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Coma Exam

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401. Habituation of auditory startle reflex is a new sign of minimally conscious state. (Full text)

Habituation of auditory startle reflex is a new sign of minimally conscious state. Neurological examination of non-communicating patients relies on a few decisive items that enable the crucial distinction between vegetative state (VS)-also coined unresponsive wakefulness syndrome (UWS)-and minimally conscious state. Over the past 10 years, this distinction has proven its diagnostic value as well as its important prognostic value on consciousness recovery. However, clinicians are currently (...) limited by three factors: (i) the current behavioural repertoire of minimally conscious state items is limited and restricted to a few cognitive domains in the goldstandard revised version of the Coma Recovery Scale; (ii) a proportion of ∼15-20% clinically VS/UWS patients are actually in a richer state than VS/UWS as evidenced by functional brain imaging; and (iii) the neurophysiological and cognitive interpretation of each minimally conscious state item is still unclear and debated. In the current

2020 Brain PubMed abstract

402. Unusual Cancers of Childhood Treatment (PDQ®): Health Professional Version

.[ ] Preoperative evaluation.[ ] A comprehensive ultrasound of all regions of the neck using a high-resolution probe and Doppler technique should be obtained by an experienced ultrasonographer. A complete ultrasound examination should be performed before surgery. The addition of cross-sectional imaging (contrast-enhanced computed tomography [CT] or magnetic resonance imaging) should be considered when there is concern about invasion of the aerodigestive tract. Importantly, if iodinated contrast agents are used

2018 PDQ - NCI's Comprehensive Cancer Database

403. Policy on Obstructive Sleep Apnea

and poor school performance due to misdiagnosed ADHD, aggressive behavior, or developmental delay. 1 Rare sequelae of untreated OSA include brain damage, seizures, coma, and cardiac complications. 1-3 These children also may experience impaired growth. 1,2 Etiology of OSA Patients with certain anatomic anomalies, craniofacial anom- alies, neuromuscular diseases, or Down syndrome are at increased risk for development of obstructive sleep apnea. 5 Anatomic anomalies may include hypertrophic tonsils (...) may contribute to OSA. 3 Diagnosis of OSA Pediatric dentists are in a unique position to be able to iden- tify patients at greatest risk. Adenotonsillar hypertrophy 6 and obesity are major risk factors for OSA in otherwise healthy children. With a history and careful clinical examination at each dental visit, pediatric dentists may identify signs and symptoms that may raise a concern for OSA. Assessment of tonsillar hypertrophy 6 and percentage of airway obstruction by the Friedman Tongue

2016 American Academy of Pediatric Dentistry

404. Canadian Cardiovascular Society/Canadian Cardiovascular Critical Care Society/Canadian Association of Interventional Cardiology Position Statement on the Optimal Care of the Post Arrest Patient (Full text)

[erratum in 2002;346:1756]. N Engl J Med . 2002 ; 346 : 549–556 | | | , x 18 Laurent, I., Adrie, C., Vinsonneau, C. et al. High-volume hemofiltration after out-of-hospital cardiac arrest: a randomized study. J Am Coll Cardiol . 2005 ; 46 : 432–437 | | | | | or a score on the Glasgow Coma Scale of < 8. x 19 Nielsen, N., Wetterslev, J., Cronberg, T. et al. Targeted temperature management at 33 degrees C versus 36 degrees C after cardiac arrest. N Engl J Med . 2013 ; 369 : 2197–2206 | | | We define

2016 Canadian Cardiovascular Society PubMed abstract

405. The role of biomarkers in ruling out cerebral lesions in mild cranial trauma

261Cs ¦ FOREWORD This morning, Johanne was surprised by the first night frost. On her way to work, the front wheel of her bike slipped on the ground frost and she fell. Since she briefly lost consciousness and had a wound on her forehead, witness of the accident called for assistance and Johanne ended up in the emergency department. Despite a reassuring history and physical examination, the question on whether she could have injured her brain remained unanswered. It is at this point of the story (...) ) and the elderly (aged over 75). 1 There is a distinction between mild (or light), moderate and severe cranial trauma. Such distinction is most often based on the Glasgow Coma Scale (GCS): a 3 to 15-point scale used to assess patients’ level of consciousness and neurologic functioning after a head injury (see Table 1). Mild cranial trauma (mCT) often defined as GCS 13-15 is by far, the most frequent, accounting for as many as 71% to 98% of cases and is the subject of interest of this review. 5 Biomarkers

2016 Belgian Health Care Knowledge Centre

406. Aspirin for prophylactic use in the primary prevention of cardiovascular disease and cancer: a systematic review and overview of reviews

relevant papers, of which 2545 were removed at title, abstract or full-paper sift, resulting in 27 papers that met the inclusion criteria. These studies comprised 22 systematic reviews and ?ve RCTs. The systematic reviews examined the use of aspirin for primary prevention of CVD (n=9) cancer (n=6) and CVD in patients with diabetes (n=7) while the RCTs assessed the use of aspirin for primary prevention of CVD (n=3) and CVD in patients with diabetes (n=2). Quality ratings were in general high. We found (...) unpleasant side effects that occasionally may be life-threatening. This short report aims to review and examine the relevant evidence. In this report we interpret primary prevention as de?ned for CVD by the National Institute for Health and Care Excellence (NICE) as follows ‘... interventions that aim to prevent CV [cardiovascular] events in people who have no clinical evidence of CVD’. 1 A similar de?nition may be used for primary prevention of cancer; we employ a corresponding de?nition by substituting

2013 NIHR HTA programme

407. Development and validation of a prognostic model to predict death in patients with traumatic bleeding, and evaluation of the effect of tranexamic acid on mortality according to baseline risk: a secondary analysis of a randomised controlled trial

shorten the time to diagnostic and life-saving procedures such as surgery and TXA. Objectives We aimed to develop a simple prognostic model that could be used at the point of care to estimate risk of death in patients with traumatic bleeding and to examine how TXA treatment effects vary according to the baseline risk of death in bleeding trauma patients. Methods We derived prognostic models in a large placebo-controlled trial of the effects of early administration of a short course of TXA (CRASH-2 (...) for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK. HEALTH TECHNOLOGY ASSESSMENT 2013 VOL. 17 NO. 24 (EXECUTIVE SUMMARY) iii We then used the prognostic model to stratify the patients in the CRASH-2 trial who were treated within 3 hours of injury into four mortality risk strata ( 50%) and examined the effect of TXA

2013 NIHR HTA programme

408. Cirrhosis

changes, development of complications, and need for hospital admission. Cirrhosis should be suspected in high-risk groups, and if there are indicative examination findings or blood test results (although liver function tests may be normal in cirrhosis). Transient elastography can be used in primary care (if available) to diagnose cirrhosis in certain groups, but referral may be required (for example, for people with hepatitis B). Referral to a specialist in hepatology is required for all people (...) (for example irritability, disinhibition, disorientation), personality changes, sleep disturbance, motor problems, and altered level of consciousness [ ; ; ]. Symptoms vary in severity, with mild hepatic encephalopathy only detectable using psychometric or neurophysiological testing and severe cases experiencing acute confusion, agitation, and coma [ ; ]. Hepatic encephalopathy affects around half of people with cirrhosis some time after diagnosis (5–25% within five years and around 1 in 5 people

2018 NICE Clinical Knowledge Summaries

409. Shingles

experienced (location, duration, and severity). Identifying risk factors for shingles, such as immunocompromise due to long-term corticosteroid use. Examining the person to assess for clinical features of shingles and to exclude differential diagnoses (such as herpes simplex virus infection and contact dermatitis). Diagnosis is usually made on clinical grounds. Shingles is characterized by a prodromal period with abnormal skin sensations and pain, followed by a unilateral vesicular rash in the affected (...) and the location, duration, and severity. Identify for shingles, such as immunocompromise due to long-term corticosteroid use. Examine the person to: Assess for the clinical features of shingles. Exclude , such as herpes simplex virus infection and contact dermatitis. Diagnose shingles on the basis of typical clinical features. There is usually a prodromal phase with abnormal skin sensations and pain in the affected dermatome (area of skin served by an individual nerve). The pain can be described as burning

2018 NICE Clinical Knowledge Summaries

410. Hypertension - not diabetic

immediately, before obtaining results of ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM). Examine the fundi for evidence of hypertensive retinopathy. Refer the person for same-day specialist care if they have: Blood pressure higher than 180/110 mmHg with signs of papilloedema and/or retinal haemorrhage (accelerated hypertension). Suspected phaeochromocytoma (labile or postural hypotension, headache, palpitations, pallor, and diaphoresis). For all people with confirmed

2018 NICE Clinical Knowledge Summaries

411. Leg cramps

(rarely thigh); visible or palpable knotting or tightening of the muscle or abnormal posture; pain usually lasting seconds to less than 10 minutes; single muscle (or part of muscle) involvement; no abnormal findings on physical examination; good response to passive and active stretching; residual tenderness in the affected muscle; and causing sleep disruption. A history and examination may help exclude secondary causes (for example lower motor neuron problems, metabolic problems, medications (...) [ ]. Diagnosis Diagnosis of cause of leg cramps Assessment for underlying cause How should I assess someone with leg cramps to identify a cause? Leg cramps can usually be diagnosed from the history and examination, with investigations not always necessary. Idiopathic nocturnal leg cramps are indicated by: Sudden intense calf, or foot pain (rarely thigh); most often at night (or when resting). Visible or palpable knotting or tightening of the muscle or abnormal posture. Duration of pain usually seconds

2018 NICE Clinical Knowledge Summaries

412. Malaria prophylaxis

take days or occur within a few hours. Poor prognostic factors include high levels of parasitaemia, peripheral P. falciparum blood schizonts, pigment deposits in leucocytes, metabolic acidosis, older age, coma and renal impairment. Most cases of severe malaria are due to P. falciparum infection but other species (such as P. vivax and P. knowlesi ) can also cause serious illness. Infections with P. vivax can be associated with severe anaemia, splenic rupture, acute respiratory distress syndrome (...) -endemic country. Travel for tourism. [ ; ; ; ; ; ; ; ; ; ] Complications What are the complications? Complications of malaria include: Cerebral malaria — severe malaria due to P. falciparum with coma (Glasgow coma score less than 11 or Blantyre coma score less than 3) or malaria with coma persisting for more than 30 minutes after a seizure. For information on the and the , see the CKS topic on . Acute respiratory distress syndrome. Spontaneous bleeding and coagulopathy. Sepsis. Severe anaemia

2018 NICE Clinical Knowledge Summaries

413. Urticaria

according to its cause as aquagenic, cholinergic, solar, cold, heat, dermatographism, delayed pressure, vibratory, and contact urticaria. Investigations are not usually required for the diagnosis of urticaria, but may be indicated (after a thorough history and physical examination) to identify associated conditions or trigger factors, or to exclude differential diagnoses. To manage urticaria, the underlying cause should be identified and managed, where possible. Acute urticaria is likely to be self (...) medical conditions, such as previous or current allergies, infections, psychosomatic or psychiatric diseases, or autoimmune conditions. Any gastrointestinal symptoms. Occurrence of symptoms in relation to the menstrual cycle (in women), foreign travels, work, or hobbies. Examine the person. Weals can vary in size (from a few millimetres to hand-sized lesions), may be single or numerous, and can be localized or generalized. They consist of three typical features: A central swelling of variable size

2018 NICE Clinical Knowledge Summaries

414. Diarrhoea - adult's assessment

, dryness of mucous membranes, delayed capillary refill time, decreased urine output, hypotension (check for postural changes), and altered mental status. For more detail, see . Also consider underlying conditions that may increase the risk of complications. Perform an abdominal examination to assess for pain or tenderness, distension, mass, increased or decreased bowel sounds, or liver enlargement. Consider a rectal examination to assess for rectal tenderness, stool consistency, and for blood, mucus (...) dehydration Profound apathy. Weakness. Confusion, leading to coma. Shock. Tachycardia. Marked peripheral vasoconstriction. Systolic blood pressure less than 90 mmHg. Oliguria or anuria. [ ; ] Basis for recommendation Basis for recommendation Determining onset, duration, frequency, and severity of symptoms This recommendation is based on expert opinion in review articles on acute and persistent diarrhoea [ ; ]. Identifying red flag symptoms Expert opinion in a review article indicates that 'red flag

2018 NICE Clinical Knowledge Summaries

415. Nausea/vomiting in pregnancy

% of pre-pregnancy weight. Findings which may suggest an alternative diagnosis include: Onset of symptoms after 11 weeks of gestation. Abdominal pain or tenderness (more than mild epigastric tenderness after retching). Fever. Headache or abnormal neurological examination. Goitre. Complications are more likely in women with severe vomiting and include: Maternal — weight loss, dehydration, hyponatraemia, vitamin deficiencies, Mallory-Weiss tear or oesophageal rupture, increased risk of venous (...) examination. Goitre. Conditions causing nausea and vomiting in pregnancy: Genito-urinary conditions — urinary tract infection, uraemia, pyelonephritis, ovarian torsion, renal stones. Metabolic disorders and endocrine conditions — hypercalcaemia, thyrotoxicosis, diabetic ketoacidosis, Addison's disease. Gastrointestinal conditions — gastritis, gastroenteritis, peptic ulcer, pancreatitis, cholecystitis, bowel obstruction, hepatitis, cholelithiasis, appendicitis. Neurological disorders — vestibular disease

2018 NICE Clinical Knowledge Summaries

416. Palliative care - oral

assessing a person with oral symptoms in palliative care: Ask about dry mouth, oral pain, halitosis, alteration in taste, excessive salivation, bad breath, difficulty chewing, difficulty speaking, dysphagia, and bleeding. Examine the oral cavity for signs of dehydration, level of oral hygiene, ulceration and vesicles, erythema or white patches, local tumour, bleeding, and infection. The cause of most oral problems can be diagnosed on the basis of clinical features alone, and investigations are rarely (...) Diagnosis of oral problems in palliative care History History Enquiry into symptoms and problems with the oral cavity should be part of a full history and examination that includes physical, psychological, social, and spiritual issues: Enquire about dry mouth, oral pain, halitosis, alteration in taste, excessive salivation, bad breath, difficulty chewing, difficulty speaking, dysphagia and bleeding. Be particularly alert if the person has any for oral problems or is using medication that may cause

2018 NICE Clinical Knowledge Summaries

417. Hypothyroidism

to symptoms such as fatigue, depression, and cold intolerance. Cardiovascular complications including dyslipidaemia, coronary heart disease, and heart failure. Reproductive complications such as impaired fertility, and serious obstetric and neonatal complications such as miscarriage, stillbirth, and congenital abnormalities. Neurological and cognitive complications including deafness, impaired concentration and memory. Myxoedema coma. Symptoms are often non-specific and may go unrecognized. They include (...) SCH and cognitive impairment in relatively healthy older adults [ ]. Myxoedema coma This is a rare but serious complication that presents with hypothermia (as low as 23°C), coma, and seizures. Affected people are typically older and have previously undiagnosed hypothyroidism or are poorly compliant with medication. The precipitant is usually onset of another condition such as heart failure, sepsis, or stroke [ ]. Diagnosis Diagnosis of hypothyroidism Clinical features When should I suspect

2018 NICE Clinical Knowledge Summaries

418. Summary of recommendations for the diagnosis and treatment of malaria by the Committee to Advise on Tropical Medicine and Travel (CATMAT)

or complicated malaria requires admission to hospital for regular monitoring of respiratory rate and pattern, coma score, and glucose and urine output, especially if the patient is unconscious. In high levels of parasitemia, exchange transfusion may be beneficial to remove infected red blood cells and toxic mediators from the circulation, and reduce the parasite load . Because of the elevated risk of severe or complicated malaria, those with a diagnosis of Plasmodium falciparum malaria should also (...) for parenteral treatment, for exchange transfusion or for admission to an intensive care unit (ICU). In addition, it is important for monitoring response to treatment. Microscopy, which involves examining thick and thin blood smears, is both rapid and accurate. A Canadian laboratory should be able to confirm the presence of a parasite and, in most cases, identify the species within one to two hours of receiving a blood specimen . However, accurate examination of a blood smear requires considerable training

2014 CPG Infobase

419. Recovery: care of the child/young person

Recovery: care of the child/young person Recovery: care of the child/young person | Great Ormond Street Hospital Google Tag Manager Navigation Search Search You are here Recovery: care of the child/young person Recovery: care of the child/young person ) ( ). Preoperative assessment for general anaesthesia The anaesthetist will assess the child in order to ascertain if s/he is fit enough to undergo anaesthesia and surgery. This is likely to include an examination of the respiratory (...) and depolarising muscle relaxants such as suxamethonium. Rationale 62: If treated promptly most patients recover although there remains a mortality rate of around 5% ( ). Rationale 63: To determine the patient’s conscious level. Rationale 64: Those with a conscious level of less than 8 (as per Great Ormond Street Hospital’s (GOSH) coma scale) will be comatose and have an unprotected airway. Rationale 65: To detect potential complications of neurosurgery such as raised intracranial pressure and the presence

2015 Publication 1593

420. CRACKCast E044 – Neck Trauma

are the indications for immediate OR vs CTA in managing penetrating neck trauma? Most injuries have nonspecific signs/symptoms: serial examination is key Presence of soft signs suggests non-vascular injury, but 5-15% may still have a vascular injury Features of decompensation: Dyspnea Dysphonia Stridor Drooling Expanding hematoma Bruit Cerebral ischemia Shock “HARD SIGNS” – very high likelihood of vascular injury Expanding Hematoma Arterial bleed Roaring bruit Neurologic Deficits Stridor Ischemia No radial (...) or weak pulse Shock Diagnostic strategies Key debate is whether physical exam is sensitive enough to diagnose significant injury Thought to be able to identify vascular and esophageal injuries Use hard and soft signs as a guide Soft signs present indicate that surgical repair is less likely needed 3) Describe an approach to managing acute neck trauma in the ER Management: Stable patients Transport to trauma centre Basic wound compression and occlusion (to prevent air embolus) Neurologic deficits

2016 CandiEM

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