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Coma Exam

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501. ESC/EACTS Guidelines in Myocardial Revascularisation

and intravenousenoxaparinOrUFHtoLower is- chaemic and bleeding events at short- and Long-term follow-up AVR aortic valve replacement AWESOME Angina With Extremely Serious Operative Mortality Evaluation b.i.d. bisin diem (twice daily) BARI-2D Bypass Angioplasty Revascularization Inves- tigation 2 Diabetes BASKET–PROVE BASKET–Prospective Validation Examin- ation BMS bare-metal stent BRAVE Bavarian Reperfusion Alternatives Evalu- ation BRIDGE Bridging Anticoagulation in Patients who RequireTemporaryInterruptionofWarfarin Therapy (...) -segment elevation acute coronary syndrome ECG electrocardiogram EF ejection fraction EMS emergency medical service ESC European Society of Cardiology EUROMAX European Ambulance Acute Coronary Syndrome Angiography EXAMINATION Everolimus-eluting stent vs. BMS in ST-segment elevation myocardial infarction EXCELLENT Ef?cacy of Xience/Promus vs. Cypher in re- ducing Late Loss After stenting FAME Fractional Flow Reserve vs. Angiography for Multivessel Evaluation FFR fractional ?ow reserve FINESSE

2014 European Society of Cardiology

502. Aortic Diseases

, including the medical, endovascular, and surgical approaches,which areoften combined. In addition, genetic disorders, congenital abnormalities, aortic aneurysms, and AD are discussedinmoredetail. In the following section, the normal- and the ageing aorta are described. Assessment of the aorta includes clinical examination and laboratory testing, but is based mainly on imaging techniques usingultrasound,computedtomography(CT),andMRI.Endovascu- lar therapies are playing an increasingly important role (...) /article-abstract/35/41/2873/407693 by guest on 02 April 2019dilationovermid-to-lateadulthoodisthoughttobeaconsequence of ageing, related to a higher collagen-to-elastin ratio, along with increasedstiffnessandpulsepressure. 20,23 Currentdatafromathletessuggestthatexercisetraining per sehas onlyalimitedimpactonphysiologicalaorticrootremodelling,asthe upperlimit(99thpercentile)valuesare40 mminmenand34 mmin women. 27 4. Assessment of the aorta 4.1 Clinical examination While aortic diseases may

2014 European Society of Cardiology

503. Guidelines for the treatment of malaria. Third edition

red cells per unit volume of blood, the number of parasites seen in one field on high power microscopy examination of a thick blood film, or the number of parasites seen per 200–1000 white blood cells on high-power examination of a thick blood film. Asymptomatic parasitaemia. The presence of asexual parasites in the blood without symptoms of illness. Cerebral malaria. Severe P. falciparum malaria with coma (Glasgow coma scale 30 min after a seizure. Combination treatment. A combination of two (...) should be secured in unconscious patients and breathing and circulation assessed. The patient should be weighed or body weight estimated, so that medicines, including antimalarial drugs and fluids, can be given appropriately. An intravenous cannula should be inserted, and blood glucose (rapid test), haematocrit or haemoglobin, parasitaemia and, in adults, renal function should be measured immediately. A detailed clinical examination should be conducted, including a record of the coma score. Several

2015 World Health Organisation Guidelines

504. Diagnosis and Management of Acute Pulmonary Embolism

that have examined VTE as a whole. The epidemiology of PE is dif?cult to determine because it may remain asymptomatic, or its diagnosis may be an incidental ?nding; 2 in some cases, the ?rst presentation of PE may be sudden death. 7,8 Overall, PE is a major cause of mortality, morbidity, and hospitaliza- tion in Europe. As estimated on the basis of an epidemiological model, over 317 000 deaths were related to VTE in six countries of the European Union (with a total population of 454.4 million) in 2004 (...) embolism. a Low or intermediate clinical probability, or PE unlikely, depending on the studies. ESC Guidelines 3042 Downloaded from https://academic.oup.com/eurheartj/article-abstract/35/43/3033/503581 by guest on 02 April 2019The incidental discovery of clinically unsuspected PE on CT is an in- creasingly frequent problem, arising in 1–2% of all thoracic CT exam- inations, most often in patients with cancer, but also among those with paroxysmal atrial ?brillation or heart failure and history of atrial

2014 European Society of Cardiology

505. Canadian Diabetes Association 2013 clinical practice guidelines for the prevention and management of diabetes in Canada : Hyperglycemic emergencies in adults

as opposed to hyperosmolar nonketotic coma (HONKC) since less than one-third of people with HHS actually present with a coma . Risk factors for DKA include new diagnosis of diabetes mellitus, insulin omission, infection, myocardial infarction (MI), abdominal crisis, trauma and, possibly, continuous subcutaneous insulin infusion (CSII) therapy, thyrotoxicosis, cocaine, atypical antipsychotics and, possibly, interferon. HHS is much less common than DKA . In addition to the precipitating factors noted above (...) . There is no conclusive evidence supporting the use of an initial insulin bolus in adults and it is not recommended in children. Although the use of an initial bolus of intravenous insulin is recommended in some reviews , there has been only 1 randomized controlled trial in adults examining the effectiveness of this step . In this study, there were 3 arms: a bolus arm (0.07 units/kg, then 0.07 units/kg/h), a low-dose infusion group (no bolus, 0.07 units/kg/h) and a double-dose infusion group (no bolus, 0.14 units/kg

2013 CPG Infobase

506. Canadian Diabetes Association 2013 clinical practice guidelines for the prevention and management of diabetes in Canada : Diabetes in the elderly

episodes of prolonged asymptomatic hypoglycemia . If these data are replicated in subsequent studies, the assumptions underlying higher A1C targets for functionally impaired people with diabetes will need to be revisited. The consequences of a moderate-to-severe hypoglycemic episode could include a fall and injury, seizure or coma, or a CV event . A1C values <6.5% and >8.0% are associated with an increased risk of fractures . Episodes of severe hypoglycemia may increase the risk of dementia , although

2013 CPG Infobase

507. Extracorporeal Membrane Oxygenation (ECMO)

described as poor did not present enough information to make this determination or did not sufficiently attempt to control for confounding variables in some way. It is also challenging to pool information across comparative observational studies (cohort and case- control study designs) because these studies examined distinct patient populations with different disease entities and variable severities of illness. Another limitation of drawing conclusions across studies is that there is so much variability (...) Cohort studies=3 Cardiopulmonary bypass Medium Inconsistent Direct Imprecise ++ Low Comparable: No survival benefit; shorter length of stay (1 study) Two studies examined heart transplant; one studied heart- lung transplant ECMO ECPR N=1,543 RCT=0 Cohort studies=5 Conventional cardiopulmonary resuscitation Medium Inconsistent Direct Imprecise ++ Low Comparable: Short-term survival benefit is lost in longer- term. One study showed neurologic benefit Only one study reported positive survival benefit

2016 California Technology Assessment Forum

508. Validation of the Full Outline of Unresponsiveness (FOUR) Scale for conscious state in the emergency department: comparison against the Glasgow Coma Scale. (Abstract)

Validation of the Full Outline of Unresponsiveness (FOUR) Scale for conscious state in the emergency department: comparison against the Glasgow Coma Scale. To determine (a) the inter-rater reliability of pairs of emergency doctors' and/or nurses' ratings of the Glasgow Coma Scale (GCS) and the Full Outline of Unresponsiveness (FOUR) Scale in emergency department (ED) patients, (b) the concurrent validity of the FOUR Scale using the GCS as the reference scale and (c) doctors' and nurses (...) to determine the predictive validity of the FOUR Scale and to further examine the reliability of the scale in various patient populations.

2010 Emergency Medicine Journal

509. Influence of alcohol on early glasgow coma scale in head-injured patients. Full Text available with Trip Pro

Influence of alcohol on early glasgow coma scale in head-injured patients. To assess the depressant effects of alcohol on the level of consciousness of patients admitted with head injuries, this study examined the changes that occur in the Glasgow Coma Scale (GCS) of traumatic brain injury patients over time.The records of 269 head trauma patients consecutively admitted to the neurosurgery intensive care unit were examined retrospectively. Eighty-one patients were excluded because of incomplete

2010 Journal of Trauma

510. Woman with acute onset involuntary limb movements. (Abstract)

Woman with acute onset involuntary limb movements. An 88-year-old woman presented with acute onset of involuntary limb movements for one day. Two days prior she had fallen a suffered a left hip contusion but no head trauma. There was no fever or difficulty breathing. Her heart rate was 72 bpm with blood pressure of 109/68 mm Hg. Physical examination revealed restricted left hip motion due to pain and a sustained twisted posture of the upper extremity without paresis. Glasgow Coma Scale was 15

2019 Emergency Medicine Journal

511. Traumatic Retroclival Epidural Hematoma. (Abstract)

Traumatic Retroclival Epidural Hematoma. Retroclival epidural hematomas are particularly rare conditions that are frequently the result of high-energy, hyperflexion-hyperextension injuries in pediatric patients. We present the case of a 7-year-old previously healthy girl with traumatic retroclival epidural hematoma after a fall from a swing. She presented with a Glasgow Coma Scale score of 15 with severe neck pain and limitation of cervical movements in all directions. Radiological examination

2019 Pediatric Emergency Care

512. Evaluation of Nonfatal Strangulation in Alert Adults. (Abstract)

a retrospective analysis of alert strangled patients treated in the ED of an academic Level I trauma center. Exclusions were Glasgow Coma Scale (GCS) score less than 13, younger than 16 years, and interhospital transfers. Trained researchers used structured forms to abstract demographics, symptoms, examination findings, radiology and operative findings, and final diagnoses. Injuries requiring greater than 24 hours' observation or specific treatment (surgery, procedure, specific medication) were considered (...) Evaluation of Nonfatal Strangulation in Alert Adults. There is a paucity of evidence to guide the diagnostic evaluation of emergency department (ED) patients presenting after nonfatal strangulation (manual strangulation or near hanging). We seek to define the rate of serious injuries in alert strangled patients and determine which symptoms and examination findings, if any, predict such injuries.Using prospectively populated databases and electronic medical record review, we performed

2019 Annals of Emergency Medicine

513. Disruption of the ascending arousal network in acute traumatic disorders of consciousness. Full Text available with Trip Pro

the brainstem tegmentum to the hypothalamus, thalamus, and basal forebrain. To assess the spatial specificity of CP differences between patients and controls, we also measured CP within 4 subcortical pathways outside the AAn.Compared to controls, patients showed a reduction in AAn pathways connecting the brainstem tegmentum to a region of interest encompassing the hypothalamus, thalamus, and basal forebrain. When each pathway was examined individually, brainstem-hypothalamus and brainstem-thalamus CPs (...) , but not brainstem-forebrain CP, were significantly reduced in patients. Only 1 subcortical pathway outside the AAn showed reduced CP in patients.We provide initial evidence for the reduced integrity of axonal pathways linking the brainstem tegmentum to the hypothalamus and thalamus in patients presenting with traumatic coma. Our findings support current conceptual models of coma as being caused by subcortical AAn injury. AAn connectivity mapping provides an opportunity to advance the study of human coma

2019 Neurology

514. Haemodynamics as a determinant of need for pre-hospital application of a pelvic circumferential compression device in adult trauma patients. Full Text available with Trip Pro

outcomes including worsening of lateral compression fracture patterns and routine use is associated with high costs. Controversy regarding indication of PCCDs exists with some centres recommending PCCD in the setting of hypovolaemic shock compared to placement for any suspected pelvic injury.To assess the need for PCCD application based on pre-hospital vital signs and mechanism of injury.A retrospective cohort study was conducted in a single adult major trauma centre examining a 2-year period. Patients (...) were sub-grouped based on initial pre-hospital and emergency department observations as haemodynamically normal (heart rate <100 bpm, systolic blood pressure ≥100 mmHg and Glasgow Coma Scale ≥13) or abnormal. Diagnostic accuracy of pre-hospital haemodynamics as a predictor of pelvic fracture requiring intervention within 24 h was assessed.There were 376 patients with PCCD in-situ on hospital arrival. Pelvic fractures were diagnosed in 137 patients (36.4%). Of these, 39 (28.5%) were haemodynamically

2019 Injury

515. Single-arm, open-label, dose escalation phase I study to evaluate the safety and feasibility of transcranial direct current stimulation with electroencephalography biomarkers in paediatric disorders of consciousness: a study protocol. Full Text available with Trip Pro

measures and interventions that fail to (1) describe the physiological consequences of ABI and (2) elicit functional gains. In paediatric DOC, there is a critical need to develop evidence-based interventions to promote recovery of basic responses to improve rehabilitation and aid decision-making for medical teams and caregivers. The purpose of this investigation is to examine the safety, tolerability and feasibility of transcranial direct current stimulation (tDCS) in children with DOC.This study (...) components and the Coma Recovery Scale-Revised total score from prestimulation to poststimulation.The Johns Hopkins IRB (#IRB00174966) approved this study. Trial results will be disseminated through journals and conferences.NCT03618849.© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

2019 BMJ open

516. Inferior clinical outcomes after femur fracture in the obese are potentially preventable. (Abstract)

with femur fractures undergoing surgical fixation at a Level 1 trauma center from 2010 to 2016. Demographics, Injury Severity Score (ISS), Glasgow Coma Scale (GCS) and mechanism of injury (MOI) were collected along with operative data and complications. Primary outcomes were hospital length of stay (HLOS), ICU length of stay (ICU-LOS), mortality, complications, and time to mobility (time first out of bed, TFOB). Bivariate correlations and multiple regression models were used to examine the relationship (...) Inferior clinical outcomes after femur fracture in the obese are potentially preventable. Obese patients with operative orthopedic trauma have increased risk of adverse outcomes, although the mechanisms accounting for the relationship remain unknown. This study examines the effect of body mass index (BMI) on outcomes after femur fracture fixation, and explores the mediating effects of pathophysiologic factors and clinical management.A retrospective chart review was performed of adult patients

2019 Injury

517. Outcomes in Critically Ill Patients With Traumatic Brain Injury: Ethnicity, Documentation, and Insurance Status. (Abstract)

Outcomes in Critically Ill Patients With Traumatic Brain Injury: Ethnicity, Documentation, and Insurance Status. Disparities in traumatic brain injury outcomes for ethnic minorities and the uninsured have previously been demonstrated; however, outcomes in undocumented immigrants have not been examined. We wanted to determine whether ethnicity, insurance, and documentation status served as risk factors for disparities in traumatic brain injury outcomes between undocumented immigrants (...) resulted in the majority of traumatic brain injuries in the total population, however, undocumented immigrants were almost twice as likely to be assaulted (p = 0.0032). There was no difference in presence of midline shifts, Injury Severity Score, Glasgow Coma Score, hypotension, hypoxia, and pupillary reactions between undocumented immigrants and documented residents. Undocumented immigrants presented with significantly more effaced basilar cisterns (p = 0.0008). There was no difference in hospital

2019 Critical Care Medicine

518. Spontaneous cerebellar hemorrhage with severe brainstem dysfunction through minimally invasive puncture treatment by locating the simple bedside. Full Text available with Trip Pro

with cerebellar hemorrhage.For these 21 patients, the bleeding amount and Glasgow Coma Scale (GCS) score before the operation were 18.5 ± 5.0 cc and 9.5 ± 3.3, respectively; 24 hours after the operation, the GCS score was 11.0 ± 4.6. Five patients died within 7 days of the operation and the head computed tomography (CT) was re-examined. It was found that the average bleeding amount was 3.4 ± 0.9 cc, the operation success rate was 76.2%, and the accurate puncture rate was 100%. Six months later, the Modified

2019 Medicine

519. Factors affecting the occurrence of gastrointestinal bleeding in acute ischemic stroke patients. Full Text available with Trip Pro

Factors affecting the occurrence of gastrointestinal bleeding in acute ischemic stroke patients. Gastrointestinal bleeding (GIB) is a common complication that occurs after stroke, and GIB may negatively affect patient prognosis. In this study, we aimed to examine:(1) the risk factors of GIB in acute cerebral infarction patients;(2) association between GIB and 1-year mortality in patients with acute cerebral infarction.Patients with acute cerebral infarction were divided into 2 groups based (...) in acute cerebral infarction patients.Clinical data of patients with acute cerebral infarction were reviewed and analyzed during the years 2015 and 2016. Finally, 1662 patients with acute cerebral infarction were included in this study, of whom 139 (8.5%) patients had GIB at admission. Multivariate logistic regression analysis revealed that the independent risk factors for GIB in patients with acute cerebral infarction were advanced age (OR = 1.030, P = .009), low Glasgow Coma Scale (GSC) score

2019 Medicine

520. Insulin therapy is not associated with improved clinical outcomes in critically ill infants with stress hyperglycemia. Full Text available with Trip Pro

Insulin therapy is not associated with improved clinical outcomes in critically ill infants with stress hyperglycemia. The aim of the present study was to examine the benefits of insulin use and non-use in critically ill infants with stress-induced hyperglycemia. The present retrospective study used clinical data from 302 critically ill infants with stress hyperglycemia admitted to pediatric intensive care units (PICUs). The patients were recruited randomly and divided into three groups (...) : The tight glycemic control, conventional insulin therapy and control groups. Correlations between insulin therapy and improved clinical outcomes were assessed according to key parameters (length of PICU stay, total length of stay, occurrence of organ dysfunction and mortality). Correlations between blood glucose level and these parameters in the three groups were also examined. Blood glucose levels following insulin therapy were not correlated with the length of PICU stay, total length of stay

2019 Experimental and therapeutic medicine Controlled trial quality: uncertain

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