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Coma Exam

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382. Lessons from research for doctors in training: recognition and early management of meningococcal disease in children and young people

disease 43 n Disease pathway 43 n Clinical features of severe disease 43 SECTION 4 Making the Diagnosis 44 A. Taking a history 44 n Symptoms of sepsis 44 n Symptoms of meningitis 45 B. Examining the patient 46 n Initial assessment of any febrile child 46 n Normal values of vital signs 48 n Clinical signs of septic shock 49 n Clinical signs of meningitis 49 n Clinical signs of raised intracranial pressure 50 n The rash 51 C. Investigation 56 n Initial laboratory assessment 56 n Lumbar puncture 57 D (...) : temp 39.9 2 hours later - ED doctor’s assessment: Presenting complaint: right hand swollen and painful, hand painful for 4 hours, no history of trauma. Was in contact with chickenpox 5 days ago. On examination: temp 40.1 (55 minutes after Calpol and Brufen). Small blanching spots on body. ENT / ABDO clear. No photophobia. Diagnosis: probable early chickenpox. Child sent home with antipyretics. Section 2 Clinical case histories Questions What do you think of this assessment? Is there anything else

2018 Meningitis Research Foundation

383. Delirium in Adult Cancer Patients: ESMO Clinical Practice Guidelines

patients [9]. The majority of studies in oncological populations examine de- lirium in advanced cancer patients admitted to palliative care units (PCUs) or inpatient palliative care consultation services [4, 9, 12–17] and do not include cancer survivors (see Supplementary Table S1, available atAnnalsofOncology online). There is limited published in- formation regarding the frequency of delirium in outpatients with advanced cancer [2]. The authors’ literature review found one study in an outpatient (...) ](Supplementary Table S1, available at Annals of Oncology online, provides more detailed information on the prevalence and incidence of delirium in admitted patients with cancer, and frequency of different delirium subtypes when reported). Mortalityandmorbidity Outcomes of delirium in the general hospital population have been examined in systematic reviews; delirium is associated with increased post-discharge mortality [hazard ratio 2.0; 95% con?- dence interval (CI): 1.5–2.5] and institutionalisation [odds

2018 European Society for Medical Oncology

385. Acute Coronary Syndromes: Reperfusion Strategy

performing immediate angiography and if necessary PCI in patients with ST elevation or new left bundle branch block on the standard 12 lead electrocardiograph who respond to cardio-pulmonary resuscitation with spontaneous return of circulation after cardiac arrest 32-35 (LOE II) (CoSTR 2015, strong recommendation, low-quality evidence) 14 . Coma is common and should not be a contraindication to angiography and PCI. We suggest immediate angiography and if necessary PCI in selected patients who do not have (...) -low-quality evidence) 14 . 2.6 Facilitated PCI Facilitated PCI refers to the routine use of fibrinolysis prior to PPCI. The strategy of facilitated PCI compared with PPCI is not recommended in STEMI. ANZCOR Guideline 14.3 January 2016 Page 5 of 10 A number of studies have examined the strategy of facilitated PCI and they have shown no benefit of PPCI and some studies have shown poor outcomes with routine PCI shortly after fibrinolysis 69,70 . (LOE II) (strong recommendation, moderate-quality

2016 Australian Resuscitation Council

386. Post-Resuscitation Therapy in Adult Advanced Life Support

element, and supplementary tests should be considered in the context of the clinical examination. The most reliable combination and timing for assessments have not been fully determined. 3 Recommendations address prognostication of comatose post-cardiac arrest patients treated with hypothermic TTM and patients not treated with hypothermic TTM. This approach was chosen because hypothermic TTM may alter the natural history of coma and may delay recovery of CNS function. Patients may be exposed to large (...) of neurological recovery during or immediately after a cardiac arrest. After cessation of sedation (and/or induced hypothermia) the probability of awakening decreases with each day of coma. ANZCOR Guideline 11.7 January 2016 Page 13 of 17 Recommendation Relying on the neurologic exam during cardiac arrest to predict outcome is not recommended and should not be used. 4 [Class A, Expert consensus opinion] 3 Prognostication for comatose cardiac arrest victims treated with TTM Recommendations ANZCOR suggest

2016 Australian Resuscitation Council

387. Guidelines on Prevention, Diagnosis and Treatment of Infective Endocarditis Full Text available with Trip Pro

is suspected. TOE must be performed in case of negative TTE when there is a high index of suspicion for IE, particularly when TTE is of suboptimal quality. TOE should also be performed in patients with positive TTE to rule out local complications. The indications of echocardiographic examination for diagnosis and follow-up of patients with suspected IE are summarized in Table and Figure . In patients with S. aureus bacteraemia, echocardiography is justified in view of the frequency of IE in this setting (...) echocardiographic findings of IE. In cases with an initially negative examination, repeat TTE/TOE must be performed 5–7 days later if the clinical level of suspicion is still high, or even earlier in the case of S. aureus infection. Other imaging techniques should also be used in this situation (see section 5.5). Finally, follow-up echocardiography to monitor complications and response to treatment is mandatory ( Figure ). Real-time three-dimensional (3D) TOE allows the analysis of 3D volumes of cardiac

2015 European Society of Cardiology

388. Ebymect - dapagliflozin / metformin

on the medicinal product, with a view to examining subsequent applications relating to other medicinal products possessing the same qualitative and quantitative composition in terms of active substances and the same pharmaceutical form. 2.2. Quality aspects Since this application is an informed consent of the Xigduo, the quality data in support of the Ebymect application are identical to the up-to-date quality data of the Xigduo dossier, which has been assessed and approved (including all post-marketing (...) associated with hypoxia. Diagnosis The risk of lactic acidosis must be considered in the event of non-specific signs such as muscle cramps with digestive disorders, abdominal pain and severe asthenia. Lactic acidosis is characterised by acidotic dyspnoea, abdominal pain and hypothermia followed by coma. Diagnostic laboratory findings are decreased blood pH, plasma lactate levels above 5 mmol/L, and an increased anion gap and lactate/pyruvate ratio. If metabolic acidosis is suspected, treatment

2015 European Medicines Agency - EPARs

389. Fexeric - ferric citrate coordination complex

, decreased muscular control, prostration, urination, bowel obstruction, gastroenteritis (including diarrhea and vomiting leading to dehydration, haemoconcentration and electrolyte imbalance), rapid and shallow respiration, convulsions, coma, respiratory failure and cardiac arrest. Post-mortem examination reveals congestion and hemorrhagic necrosis of the GIT. Citric acid has a low acute toxicity when administered orally to mice (LD50=5.4 g/kg) and rats (LD 50 =3 to 12 g/kg); these doses are associated

2015 European Medicines Agency - EPARs

390. Public health guidance on varicella vaccination in the European Union

of infection and (potentially) the boosting of immunity to zoster [265,267]. A few models also took into account potential waning of vaccine protection. New information on parameters related to the vaccine or to the mechanisms of HZ development may result in additional costs. For example, additional costs could arise if new findings would result in a need to protect more adults (or adults at high risk, e.g. vaccinated women of childbearing age) after childhood vaccination. Studies examining varicella

2015 European Centre for Disease Prevention and Control - Public Health Guidance

391. Ionsys - fentanyl

of these studies is acceptable. Concomitant use of other CNS depressants, including other opioids, sedatives or hypnotics, general anaesthetics, phenothiazines, tranquillisers, skeletal muscle relaxants, sedating antihistamines and alcoholic beverages are noted to produce additive depressant effects. Hypoventilation, hypotension and profound sedation or coma may occur. Use of fentanyl with monoamine oxidase (MAO) inhibitors within 14 days is not recommended due to Medicinal product no longer authorised (...) however are based upon the techniques used by Janssen Research for the initial studies with fentanyl. In addition the applicant has described methodology used to quantify fentanyl in the mouse dermal repeat-dose toxicity studies. Fentanyl absorption has been described from both a transdermal and intravenous perspective. The transdermal data are obviously more relevant for this product and this was examined using hairless rat skin preparations, examining the influence of iontophoresis on increasing

2015 European Medicines Agency - EPARs

392. Addyi - Flibanserin

with a strong CYP3A4 inhibitor (ketoconazole) ? Concern with flibanserin being a P-gp inhibitor given the increase in digoxin level when co-administered with flibanserin The second CR letter requests that the Applicant conduct additional pharmacokinetic investigations to examine whether additional enzymes, such as CYP2C9 or CYP2C19, contribute to the metabolism of flibanserin. The letter also recommended a driving simulation study to assess the potential for impaired next-day driving. The applicant

2015 FDA - Drug Approval Package

393. Ravicti - glycerol phenylbutyrate

, hyperventilation, posturing, coma) as well as more subtle (e.g., loss of appetite, headache, cyclical vomiting, somnolence, lethargy, fatigue, Assessment report EMA/676925/2015 Page 10/89 disorientation, behavioural abnormalities, sleep disorders, delusions, hallucinations, psychosis, headaches, nausea, vomiting) manifestations are nonspecific, long delays in diagnosis are common (Rüegger, 2014, Nassogne, 2005). Some critically ill infants are misdiagnosed, for example, with sepsis, resulting in delayed (...) inability to synthesize urea can result in dramatic hyperammonaemia leading to coma and death shortly after birth, whereas less severe defects in urea formation are typically associated with lesser degrees of hyperammonaemia and often present somewhat later in life. UCD management is aimed at prompt diagnosis and reducing production of ammonia through dietary protein restriction and, for patients in whom dietary measures are insufficient, control of blood ammonia through the use of waste nitrogen

2015 European Medicines Agency - EPARs

394. Praxbind - idarucizumab

to idarucizumab have not been identified. However, DNA banking samples are collected in the ongoing study 1321.3. These will be stored by the applicant for up to 15 years and may be analysed at a later time to identify potential genetic factors that could influence therapeutic outcome or adverse reactions. This was endorsed. PK-PD results: Linear and nonlinear (Emax) mixed effects models were used to examine the PK/PD relationship of dabigatran analyte concentration and ECT, dTT, TT, and aPTT and to identify

2015 European Medicines Agency - EPARs

395. Kyprolis - carfilzomib

of 5 daily doses (TR-0021-171). After both single and QDx5 administration, dose- dependent inhibition in proteasome activity was observed in all tissues examined, with the exception of brain, where there was no inhibition of proteasome activity. After five daily doses ofPR-171, proteasome inhibition increased in whole blood, PBMCs, heart and lung, where a statistically significant increase in proteasome inhibition was noted. Recovery occurred in all tissues, except whole blood, with a t1/2 of ~ 24 (...) seen. Carfilzomib did not markedly affect male CYP1A, female CYP2C and male or female CYP3A enzyme expression at the concentrations examined (TR-0197-171). In contrast, carfilzomib may decrease female CYP1A and increase male CYP2C enzyme expression. Additionally, a dose-dependent decrease in total hepatic CYP content was observed in female monkeys treated with carfilzomib. Study (TR-0087-171) was conducted to investigate whether carfilzomib is a substrate and/or an inhibitor of P-gp using the Caco

2015 European Medicines Agency - EPARs

397. Public Health Interventions to Reduce the Secondary Spread of Measles

allowed for calculation of the relative risk of contracting the disease between treated and untreated groups, whereas the matched case-control study allowed for calculation of the odds of vaccine recipients contracting measles as compared with people who did not receive the vaccine. Immunoglobulin for susceptible measles contacts One retrospective cohort study addressed this strategy: a 2009 report from Australia that also examined the strategy of vaccinating susceptible measles contacts, as described (...) , and probable measles cases; possible cases were excluded from the analysis. Isolation of communicable measles cases No studies were located that met the inclusion criteria and examined the effectiveness of this strategy. Public Health Interventions to Reduce the Secondary Spread of Measles 10 Targeted measles vaccination activities during an outbreak One retrospective cohort study addressed a special vaccination initiative 19 in which infants aged six to 11 months were immunized during a local measles

2015 Canadian Agency for Drugs and Technologies in Health - Rapid Review

398. Emergency surgery for brainstem cavernoma haemorrhage with severe neurological presentation. Is it indicated and worthwhile? (Abstract)

. The pre-operative status, pre- and post-operative examinations, surgical approach and neurological residual deficits/outcomes are reported.Results: Four females and one male with ages ranging from 36 to 66 years with rapid neurological deterioration, ventilatory impairment and/or coma were operated between 2011 and 2018. Favourable outcomes were observed with a modified Rankin Scale varying from 1 to 4. Cranial nerve deficits as well as motor and sensitive deficits were observed but all the patients (...) . Since rebleeding is frequent and carries a high mortality, many of these patients do not tolerate this approach. Urgent/emergent surgery may be indicated and lifesaving.Methods: A single center experience is reported in which an aggressive approach was used with urgent/emergency surgery carried out on patients with BSCM haemorrhage and rapid neurological deterioration, ventilatory impairment and/or coma. A review of 5 consecutive cases where urgent/emergent surgery was performed is presented

2020 British Journal of Neurosurgery

399. Clinical Predictors of Intracranial Bleeding in Older Adults Who Have Fallen: A Cohort Study. (Abstract)

bleeding: new abnormalities on neurologic examination (odds ratio [OR] = 4.4; 95% CI = 2.4-8.1), bruise or laceration on the head (OR = 4.3; 95% CI = 2.7-7.0), chronic kidney disease (OR = 2.4; 95% CI = 1.3-4.6), and reduced Glasgow Coma Scale from normal (OR = 1.9; 95% CI = 1.0-3.4).The incidence of intracranial bleeding in our study was 5.0%. We found significant associations between intracranial bleeding and four simple clinical variables. We did not find significant associations between

2020 Journal of the American Geriatrics Society

400. Prognostic factors among children with acute encephalitis/encephalopathy associated with viral and other pathogens. (Abstract)

Prognostic factors among children with acute encephalitis/encephalopathy associated with viral and other pathogens. Acute encephalitis/encephalopathy (AE) associated with viral and other pathogens leads to neurological sequelae and mortality. Knowing the prognostic factors is therefore important for immediate interventions. We examined early-phase unfavorable prognostic factors among children with AE using a nationwide database.We performed a retrospective cohort study using the Diagnosis (...) pathogens, and interventions within 2 days of admission adjusting for within-hospital clustering.This study included 9,386 children with AE (median age of 3 years). A total of 241 (2.6%) in-hospital deaths occurred, and 2,027 (21.6%) patients had the composite unfavorable outcome. Significant unfavorable prognostic factors were age of 12 to 18 years, congenital anomalies, epilepsy, and Japan Coma Scale score of 100 to 300 at admission (i.e., worse levels of consciousness). In contrast, herpes simplex

2020 Clinical Infectious Diseases

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