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121. Management of Multiple Sclerosis

Demyelinating Encephalomyelitis (ADEM) 47, level III; 63, level III • An acute autoimmune demyelinating disease of CNS • Triggered by viral infections and immunisations • Usually a monophasic course • Characterised by: ? subacute encephalopathy evolving over one week to three months, disturbance of consciousness and/or behavioural abnormality ? seizures or coma ? multifocal symptoms and signs: cerebellar or cerebral ? ON or TM ? MRI brain shows symmetrical multifocal or diffuse brain lesions - supra

2015 Ministry of Health, Malaysia

122. Recommendations for the Management of Cerebral and Cerebellar Infarction with Swelling

Cerebellar Stroke Cerebellar infarction can be difficult to diagnose, especially when the chief complaints are dizziness, vertigo, and vomit- ing. Careful attention to speech, gait, coordination, and eye movements is required to make the diagnosis. It is a common pitfall to miss truncal ataxia in a patient during a bedside exam- ination. 48 Few, if any, reliable clinical signs and symptoms can serve to stratify cerebellar stroke patients across a continuum of clinical severity. Swelling after cerebellar

2014 Congress of Neurological Surgeons

123. Treatment and recommendations for homeless people with Opioid Use Disorders

for comorbidities that are strongly associated with opioid use disorders, including polysubstance use and sexually transmitted/ bloodborne infections. ? Evaluate findings from the clinical history, physical exam, and diagnostic testing to determine diagnosis and severity of opioid use disorder; identify any contraindications to medication-assisted treatment or acute conditions requiring a higher level of care. PLAN OF CARE ? Work collaboratively with patients to develop realistic, attainable, short-term goals (...) and transgender persons are among those at highest risk for sexual and physical assault (Kushel 2003). Elicit information about a history of trauma/ abuse: Has anyone ever hurt you? Are you safe now? Have you had to have sex in exchange for drugs? Inquire about head injuries, falls, assaults, accidents, participation in military combat or contact sports, and if the patient has ever been knocked unconscious or been in a coma. Did you ever hit your head or pass out? Do you have bad dreams? If so, inquire about

2014 National Health Care for the Homeless Council

125. Royal Flying Doctor Service Western Operations Clinical manual part 1.Clinical guidelines

blood count CNS Central nervous system FFP Fresh frozen plasma CPAP Continuous positive airway pressure FHR Foetal heart rate RFDS Western Operations Version 6.0 Clinical Manual Issue Date: January 2013 Part 1 - Clinical Guidelines Abbreviations & Measures ii FM Foetal movements NGT nasogastric tube GCS Glasgow coma score NIBP Non-invasive blood pressure GIT Gastrointestinal tract NIV Non invasive ventilation GPS Global positioning system NM Neuromuscular GTN Glyceryl trinitrate NSAIDS Non-steroidal (...) (exacerbates hyperkalemia and causes hypotension and nausea). More rapid onset in catabolic states (sepsis, GIT bleed, rhabdomyolysis) ? Uraemic symptoms - nausea, hiccoughs, drowsiness, flap, foetor, pericarditis, bruising / bleeding, itch, hypotension, coma, ? Death due to arrhythmia (secondary to high K + ), pulmonary oedema, GIT bleed, pericardial tamponade. Pre-flight and In-flight Management 1. Priority and the need for a doctor will need to be determined on an individual basis. Most patients

2014 Clinical Practice Guidelines Portal

126. My new book is out today. Here is the introduction. Hooray!

, is organic food really better, is it wise for the Catholic Church to campaign against condoms, and are exams really getting easier? We see a thinktank report on maths, promoted by a TV maths professor, that gets its own maths catastrophically wrong, and a select committee misleading, and being misled. After all this carping, in a report for the Department For Education I set out how the teaching profession could have its own evidence-based practice revolution to mirror what we’ve seen in medicine (...) in orchestras, how people can turn their back on all of science when some evidence challenges just one of their prejudices, how people win more in a simple game when they’re told they’ve got a lucky ball, how responding to a smear can reinforce it, how smokers are misled by cigarette packaging, how people can convince themselves that patients in comas are communicating, and how negative beliefs can make people experience horrible side effects, even when they’re only taking sugar pills with no medicine

2014 Bad Science

128. Clinical practice guideline for care in pregnancy and puerperium

Technologies Assessment Agency (AETSA), Seville. Rocío García-Aguilar. Diploma in Nursing, Andalusian Health Technologies Assessment Agency (AETSA), Seville Laura Martínez-García. Specialist in Preventive Medicine and Public Health, Iberoamerican Cochrane Centre, Santa Creu i Sant Pau Hospital, Barcelona. Maria de las Nieves Respaldiza-Salas. Specialist in Immunology, Andalusian Health Technologies Assessment Agency (AETSA), Seville. David Rigau-Comas. Specialist in Clinical Pharmacology, Iberoamerican

2014 GuiaSalud

129. The FDA-approved concussion blood test isn’t ready for prime time

, the diagnosis of a concussion is a timely, complicated task, taking into account both subjective historical elements and objective findings from the physical exam. The idea that a blood test could diagnose a concussion would be a game-changer. Unfortunately, after reading the release and the corresponding studies, we have yet to reach the goal line. The blood test released by San Diego based biotechnology company Banyan Biomarkers looks for serum levels of UCH-L1 (ubiquitin carboxy-terminal hydrolase L1 (...) from a CT scan to patients. Subjects were considered to have a mild Traumatic Brain Injury (not clear if this is how they define concussion since the patients were not followed) if they had an initial Glasgow Coma Scale (GCS) > 13 and met one or more of the following criteria: loss of consciousness (LOC), posttraumatic amnesia, or confusion. Since only 10% of concussions experience a LOC, this disregards a lot of people. And I would submit, if someone came to the ED with any of these criteria

2018 KevinMD blog

130. Delayed Post-hypoxic Leukoencephalopathy: A Case Series and Review of the Literature (PubMed)

by a recovery phase with subsequent delayed clinical decline. Patient 1 suffered hypoxia from drug-induced respiratory depression and lack of post-operative positive airway pressure (PAP) support. Her neurological exam on follow-up revealed progressive cognitive decline. Magnetic resonance imaging (MRI) brain showed bilateral white matter changes involving the centrum semiovale. Patient 2 developed a generalized tonic-clonic seizure during an endobronchial biopsy procedure and was found to have multiple air (...) emboli on computed tomography (CT) head scan. She was initially in a drug-induced coma for her seizures. Electroencephalography (EEG) on day 14 of admission showed changes consistent with diffuse encephalopathy. MRI brain showed bilateral white matter changes particularly at the watershed zones and in the centrum semiovale. DPHL is a rare and under-recognized clinical entity that requires clinical suspicion and detailed evaluation for diagnosis. Neuroimaging studies can provide prognostic information

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2018 Cureus

131. Head CT Guidelines Following Concussion among the Youngest Trauma Patients: Can We Limit Radiation Exposure Following Traumatic Brain Injury? (PubMed)

, head injury characteristics, clinical indicators for head CT scan (severe mechanism, physical exam findings of basilar skull fracture, non-frontal scalp hematoma, Glasgow Coma Scale score, loss of consciousness, neurologic deficit, altered mental status, vomiting, headache, amnesia, irritability, behavioral changes, seizures, lethargy), CT results, and hospital course were collected.One-hundred thirty-three patients (78.2%) received a head CT scan, 7 (5.3%) of which demonstrated fractures

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2018 Kansas Journal of Medicine

132. Treating Severe Brain-injured Patients With Apomorphine

to receive a 4-weeks regimen of daily subcutaneous infusions of apomorphine hydrochloride. Patients will be monitored for four weeks before the initiation of the therapy, closely during treatment and they will undergo a 4-weeks inpatient follow-up after washout, as well as a two-year long-term remote follow-up. Shortly before and after the treatment regimen, the subjects will receive a multimodal assessment battery including neuroimaging exams. Primary outcome will be determined as behavioral response (...) to treatment as measured by changes of diagnosis using the Coma Recovery Scale - Revised (CRS-R), while secondary outcome measures will include the Nociception Coma Scale - Revised (NCS-R, circadian rhythm modifications using actimetry, core body temperature recording and night electroencephalography (EEG), positron emission tomography (PET), resting-state high-density EEG and functional magnetic resonance imaging (fMRI). The Glasgow Outcome Scale - Extended (GOS-E) and a phone-adapted version of the CRS-R

2018 Clinical Trials

133. Randomized Controlled Trial for Vestibular Treatment in Concussion

research staff using the contacts provided below. For general information, Layout table for eligibility information Ages Eligible for Study: 18 Years to 40 Years (Adult) Sexes Eligible for Study: All Accepts Healthy Volunteers: No Criteria Inclusion Criteria: 18-40 years of age Normal/corrected vision Diagnosed with sport-related mTBI/concussion in the past 1-6 months with clear mechanism of injury Glasgow coma scale (GCS) of 13 or greater Reported signs of mTBI including: loss of consciousness (...) , amnesia, disorientation, confusion, dizziness, imbalance, memory problems, vomiting mTBI-related vestibular symptoms (dizziness, vertigo, motion intolerance) and/or impairments (gaze stabilization, standing balance, functional gait) per a comprehensive assessment, clinical exam, and interview Exclusion Criteria: History of vestibular disorder prior to current mTBI (benign paroxysmal positional vertigo, unilateral or bilateral vestibular hypofunction) Benign Paroxysmal Positional Vertigo (BPPV

2018 Clinical Trials

134. Pilot Study Evaluating the Success (= Safe Decannulation) of a Standardized Tracheotomy Weaning Procedure in Brain-injury's Patients

, acute respiratory failure, acute neurological condition or severe electrolyte disturbances Mortality at 6 months [ Time Frame: 6 month after weaning procedure start (Inclusion) ] Communication capacity with CRS-R (Coma Recovery Scale Revised) communication subscore [ Time Frame: Up 6 month after weaning procedure start (Inclusion) ] Communication subscore: 2 Functional Accurate 1 Non-Functional: Intentional 0 None Nutrition evolution with DOSS (Dysphagia Outcome and Severity Scale) score [ Time (...) the inclusion and before all exam necessary for the research) Exclusion Criteria: Malnutrition (defines by the age) : age < 70 years old: body mass index (B.D.I.) <16 kg/m² or albuminemia <20 g/L age > 70 years old: body mass index (B.D.I.) <18 kg/m² or albuminemia <30 g/L 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 by the sponsor. Please refer

2018 Clinical Trials

135. Reproducibility of Lung Ultrasound in the Diagnosis of Acute Heart Failure in the ED

on the base of clinical exam, chest x-ray , brain natriuretic peptide (BNP) and echocardiographic findings. A patient lung comet score (LCS) was obtained by summing the number of comets in each of the scanned spaces. Then the probability of AHF was defined as : low probability (LCS<15) intermediate probability (15 30 ). Study Design Go to Layout table for study information Study Type : Observational Estimated Enrollment : 600 participants Observational Model: Case (...) admitted to the ED with acute dyspnea, with the final diagnosis of heart failure by the ICU team Criteria Inclusion Criteria: non traumatic dyspnea with the final diagnosis of heart failure Exclusion Criteria: coma, shock,Mechanical Ventilation, vasopressor drugs arrhythmia serious and sustained, pace maker severe mitral valve disease, severe pulmonary arterial hypertension renal failure with creatinine >350micromol/l Contacts and Locations Go to Information from the National Library of Medicine

2018 Clinical Trials

136. Two Bag System for Diabetic Ketoacidosis

Frame: During hospitalization ] Desaturations less than 89% requiring supplemental oxygen Pulmonary edema [ Time Frame: During hospitalization ] Pulmonary edema seen on either chest X-ray or with the change in the lung exam Chest pain with EKG changes [ Time Frame: During hospitalization ] Onset of new chest pain with new EKG changes concerning for ischemia Hyponatremia events [ Time Frame: During hospitalization ] Sodium values less than 135 mmol/L (corrected for glucose) Hypokalemia events [ Time (...) Frame: During hospitalization ] Potassium values less than 3.3 mmol/L ICU length of stay [ Time Frame: During hospitalization ] Total time the patient was admitted in the stepdown unit and/or medical ICU Changes in mental status [ Time Frame: During hospitalization ] Worsening in either CAM-ICU score or Glasgow Coma Scale Total volume of intravenous fluids administered [ Time Frame: During hospitalization ] Total volume of intravenous fluids administered Eligibility Criteria Go to Information from

2018 Clinical Trials

137. Exertional Exhaustion in Chronic Fatigue Syndrome

and physical, screening blood work, mental status exam, heart rate variability for orthostasis, and dolorimetry for systemic hyperalgesia. On Exercise Day 1, subjects had magnetic resonance imaging (MRI) for structure (MPRAGE), white matter integrity (diffusion tensor imaging, DTI), and blood oxygenation level dependent (BOLD) analysis during working memory tasks. The tasks were the simple stimulus-response 0-back "see a letter, push a button" task, and the difficult continuous 2-back task "see a string (...) serious neurological diseases Brain injury. stroke, severe head injury (concussion, severe motor vehicle accidents), bleeding into brain, have been unconscious for more than 1 day (in a coma), seizures, brain inflammation such as multiple sclerosis or lupus. Metal implants such as prostheses, wires, plates, or screws that may heat up in the magnetic resonance imaging scanner and cause harm. Claustrophobia. Abnormal laboratory and questionnaire results. Heart, lung, kidney, arthritis, autoimmune

2018 Clinical Trials

138. Cervico-vestibular Rehabilitation for Mild Traumatic Brain Injury

the patient will achieve the last step of this progression which means that the patient can safely return to play, the neuropsychologist and the kinesiologist will confirm the decision with a structured interview (neuropsychologist) and an aerobic test (kinesiologist). The clearance will be determined by the day for which 1) the symptoms will have resolved 2) the neurological, cervical spine and vestibular exams will be deemed normal by the treating physiotherapist 3) the subject returned to his normal (...) Criteria: Patients with more than 30 minutes of loss of consciousness for the current episode; Patients with more than 24 hours of post-traumatic amnesia; Glasgow Coma Scale score lower than 14 at the time of injury; Patients with radiographic evidence of subdural hemorrhage, epidural hemorrhage, intraparenchymal hemorrhage, and cerebral or cerebellar contusion; Post-injury hospitalization for more than 48 hours; Fracture (head, neck and spine); Having a neurological condition, other than the actual

2018 Clinical Trials

139. Is There a Benefit of Whole Body Computed Tomography (WBCT) for Patients With Only High Velocity Road Traffic Collision (RTC) Vittel Criteria?

Vittel criteria of gravity, normal clinical examination of the thorax, abdomen and pelvis and Glasgow Coma Scale (GCS) score of 15. Criteria Inclusion Criteria: Consecutives patients consulting the emergency department between August 1st 2016 and July 31th 2017 : Older than 18 y.o. WBCT performed, Victim of a high velocity RTC as defined by the presence of at least one criteria of the kinetics elements of the Vittel Criteria Normal physical exam of the chest, abdomen and pelvis, GCS score of 15 (...) . ClinicalTrials.gov Identifier: NCT03679416 Recruitment Status : Completed First Posted : September 20, 2018 Last Update Posted : September 25, 2018 Sponsor: Rennes University Hospital Information provided by (Responsible Party): Rennes University Hospital Study Details Study Description Go to Brief Summary: For victims of high velocity RTC, with no other Vittel criteria of gravity, normal clinical examination of the thorax, abdomen and pelvis and Glasgow Coma Scale (GCS) score of 15 : Study of clinically

2018 Clinical Trials

140. Absence of cognitive symptoms in a 6-year-old male with post-traumatic increased intracranial pressure - A case report (PubMed)

Absence of cognitive symptoms in a 6-year-old male with post-traumatic increased intracranial pressure - A case report Traumatic Brain Injuries (TBIs) can range from mild to severe, and may result in increased intracranial pressure (ICP). Increased ICP causes hallmark physical signs, such as diaphoresis, emesis, fixed pupils, and altered mental status. Monitoring the patient's score on the Glasgow Coma Scale (GCS) and cranial CT scans are routine measures used in clinical practice to monitor (...) the development of a TBI.A 6-year-old male fell off his father's shoulders and subsequently presented to ED for suspected head trauma. He was transferred to our Level 1 Trauma Center after a head CT scan demonstrated a subdural hematoma. His GCS score remained 15. The next day he began to have episodes of apnea and desaturation. Further imaging indicated expansion of the hematoma with a 5mm midline shift. He remained consistently alert and a neurological exam revealed cranial nerves to be grossly intact

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2018 Annals of Medicine and Surgery

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