject with ferromagnetic device that precludes safe MRI imaging Pregnant female Unstable medically, at risk for decompensations Combative, or severely neurologically compromised irrespective of ammonia

2016 Clinical Trials

197. Stellate Ganglion Blockade in Post-Menopausal Women

treatment. safety labs within 30 days of SGB intervention Exclusion Criteria: conditions that preclude SGB or sham intervention (e.g., anatomic abnormalities of the anterior neck or cervical spine ; goiter, cardiac/pulmonary compromise; contralateral (left-sided) phrenic nerve paralysis or diaphragmatic paresis; history of seizure, coma, or stroke; history of neurologic deficit to the brachial plexus or an abnormal brachial plexus neurologic exam; history of Zenker's diverticulum; acute illness (...) -Delay Free Recall, Short-Delay Cued Recall, Long Delay Free Recall, Long Delay Cued Recall, Card Rotation Tests, Finding As, Letter, Semantic and Phonemic Fluency, Logical Memory Subtest of Wechsler Memory Scale (WMS-R/LM-R) Part 1 and (WMS-R/LM-R) Part 2, Mini-Mental State Exam (MMSE), Memory Functioning Questionnaire (MFQ),Closing Question at baseline, 12 weeks (3 months) and 24 weeks (6 months) Composite changes from baseline of scores of measures of mood [ Time Frame: Up to 24 weeks (6 months

2016 Clinical Trials

198. Trial of Aerobic Treadmill Exercise Treatment for Concussion

at all subsequent follow-ups with the neurosurgeon (every 1 to 2 weeks) to determine physiological recovery. All participants will be asked to document their symptom data into a form between 7-10 PM each evening (following that day's exercise for the exercise group), along with hours of work/school, and minutes of exercise. The study end point for each subject is at recovery (as determined by a normal exercise level and an exam from the treating neurosurgeon). Data Analysis All statistics (...) in Outcome measure) or when the patient is discharged from care, whichever came first, assessed up to 180 days post-injury ] To be considered at "Full recovery", participant must meet the following criteria - Asymptomatic at rest (PCSS score under 7), participating in full school activities (as pre-injury) without symptoms, normal neurological exam, and normal vestibulo-ocular exam Eligibility Criteria Go to Information from the National Library of Medicine Choosing to participate in a study

2016 Clinical Trials

199. Severe respiratory depression after snorting U-47700

believing it was “synthetic cocaine.” He was found lying face down, cyanotic with agonal breathing. He was intubated in the field. On arrival he had a Glasgow Coma Scale of 3 and pinpoint pupils. Arterial blood gas showed severe respiratory acidosis with PCO2 > 90. Urine drug screen was negative and serum ethanol level was 55 mg/dL. He recovered with supportive care. His exam was reported as “normal” on discharge 3 days later. of the patient’s urine revealed U-47700 but no other opioids. The authors (...) note that this patient’s presentation was consistent with an opioid toxidrome, featuring coma, miosis, and respiratory depression. The video above, from KPIX in the San Francisco Bay Area, is 3 months old. Last month, the U.S. Drug Enforcement Agency U-47700 — along with another synthetic opioid, furanyl fentanyl — as . Related post: Posted in by Leon Gussow « » Comments are closed. Search for: The Best of TPR Archives » TPR Is Currently Reading: by Cliff Sloan and David McKean Drug Culture Medical

2016 The Poison Review blog

200. Family Practice Notebook Updates 2017

(perform each task with confidence of success) III. Updates: November 2017 (ent, sinus) is an inflammatory condition (analogous to , ) more than an infectious condition Diagnosis is based on 2 of 4 cardinal symptoms, exam or imaging evidence of , and at least 12 weeks of findings Primary management is with and s (urology, hemeonc) oscopy for all patients with and with risk (age >35, symptoms without cause) and CT should be included in evaluation for screening is not recommended Urine cytology and urine (...) ) Adequate fundoscopic exam relies on use s are safe to use in emergency department eye evaluation (with caveats regarding contraindications) (ortho, sx, ) Do not forget in children with high mechanism injuries (esp. under age 8 years) Non-displaced s are initially missed in 10%, often have negative XRay (but positive MRI or CT), and may present as should be considered when evaluating the in a child with elbow injury First exclude before diagnosing a red, hot, swollen large joint as gout (tap the joint

2018 FP Notebook

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