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3. Bruising: Scenario: Management of bruising

Bruising: Scenario: Management of bruising Scenario: Management | Management | Bruising | CKS | NICE Search CKS… Menu Scenario: Management Bruising: Scenario: Management of bruising Last revised in March 2016 Scenario: Management of bruising When should I admit or refer a person with abnormal bruising? Admit the person if they have significant active bleeding and are not responding to simple measures (such as local compression). If is suspected in children and young people, the elderly (...) if they have : Unexplained petechiae or Hepatosplenomegaly or Full blood count results suggestive of . For more information, see the CKS topic on . Refer children with periorbital bruising urgently (for an appointment within 48 hours) for specialist assessment for if they have: A palpable abdominal mass or An unexplained enlarged abdominal organ. For all other children, liaise with a paediatrician or paediatric haematologist to arrange venepuncture and further investigations as needed. Refer adults

2019 NICE Clinical Knowledge Summaries

4. Bruising: How should I investigate a person with bruising?

Bruising: How should I investigate a person with bruising? How should I investigate a person with bruising? | Diagnosis | Bruising | CKS | NICE Search CKS… Menu How should I investigate a person with bruising? Bruising: How should I investigate a person with bruising? Last revised in March 2016 How should I investigate a person with bruising? Arrange a urine dipstick test to check for non-visible haematuria which may suggest an underlying bleeding disorder or vasculitis. In adults (...) with unexplained bruising, bleeding, petechiae, or hepatosplenomegaly consider arranging: A very urgent full blood count including platelet count (within 48 hours) and blood film. Clotting screen (prothrombin time [PT], activated partial thromboplastin time [aPTT], and international normalized ratio [INR] if the person is taking warfarin). Liver, renal, and thyroid function tests, depending on clinical judgement. In children and young people with unexplained bruising or bleeding offer: A very urgent full blood

2019 NICE Clinical Knowledge Summaries

5. Bruising: How should I assess a person with bruising?

Bruising: How should I assess a person with bruising? How should I assess a person with bruising? | Diagnosis | Bruising | CKS | NICE Search CKS… Menu How should I assess a person with bruising? Bruising: How should I assess a person with bruising? Last revised in March 2016 How should I assess a person with bruising? Ask about symptoms which suggest an underlying platelet or coagulation disorder: Nosebleeds or gingival bleeding (mucocutaneous bleeding). Excessive or prolonged bleeding from (...) haemorrhoids, other rectal bleeding, haematuria, or menorrhagia. Previous excessive bruising, or excessive or prolonged bleeding, that: Occurs soon after trauma (particularly if it is associated with a petechial rash or mucocutaneous bleeding) — suggests a . Is delayed, such as haemorrhage occurring 24 hours after a dental extraction (particularly if it is associated with bruises, haemarthrosis, or muscle haematomas) — suggests a coagulation disorder, such as . Is new in onset, following previously normal

2019 NICE Clinical Knowledge Summaries

6. Standards for post-concussion care from diagnosis to the interdisciplinary concussion clinic

Standards for post-concussion care from diagnosis to the interdisciplinary concussion clinic 1 June 8, 2017 STANDARDS FOR POST- CONCUSSION CARE from diagnosis to the interdisciplinary concussion clinic ONF Standards for Post- Concussion Care 2 This report is submitted by the following: The Concussion Advisory Subcommittee of the Ontario Neurotrauma Foundation: Diana Velikonja, PhD, CPsych (Chair) - Hamilton Health Sciences & McMaster University Tara Baldisera, MD, CCFP - Sudbury Family Health (...) Organization, Health Sciences North, Northern Ontario School of Medicine Shannon Bauman, MD, CCFP, Dip. Sports Med - Concussion North, Royal Victoria Regional Health Centre Sheree Davis, MSW, CDR, CPF - Consultant, Health Systems Advisor Carol Di Salle, MSc(S), Reg CASLPO, S-LP (C) - Health Sciences North Melissa Freedman, MSW, RSW, Patient/Family Expert - Ontario Brain Injury Association Donna Ouchterlony, MD, CCFP - St. Michael's Hospital Deanna Quon, MD, FRCPC - Ottawa Hospital Rehabilitation Centre

2017 CPG Infobase

7. Guideline for concussion/mild traumatic brain injury & persistent symptoms - Initial Management of Concussion/mTBI

Guideline for concussion/mild traumatic brain injury & persistent symptoms - Initial Management of Concussion/mTBI Initial Management of Concussion/mTBI // Brain Injury Guidelines Toggle navigation NAVIGATION > > > > > > > > > > > > > > > > > > Guideline For Concussion/Mild Traumatic Brain Injury & Persistent Symptoms 3rd Edition, for Adults over 18 years of age Initial Management of Concussion/mTBI Whether a patient first presents to the Emergency Department (ED) or to the primary care (...) to specialists should also be considered if symptoms exhibit an atypical pattern or cannot be linked to a concussion event, and/ or when there are other major comorbid conditions present (e.g., depression, PTSD). The majority of patients will be discharged home; it should be noted that a person who remains symptomatic post mTBI should not drive for at least 24 hours. 3-6 Even asymptomatic patients after 48 hours exhibited poorer vehicle control, especially when navigating curves suggesting that driving

2018 Ontario Neurotrauma Foundation

8. Guideline for concussion/mild traumatic brain injury & persistent symptoms - Sport-Related Concussion/mTBI

Guideline for concussion/mild traumatic brain injury & persistent symptoms - Sport-Related Concussion/mTBI Sport-Related Concussion/mTBI // Brain Injury Guidelines Toggle navigation NAVIGATION > > > > > > > > > > > > > > > > > > Guideline For Concussion/Mild Traumatic Brain Injury & Persistent Symptoms 3rd Edition, for Adults over 18 years of age Sport-Related Concussion/mTBI In the sports literature, the effects of traumatic biomechanical forces on the brain have traditionally been referred (...) to as a concussion. In this Guideline, the term concussion/mTBI will be used to maintain consistency within this document. A sport-related concussion/mTBI is a traumatic brain injury that may be caused by either a direct blow to the head, face, neck or elsewhere on the body as an indirect force being transmitted to the head during sports activity. A sport-related concussion/mTBI can result in a range of clinical signs and symptoms that may or may not involve a loss of consciousness. While the injury may result

2018 Ontario Neurotrauma Foundation

9. Guideline for concussion/mild traumatic brain injury & persistent symptoms - Diagnosis/Assessment of Concussion/mTBI

Guideline for concussion/mild traumatic brain injury & persistent symptoms - Diagnosis/Assessment of Concussion/mTBI Diagnosis/Assessment of Concussion/mTBI // Brain Injury Guidelines Toggle navigation NAVIGATION > > > > > > > > > > > > > > > > > > Guideline For Concussion/Mild Traumatic Brain Injury & Persistent Symptoms 3rd Edition, for Adults over 18 years of age Diagnosis/Assessment of Concussion/mTBI Diagnosis of mTBI/concussion (Table B) is the first critical step in successful management (...) leading to improved outcomes and prevention of further injury. Patients commonly present to the Emergency Department (ED) or their Primary Care Provider’s (PCP’s) office following trauma and may be unaware that they have sustained concussion/mTBI. A high level of suspicion is required particularly when there is evidence of direct trauma to the head or mechanism of injury 1 that is frequently associated with mTBI, such as motor vehicle collision, falls, assaults and nonintentional strike by/against

2018 Ontario Neurotrauma Foundation

10. Guidelines for diagnosing and managing pediatric concussion

Guidelines for diagnosing and managing pediatric concussion Guidelines for Diagnosing and Managing Pediatric Concussion First edition, June 2014, v1.1 Recommendations for Health Care Professionals This document is intended to guide health care professionals in diagnosing and managing pediatric—not adult—concussion. It is not for self-diagnosis or treatment. Parents and/or caregivers may bring it to the attention of their child/adolescent’s health care professionals. The best knowledge available (...) or damage arising from any claims made by a third party. Also, as the sponsor of this document, the Ontario Neurotrauma Foundation assumes no responsibility or liability whatsoever for changes made to the guidelines without its consent. Any changes must be accompanied by the statement: “Adapted from Guidelines for Diagnosing and Managing Pediatric Concussion with/without permission,” according to whether or not permission was sought and/or given. About the Ontario Neurotrauma Foundation The Ontario

2019 CPG Infobase

11. Assessment of easy bruising

Assessment of easy bruising Assessment of easy bruising - Differential diagnosis of symptoms | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Assessment of easy bruising Last reviewed: February 2019 Last updated: September 2018 Summary A bruise (ecchymosis) is caused by bleeding beneath the skin as a result of extravasation of blood from surrounding blood vessels. It may develop due to abnormalities in haemostasis or alteration in the structural (...) integrity of the blood vessel wall and surrounding subcutaneous tissue. Easy bruising implies that no significant trauma has occurred to the skin or soft tissue to cause the bruise, and the bruises are larger and/or more frequent than what would normally be seen. It is a common complaint of patients seen in a medical practice. Surveys of normal healthy individuals report the frequency of easy bruising to range from 12% to 55%. Srámek A, Eikenboom JC, Briët E, et al. Usefulness of patient interview

2018 BMJ Best Practice

12. Concussion

Concussion Concussion - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Concussion Last reviewed: February 2019 Last updated: March 2018 Summary A closed head injury due to a direct blow to the head or deceleration of the head from an impulsive force, resulting in a transient change in mental status. Most common causes are motor vehicle accidents, sports, assaults, and falls. Diagnosing concussion (mild traumatic brain (...) injury) is difficult based on acute injury characteristics and presenting signs and symptoms. Headache, mental slowing and fogginess, and memory difficulties are typical symptoms. Symptoms may fluctuate, but typically subside after 1 week to 1 month. Loss of consciousness is not necessary for a positive diagnosis. CT scan and MRI are typically normal in concussive injury. For uncomplicated cases, physical and cognitive rest is usually sufficient. Definition Concussion (mild traumatic brain injury

2018 BMJ Best Practice

13. Assessment of easy bruising

Assessment of easy bruising Assessment of easy bruising - Differential diagnosis of symptoms | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Assessment of easy bruising Last reviewed: February 2019 Last updated: September 2018 Summary A bruise (ecchymosis) is caused by bleeding beneath the skin as a result of extravasation of blood from surrounding blood vessels. It may develop due to abnormalities in haemostasis or alteration in the structural (...) integrity of the blood vessel wall and surrounding subcutaneous tissue. Easy bruising implies that no significant trauma has occurred to the skin or soft tissue to cause the bruise, and the bruises are larger and/or more frequent than what would normally be seen. It is a common complaint of patients seen in a medical practice. Surveys of normal healthy individuals report the frequency of easy bruising to range from 12% to 55%. Srámek A, Eikenboom JC, Briët E, et al. Usefulness of patient interview

2018 BMJ Best Practice

14. Artificial intelligence for understanding concussion: Retrospective cluster analysis on the balance and vestibular diagnostic data of concussion patients. Full Text available with Trip Pro

Artificial intelligence for understanding concussion: Retrospective cluster analysis on the balance and vestibular diagnostic data of concussion patients. We propose a bottom-up, machine-learning approach, for the objective vestibular and balance diagnostic data of concussion patients, to provide insight into the differences in patients' phenotypes, independent of existing diagnoses (unsupervised learning).Diagnostic data from a battery of validated balance and vestibular assessments were (...) extracted from the database of the Swiss Concussion Center. The desired number of clusters within the patient database was estimated using Calinski-Harabasz criteria. Complex (self-organizing map, SOM) and standard (k-means) clustering tools were used, and the formed clusters were compared.A total of 96 patients (81.3% male, age (median [IQR]): 25.0[10.8]) who were expected to suffer from sports-related concussion or post-concussive syndrome (52[140] days between diagnostic testing and the concussive

2019 PLoS ONE

15. A novel technique to develop thoracic spinal laminectomy and a methodology to assess the functionality and welfare of the contusion spinal cord injury (SCI) rat model. Full Text available with Trip Pro

A novel technique to develop thoracic spinal laminectomy and a methodology to assess the functionality and welfare of the contusion spinal cord injury (SCI) rat model. This study reports the advantage of a novel technique employing a motorised dental burr to assist laminectomy over the conventional manual technique at T10-T11 vertebra level in a rat model of spinal cord injury. Twenty-four female rats were randomly assigned to four groups: (1) conventionally laminectomised, (2) dental burr (...) assisted laminectomised, (3) conventionally laminectomised with spinal cord contusion and (4) dental burr assisted laminectomised with spinal cord contusion. Basso Beattie Bresnahan (BBB) score, postoperative body weights, rat grimace scale (RGS), open cage activity and rearing was studied at 1, 7, 14, 21 and 28 days postoperatively, and area of spinal tissue affected was evaluated histologically. Laminectomised and spinal cord injured rats from dental burr groups showed significantly more weight gain

2019 PLoS ONE

16. Association between concussion education and concussion knowledge, beliefs and behaviours among youth ice hockey parents and coaches: a cross-sectional study. Full Text available with Trip Pro

Association between concussion education and concussion knowledge, beliefs and behaviours among youth ice hockey parents and coaches: a cross-sectional study. To examine the association between self-reported exposure to concussion education and knowledge, beliefs and self-reported behaviour among parents and coaches of youth ice hockey players.Cross-sectional.Community ice hockey teams from Calgary and Edmonton, Alberta, Canada.Parents and coaches of ice hockey players (ages 11-17, all (...) divisions of play).Participants completed a questionnaire developed and validated to measure concussion knowledge, beliefs and concussion management behaviour (ie, coaches removing athletes from play; parents taking children with suspected concussions to physicians) consistent with the Health Action Process Approach (HAPA). The questionnaire examined specific HAPA constructs (ie, risk perception, outcome expectancies, action self-efficacy, intention, action planning, maintenance self-efficacy, recovery

2020 BMJ open

17. The youth concussion awareness network (You-CAN) - a school-based peer-led intervention to improve concussion reporting and social support: the protocol for a cluster randomized trial. Full Text available with Trip Pro

The youth concussion awareness network (You-CAN) - a school-based peer-led intervention to improve concussion reporting and social support: the protocol for a cluster randomized trial. Concussion prevalence is increasing in the pediatric population, and is a matter of public health concern. Concussion symptoms can be physical, cognitive, emotional and behavioural, and last longer in high school aged youth than adults. Concussions are underreported in youth due to their lack of knowledge, social (...) environment, perceived outcomes of reporting, norms, and self-efficacy. The Youth Concussion Awareness Network (You-CAN) is a school-based peer-led program designed to increase high school students' intent to report a concussion, and provide social support to a peer. This study aims to investigate whether participation in You-CAN, a program grounded in service learning principles, impacts concussion knowledge, attitudes, intent to report a suspected concussion to an adult, and intent to provide social

2020 BMC Public Health

18. Intravenous delivery of microRNA-133b along with Argonaute-2 enhances spinal cord recovery following cervical contusion in mice. (Abstract)

Intravenous delivery of microRNA-133b along with Argonaute-2 enhances spinal cord recovery following cervical contusion in mice. Acute spinal cord injury (SCI) is a devastating condition for which spine decompression and stabilization of injury remains the only therapy available in the clinical setup. However, fibrous scar formation during the healing process significantly impairs full recovery. MicroRNAs (miRs) are small noncoding RNAs that regulate gene expression by binding to target mRNA(s (...) ) and initiating translational repression or mRNA degradation. It has been reported that microRNA-133b (miR133b) is highly expressed in regenerating neurons following a SCI in zebrafish, and lentiviral delivery of miR133b at the time of SCI in mice resulted in improved functional recovery.The aim of this study was to investigate whether intravenous delivery of miR133b enhances spinal cord recovery when administered 24 hours following a cervical contusion injury in mice.This is an experimental animal study

2020 The Spine Journal

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