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Corneal Reflex

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103. Post-Resuscitation Therapy in Adult Advanced Life Support

that multiple modalities of testing (clinical exam, neurophysiological measures, imaging, or blood markers) be used to estimate prognosis instead of relying on single tests or findings. 25. ANZCOR recommends using bilaterally absent pupillary light reflexes (PLRs) or the combined absence of both pupillary and corneal reflexes at least 72 hours after ROSC to predict poor outcome in patients who are comatose after resuscitation from cardiac arrest and who are treated with TTM. 26. ANZCOR suggests against (...) of clinical criteria alone before 72 hours after ROSC to estimate prognosis. 38. ANZCOR suggests that multiple modalities of testing (clinical exam, neurophysiological measures, imaging, or blood markers) be used to estimate prognosis instead of relying on single tests or findings. 39. ANZCOR recommends using the absence of PLR (or the combined absence of both pupillary and corneal reflexes) at 72 hours or greater from ROSC to predict poor outcome in patients who are comatose after resuscitation from

2016 Australian Resuscitation Council

104. Hetlioz - tasimelteon

after dosing. In two rat studies, the highest doses of 400 and 1750 mg/kg did not cause mortality. Clinical signs included ptosis at = 400 mg/kg, and ataxia, impaired respiration and loss of righting reflex at 1750 mg/kg. In a non-GLP compliant dose range finding study in cynomolgus monkeys no mortality was seen up to the highest dose of 200 mg/kg. Clinical signs of salivation were seen in males = 50 mg/kg, and emesis was seen in one female at 100 and 150 mg/kg. In all species, doses which produced (...) ); exposures decreased with repeat dosing NOEL C max 843/3606 ng/mL in M/F NOEL AUC 2468/10196 ng/mL in M/F TAJ0007 SD rat 20 M/F 0, 5, 50, 500 Oral 26 weeks 5 Mortality: 1 F, Day 3 given 500 mg/kg Clinical signs: at 500 mg/kg; Convulsions, hypoactivity, laboured respiration, ataxia, loss of righting reflex, extension of the limbs, recumbency, tremors; more severe in females. ? weight gain in males overall; ? weight gain in females at 500 mg/kg Clinical pathology: 500 and 50 mg/kg: ? RBC indices

2015 European Medicines Agency - EPARs

107. Omidria - phenylephrine / ketorolac

). There were no drug-related adverse local tolerance findings. Other toxicity studies An additional GLP-compliant rabbit ocular toxicity study was conducted to evaluate the effect on corneal endothelium. In this study Omidria was diluted in balanced salt solution to the diluted clinical concentration and administered by intracameral injection into one eye, and vehicle control was injected into the contralateral eye. In this study, eight female New Zealand White rabbits were evaluated by a board-certified (...) veterinary ophthalmologist every four weeks during a 12-week post-dose observation period. At the end of the 12-week post-dose observation period, the ocular tissues were collected for microscopic evaluation by a board-certified veterinary pathologist. No treatment-related effects on the cornea were observed. 2.3.5. Ecotoxicity/environmental risk assessment The predicted environmental concentration in the surface water (PECsurfacewater) of PE and KE was calculated based on a dose of 49.5mg and 17 mg

2015 European Medicines Agency - EPARs

108. Newborn Nursing Care Pathway

history) Assess mother’s/ family/ supports understanding of newborn physiology and capacity to identify variances that may require further assessments Refer to: • Skin Norm and Normal Variations • Outer canthus aligned with upper ear • Dark or slate blue color • Blink reflex present • Edematous lids • Sclera clear • No tears • Pupils equal and reactive to light • May see subconjunctival hemorrhage • Administer eye prophylaxis (after completion of initial feeding or by 1 hour after birth) 20 promotes (...) months Parent education/ Anticipatory Guidance • Parent Education • Refer to >12 – 72 hr • No tears- tear ducts patent ~ 5 – 7 months Physiological Health: eyes Refer to: Healthy Families BC Website – Newborn Guideline 13: Newborn Nursing Care Pathway Physiological Assessment 0 – 12 hours Period of Stability (POS) >12 – 24 hours >24 – 72 hours >72 hours – 7 days and beyond eyeS (Continued) Variance • Hazy, dull cornea • Pupils unequal, dilated constricted

2015 British Columbia Perinatal Health Program

109. Optimal combination of clinical examinations for neurologic prognostication of out-of-hospital cardiac arrest patients. (Abstract)

TTM.We conducted a retrospective analysis of prospectively collected multicentre registry data. All enrolled patients were supposed to undergo pupil light reflex (PLR), corneal reflex (CR), and Glasgow Coma Scale for 7 days after return of spontaneous circulation (ROSC). We investigated the timing of each examination based on the ROSC and rewarming completion times. The primary outcome was poor neurologic outcome (cerebral performance category 3,4, or 5) at 6 months after cardiac arrest.A total

2020 Resuscitation

110. Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review. Full Text available with Trip Pro

, and the Cochrane Database of Systematic Reviews (January 2013-April 2020) were searched. Sensitivity and false-positive rate (FPR) for each predictor were calculated. Due to heterogeneities in recording times, predictor thresholds, and definition of some predictors, meta-analysis was not performed.Ninety-four studies (30,200 patients) were included. Bilaterally absent pupillary or corneal reflexes after day 4 from ROSC, high blood values of neuron-specific enolase from 24 h after ROSC, absent N20 waves

2020 Intensive Care Medicine

111. Neuroprognostication Practices in Postcardiac Arrest Patients: An International Survey of Critical Care Providers. (Abstract)

unconscious cardiac arrest patients to characterize practitioner demographics and current neuroprognostic practice patterns.Physicians that are members of aforementioned societies who care for successfully resuscitated cardiac arrest individuals.Not applicable.A total of 762 physicians from 22 countries responses were obtained. A significant proportion of respondents used absent corneal reflexes (33.5%) and absent pupillary reflexes (36.2%) at 24 hours, which is earlier than the recommended 72 hours

2020 Critical Care Medicine

112. Donation after circulatory determination of death in western Canada: a multicentre study of donor characteristics and critical care practices. (Abstract)

practices, and their relation to one-year recipient and graft survival.There were 257 patients in four provinces that underwent withdrawal of life-sustaining therapies (WLST) in anticipation of possible DCD. The proportion of patients that died within two hours of WLST ranged from 67% to 88% across provinces (P = 0.06), and was predicted by deeper coma (P = 0.01), loss of pupillary light or corneal reflexes (P = 0.02), and vasopressor use (P = 0.01). There were significant differences between provinces

2020 Canadian Journal Of Anaesthesia

113. Legal and Ethical Issues related to Resuscitation

, severe cerebral disability). The earliest time to prognosticate an unfavourable neurological outcome is 72 hours after ROSC, but longer if sedative or paralytic drugs confound the situation. 9 Among predictive factors are the clinical observations of persistent coma, bilateral absent pupillary or corneal reflexes, absent motor and extensor response to pain, presence of myoclonus, absent N20 wave in somato-sensory evoked potentials, high serum values of neurological biomarkers, a marked reduction

2015 Australian Resuscitation Council

115. Squint in children

of amblyopia, correct misalignment of the eyes, and some people regain binocular vision. For diagnosis: Routine childhood screening may detect a squint but parents often present their child with a 'turning eye'. Clinical tests to confirm the presence of a squint in primary care include general inspection of the eyes, the corneal light reflex test, and cover tests. General clinical assessment is important to detect a serious underlying disorder that may present as a squint. In addition, testing the red (...) reflex can help to exclude rare serious intraocular disease such as retinoblastoma. Any child with a suspected or confirmed squint should be referred to the paediatric eye service for management (urgently if a serious cause is suspected). Treatments that may be offered include: Glasses to correct any refractive error. Occlusion therapy to treat amblyopia. Surgery (or in some cases injection of botulinum toxin) to correct misalignment of eyes. © .

2016 NICE Clinical Knowledge Summaries

117. Prolonged analgesic response of cornea to topical resiniferatoxin, a potent TRPV1 agonist. Full Text available with Trip Pro

and consequently a target for pain control. Resiniferatoxin (RTX), a potent TRPV1 agonist, produces transient analgesia when injected peripherally by inactivating TRPV1-expressing nerve terminals through excessive calcium influx. The aim of the present study was to evaluate topical RTX as a corneal analgesic. In rat cornea, a single application of RTX dose dependently eliminated or reduced the capsaicin eye wipe response for 3-5 days, with normal nociceptive responses returning by 5-7 days. RTX alone produced (...) a brief but intense noxious response, similar to capsaicin, necessitating pretreatment of the cornea with a local anesthetic. Topical lidocaine, applied prior to RTX, blocks acute nociceptive responses to RTX without impairing the subsequent analgesic effect. Importantly, RTX analgesia (a) did not impair epithelial wound healing, (b) left the blink reflex intact and (c) occurred without detectable histological damage to the cornea. Immunohistochemistry showed that loss of CGRP immunoreactivity

2010 Pain

119. The Neurology and Neuropsychiatry of COVID-19 Full Text available with Trip Pro

, dysarthria, and paraesthesia in his feet. His lower limb reflexes were absent. He was SARS-CoV-2 swab positive but had no respiratory symptoms. Publication date / reference: 28/05/20 Summary: Case series of (n=2) of two COVID-19 related GBS. One of GBS/Miller-Fisher overlap, the other an Acute Motor Sensory Axonal Neuropathy with whole body impairment. In both cases, patients were highly responsive to IVIG. CSF for SARS-CoV-2 was negative in both cases. Publication date / reference: 28/05/20. Summary

2020 JNNP blog

120. Laventair - umeclidinium bromide / vilanterol

(e.g. motor activity, behaviour, co-ordination, somatic sensory/motor reflex responses and automatic responses such as piloerection, pupil size, lachrymation, salivation, overt cardiovascular and gastrointestinal effects) and potential effects on body temperature. Assessment report EMA/CHMP/163509/2014 Page 28/309 In other study also performed in conscious male Sprague Dawley CD rats, GW642444M was administered as a single dose via snout-only inhalation. Animals were subjected to neurobehavioural

2014 European Medicines Agency - EPARs

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