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Coma Exam

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161. CT-Perfusion for Neurological Diagnostic Evaluation

reconstructions) followed by a complete NDD assessment. Both CT-perfusion and the clinical exam will be performed by independent assessors blinded from each others' interpretation. The primary endpoints will be the sensitivity and specificity of CT-perfusion to confirm NDD. Safety endpoints will be CT-perfusion -related adverse events (i.e. contrast-induced kidney injury, new hemodynamic instability while undergoing CT-perfusion). The true negative, true positive, false negative and false positive for CT (...) Evaluation Exams performed according to a determined schedule following admission in the intensive care unit in order to validate CT-perfusion as an accurate ancillary test for neurological diagnostic. Diagnostic Test: Neurological Diagnostic Evaluation Clinical Data: Demographic data Daily data (clinical exams, laboratory data) Drug administration Additional clinical or ancillary neurological determination test Diagnostic Intervention: CT-Perfusion CT-Angiography reconstructions Reference Standard

2017 Clinical Trials

162. Pilot Study of the Neuro-Spinal Scaffold for the Treatment of AIS A Cervical Acute SCI

Frame: 6 Months ] Other Outcome Measures: American Spinal Injury Association Impairment Scale (AIS) improvement of one or more grade [ Time Frame: 6 months ] International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) Exams Improvements in motor and sensory scores [ Time Frame: 6 months ] ISNCSCI exams Improvements in Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP) [ Time Frame: 6 months ] GRASSP Assessment Eligibility Criteria Go (...) Spinal cord injury associated with significant traumatic brain injury or coma that Radiographic or visual evidence of parenchymal dissociation or anatomic transection as determined by the Investigator where the contusion completely bridges a full cross-section of the spinal cord Subjects with spinal cord injuries directly due to gunshot, knife, or other penetrating wounds Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study, you or your doctor

2017 Clinical Trials

163. Unusual Listeria monocytogenes peritonitis in peritoneal dialysis patient with liver cirrhosis: a case report and review of literature (PubMed)

. On admission, patient was soporous without signs of peritonitis and meningitis. Patient's peritoneal effluent was clear, with normal leukocytes. Cranial CT scan showed no abnormalities. Laboratory exams revealed positive inflammatory syndrome. Despite antibiotic therapy, next day, symptoms aggravated with coma development. Peritoneal effluent became cloudy and its leukocyte count rose up. Effluent microscopy revealed Gram-positive bacilli. Patient was started with intraperitoneal Vancomycin and Amikacin

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2017 CEN Case Reports

164. Intracerebral Hemorrhage with Intraventricular Extension—Getting the Prognosis Right Early (PubMed)

with a large IVH burden and poor exam.We present a patient with significant IVH and minimal ICH who deteriorated rapidly to coma after presentation. Despite this exam, an initially non-functioning diversion of cerebrospinal fluid (CSF) and temporary halt of further attempts of CSF diversion in the setting of an early "do not resuscitate order," our patient gradually improved and, with supportive ICU care and rehabilitation, was able to communicate and ambulate with assistance at 12 weeks.Patients with ICH (...) Intracerebral Hemorrhage with Intraventricular Extension—Getting the Prognosis Right Early Early accurate outcome prognostication for patients with intracerebral hemorrhage (ICH) and accompanying intraventricular hemorrhage (IVH) is often challenging (1). Acute hydrocephalus often contributes to a poor clinical exam (2) and can portend significant morbidity and mortality (3). Accordingly, the inpatient neurologist may feel inclined to recommend limitations of care for an ICH patient admitted

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2017 Frontiers in neurology

165. La sténose trachéale sévère post-intubation prolongée (PubMed)

stroke due to hypertensive peak, who had been in a coma for 3 months, requiring prolonged intubation and tracheotomy. Tracheal cannula removal had been proven time and again, but it was impossible due to respiratory distress. ENT exam showed important subglottic stenosis above the hole due to tracheotomy. Ct scan confirmed tracheal stenosis (A, B, C). Tracheoscopy under general anesthesia objectified subglottic stenosis at 1 cm from the glottic floor. The patient underwent surgery with proximal

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2017 The Pan African medical journal

167. ACCF/AHA/SCAI 2013 Update of the Clinical Competence Statement on Coronary Artery Interventional Procedures

accepted model to predict PCI mortality is the NCDR ® CathPCI Risk Score system ( ), which utilizes multiple variables to predict inpatient mortality. , This model performs very well (C statistic: approximately 0.90), although the predictive capability decreases in high-risk patients. Consideration ofcertain general and neurological patient factors in addition to NCDR ® variables improves the predictive value of the model. Consideration of “compassionate use” features (coma on presentation, active

2013 American Heart Association

168. Management of paediatric minor head injuries. Safe discharge?

-discharge No abnormalities on CT scan. Two children returned due to persistent vomiting, repeat scans normal in both cases Poor follow-up rate. Telephone follow-up abandoned after 2 months Mitchell et al, 1994, USA 401 Patients 12 who were admitted for observation following head injury; 218 of the children had a CT scan, the rest of the children only had skull x-ray. 51 Patients had GCS 15, normal neuro exam and normal radiological exam Retrospective review. Follow-up to document occurrence and duration (...) of symptoms No adverse events in the subset of patients with normal GCS, neuro exam and radiological investigations Small subset applicable to question. Radiological examination was CT or plain x-ray or both. Limited follow-up Davies et al, 1995, USA 400 Patients 12 and negative CT scan following head injury Retrospective case-series study. Readmission or death within 1 month of head injury Four patients were readmitted. One patient taking coumarin was found to have a subdural haematoma and required

2013 BestBETS

171. Patient Dignity (Formerly: Patient Modesty): Volume 94

of the patient on the belt (entry into the doctor's office, for example) through to the 10 minute history taking and onward to the exam room with its structural and other attending issues of privacy and then perhaps a procedure with the attending assistants and so forth. The "conveyor belt", as in the NEJM article is there starting up actually even before the patient arrived at the major hospital to "prepare" for the "endpoint". The "belt" is for efficiency and meeting some goals set by the profession (...) to financial aspects of medical care but the other misbehaviors toward their patients. What do you think? ..Maurice. At , Anonymous said... Not much preservation of patient dignity at this facility: https://www.theguardian.com/us-news/2019/jan/08/phoenix-woman-coma-gives-birth-hacienda-healthcare-ceo-resigns REL At , said... This Comment was attempted to be posted today on Volume 86 of course closed to further comments but I thought it was worthy of publishing it here on Volume 94. ..Maurice. At Wednesday

2019 Bioethics Discussion Blog

172. Patient Dignity (Formerly: Patient Modesty): Volume 93

and wasn't bothered by it but this being her 1st job it was notable to her. On the touch issue, I'm fine with handshakes, touching my shoulder, or similar normal social interaction type stuff, but I do want healthcare staff to tell me or ask me as appropriate before they touch me for medical exam purposes. At , said... Biker, elements of human dignity are present and should be aware to the medical staff whether or not the patient is fully under general anesthesia. I can present here an example (...) gynecological procedures on women. Before that time, only midwives examined women intimately. I have this very picture on an article I wrote about . Misty At , Anonymous said... Misty On your site regarding your illustration “ what to expect during a pelvic exam”, it would be beneficial to readers that female patients can additionally request drapes to cover their inner and outer thighs for more privacy. Many more proactive facilitiesare doing just this to enhance the patient experience. Again, thank you

2019 Bioethics Discussion Blog

173. Preserving Patient Dignity (Formerly: Patient Modesty):Volume 105

be considered in the general term "sexual misconduct" are all terms related to the anatomic area of the body needed to be inspected or attended to. Yes, a nurse exposing a patient's penis in preparation for the physician to perform an ophthalmology exam for vision symptoms can be called "inappropriate" or worse BUT unexplained eye pain, sensitivity to light and purulent discharge from one or both eyes which is clinically unexplained may warrant subsequent uncovering of a penis, covered during the eye exam (...) could decide what happens to your modesty if you were placed in a nursing home or you were in a coma? Here are some possible scenarios: 1.) Let’s say that an elderly woman who has dementia is placed in a nursing home and she has expressed in the past she did not want any male nurses or aides to do intimate things to her such as assisting her with bathing. Her daughter who has Power of Authority feels differently and does not think modesty is important so she said it is okay for her to have male

2019 Bioethics Discussion Blog

174. Patient Dignity (Formerly:Patient Modesty): Volume 96

healthcare has become the priority while men’s healthcare has not been given much attention. I’d like to explore another reason why some men are dying at a younger age. The reason more men would rather let nature take its course than seek out medical care is due to the lack of Choice, Privacy, and Respect (CPR), afforded men by our medical system. This is especially true when gender specific intimate exams, tests, or procedures come into play. Same gender caregivers are a subject whose time has come (...) givers for an intimate exam, test, and/or procedure will raise his anxiety level through the roof. The medical community’s answer to that is to just say “too bad, it is what it is”. End part 2 NTT At , said... Good Afternoon: Part 3 So, what can be done to alleviate the unnecessary confrontations between male patients and female healthcare workers when male specific intimate issues are in play? First and foremost, the industry has to let go of the dark ages stereotype they’ve branded on all men

2019 Bioethics Discussion Blog

175. Thoracolumbar Spinal Injuries in Blunt Trauma, Screening for

with a Glasgow Coma Scale (GCS) score between 13 and 15. Thirty-one percent of these patients were recorded as having no pain or tenderness, yet all had fractures. The evidence would suggest that many of these fractures are not truly asymptomatic but rather are occult fractures that are missed owing to the presence of intoxication or an unreliable physical examination. There is considerable evidence to support the notion of performing radiographic screening on the basis of mechanism alone regardless (...) . Evaluation of vertebral fractures and associated injuries in adults. Acta Orthop Traumatol Turc . 2005; 39: 387–390. Enderson BL, Reath DB, Meadows J, et al.. The tertiary trauma survey: a prospective study of missed injury. J Trauma . 1990; 29: 1643–1646. Samuels LE, Kerstein MD. Routine radiologic evaluation of the thoracolumbar spine in blunt trauma patients: a reappraisal. J Trauma . 1993; 34: 85–89. Sava J, Williams MD, Kennedy S, Wang D. Thoracolumbar fracture in blunt trauma: is clinical exam

2012 Eastern Association for the Surgery of Trauma

176. Death, Be Not Proud: The Case for Organ Donation

testing if deemed appropriate. These criteria for declaring death are more stringent than for patients who have not designated themselves as potential donors. Furthermore, unlike coma, in which limited brain function is still intact and the patient may eventually “wake up,” there have been no documented cases of revival after brain death. Will my organs be given to alcoholics or drug abusers? Although potential donors cannot specify the race, sex, age, or religious affiliation of their potential (...) will be what we recommend or what we would do ourselves (donating organs to help another person, signing a DNR order, consenting to a biopsy) but sometimes it will not. Lastly, while the current guidelines for determining brain death are for 2 examinations by qualified providers spaced at least 6 hours apart, there is literature and movement to support changing this protocol to 1 examination. Lustbader and colleagues reported in Neurology that the actual time interval between exams is not 6 hours

2012 Clinical Correlations

177. Australian and New Zealand Society for Geriatric Medicine position statement 13. Delirium in older people

and visual hallucinations. Altered consciousness is reflected by impaired clarity of awareness and alertness ranging from vigilant through to coma. Its clinical presentation can be divided into hyperactive or hypoactive subtypes although the presentation can be mixed. Hyperactive delirium is easily recognised. There is hyperarousal with increased sensitivity to immediate surroundings to the point where patients can be verbally and physically aggressive. Restlessness and wandering are common features (...) , CXR and ECG. Other tests to consider include blood cultures, thyroid function tests, arterial blood gases, B12 and folate, CT brain, lumbar puncture and CSF exam, and EEG. CT brain should not be routine unless there is a positive history of falls, anticoagulation or focal neurological signs. Lumbar puncture should be considered (after CT brain) if there is headache, meningism or no other source of fever. EEG may be helpful if the diagnosis is in doubt and occasionally assists in determining

2012 Clinical Practice Guidelines Portal

180. Oral anticoagulation with warfarin - 4th edition

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

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2011 British Committee for Standards in Haematology

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