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Management of Severe Head Injury

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10341. The role of amifostine as a radioprotectant in the management of patients with squamous cell head and neck cancer

The role of amifostine as a radioprotectant in the management of patients with squamous cell head and neck cancer The role of amifostine as a radioprotectant in the management of patients with squamous cell head and neck cancer The role of amifostine as a radioprotectant in the management of patients with squamous cell head and neck cancer Hodson D I, Browman G P, Thephamongkhol K, Oliver T, Zuraw L, Head and Neck Cancer Disease Site Group CRD summary This review assessed amifostine (...) ; Ontario Ministry of Health and Long-term Care. Bibliographic details Hodson D I, Browman G P, Thephamongkhol K, Oliver T, Zuraw L, Head and Neck Cancer Disease Site Group. The role of amifostine as a radioprotectant in the management of patients with squamous cell head and neck cancer. Cancer Care Ontario Practice Guidelines Initiative 2003. Available at: Accessed April, 2014 This paper is produced by Cancer Care Ontario Practice Guidelines Initiative. The series is published on the Internet

2003 DARE.

10342. A look at recent hyperventilation studies: outcomes and recommendations for early use in the head-injured patient

of the total management of the severely head-injured patient. Hyperventilation or suction procedure cycle. Tromethamine and hyperventilation versus hyperventilation alone versus normal ventilation. Participants included in the review Head-injured patients, ranging from 2T to 12 on the Glasgow Coma Scale and aged 1 month upwards. Variable pathology including trauma, asphyxia, stroke, meningitis, intracerebral haematoma, subarachnoid haemorrhage and acute subdural haematoma. Outcomes assessed in the review (...) between studies investigated? The authors do not state how differences between the studies were investigated. Results of the review Five descriptive case studies (N=235), 6 quasi-experimental studies (N=245) and 1 RCT (N=113) were included. Hyperventilation in each study was associated with ischaemia, secondary brain injury and adverse patient outcomes. Early use of hyperventilation (especially under 24 hours) was an area of particular concern. Authors' conclusions Findings suggest that head-injured

1996 DARE.

10343. Prevention of Falls and Fall Injuries in the Older Adult

of falls and fall injuries IV should be included in nursing curricula and on-going education with specific attention to: ¦ Promoting safe mobility; ¦ Risk assessment; ¦ Multidisciplinary strategies; ¦ Risk management including post-fall follow-up; and ¦ Alternatives to restraints and/or other restricted devices. Organization & Policy Recommendations Least Restraint 5.0 Nurses should not use side rails for the prevention III I of falls or recurrent falls for clients receiving care in health care (...) teams in case management; and ¦ Availability of supplies and equipment such as transfer devices, high low beds, and bed exit alarms. Prevention of Falls and Fall Injuries in the Older Adult 10 RECOMMENDATION *LEVEL OF + GRADE OF EVIDENCE RECOMMENDATION Medication Review 8.0 Implement processes to effectively manage IV polypharmacy and psychotropic medications including regular medication reviews and exploration of alternatives to psychotropic medication for sedation. RNAO Toolkit 9.0 Nursing best

2002 Registered Nurses' Association of Ontario

10344. Antiepileptic drug prophylaxis in severe traumatic brain injury

of the American Academy of Neurology Bernard S. Chang , Daniel H. Lowenstein First published January 14, 2003, DOI: https://doi.org/10.1212/01.WNL.0000031432.05543.14 Bernard S. Chang Daniel H. Lowenstein Practice parameter: Antiepileptic drug prophylaxis in severe traumatic brain injury Bernard S. Chang , Daniel H. Lowenstein Neurology Jan 2003, 60 (1) 10-16; DOI: 10.1212/01.WNL.0000031432.05543.14 Citation Manager Formats Make Comment See Comments Downloads 39137 Share Abstract Objective: To review (...) the prophylactic use of antiepileptic drugs (AEDs) in patients with severe traumatic brain injury (TBI). TBI is a common neurologic disorder, accounting for about 1.1 million emergency department visits and one hospitalization per 1,000 people each year in the United States. Among all patients with head trauma who seek medical attention, about 2% develop post-traumatic seizures, although the number varies widely depending primarily on injury severity. About 12% of patients with severe TBI develop post

2003 American Academy of Neurology

10345. Chiropractic Management of a Patient with Post Traumatic Vertigo of Complex Origin (PubMed)

Chiropractic Management of a Patient with Post Traumatic Vertigo of Complex Origin To illustrate a case of vertigo in a patient with cervical spine injury and mild traumatic brain injury following a motor vehicle accident and present chiropractic and rehabilitative procedures used for management.A 30-year-old female had neck pain, head pain, a variety of cognitive problems, vertigo, and restricted cervical range of motion following a serious motor vehicle collision. Following several weeks (...) of chiropractic management with positive progress the patient suddenly had worsening of the vertigo and the cognitive problems. Positional vertigo was ruled out by the emergency room doctors and a neurologist. A neuropsychological assessment indicated that mild traumatic brain injury was present.The patient began chiropractic treatment with both passive and active care, prior to the vertigo incident. Following the vertigo incident, treatment was modified to include 6 weeks of cervical exercises in clinic

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2005 Journal of chiropractic medicine

10346. Cerebral Perfusion Pressure (CPP) Management Information Feedback and Nursing

CPP on a moment-to-moment basis may allow measurable improvement in short and long-term patient functional outcome. Computer interfaces that provide highly visible information about CPP will be randomly allocated to intensive care unit beds of patients with closed head injury (CHI) or subarachnoid hemorrhage (SAH) in whom intracranial pressure monitors and arterial lines have been placed for medical management, stratified by primary diagnosis (CHI or SAH) and severity. Continuous data (...) . The researchers will also assess the value individuals place on varying outcomes following brain injury. Condition or disease Intervention/treatment Phase Traumatic Brain Injury Subarachnoid Hemorrhage Other: Bedside display of cerebral perfusion pressure information Not Applicable Detailed Description: Prevention or reduction of secondary brain injury is a key component in the critical care management of patients with a variety of brain insults. Current clinical management emphasizes maintaining cerebral

2005 Clinical Trials

10347. Interventional Management of Stroke (IMS) II Study

, with internal injuries or ulcerative wounds Recent (within 90 days) severe head trauma or head trauma with loss of consciousness Any active or recent (within 30 days) hemorrhage Known hereditary or acquired hemorrhagic diathesis, coagulation factor deficiency or oral anticoagulant therapy with INR > 1.5 or institutionally equivalent prothrombin time Females of childbearing potential who are known to be pregnant and/or lactating or who have positive pregnancy tests on admission Baseline lab values: glucose (...) Interventional Management of Stroke (IMS) II Study Interventional Management of Stroke (IMS) II Study - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Interventional Management of Stroke (IMS) II Study

2005 Clinical Trials

10348. Virtual Reality in Burn Pain Management

Go to Brief Summary: To examine the safety and efficacy of Virtual Reality (VR) distraction therapy in burn patients experiencing severe procedural pain during wound care. Condition or disease Intervention/treatment Phase Burns Pain Procedure: Pain management Other: Standard of care/no virtual reality game Not Applicable Detailed Description: This is a prospective, randomized cross-over study of the safety and effectiveness of the use of a virtual reality distraction intervention to management (...) than 6 on a numeric pain scal of 0-10 where 0= no pain and 10=worst pain ever experienced ability to use a computer mouse or hit the space bar on a computer keyboard Exclusion Criteria: unhealed burned wounds on face, neck or head history of severe susceptibility to motion sickness presence of open woun ds to the hands that cannot be covered with a dressing while operating the control button patients who report a feeling of anxiety or discomfort while viewing the Snow World software on a computer

2007 Clinical Trials

10349. Interventional Management of Stroke (IMS) III Trial

or ulcerative wounds Recent (within 90 days) severe head trauma or head trauma with loss of consciousness Any active or recent (within 30 days) hemorrhage Pts with known hereditary or acquired hemorrhagic diathesis, coagulation factor deficiency or oral anticoagulant therapy require coagulation labs results prior to enrollment. Any subject with INR > 1.7 or institutionally equivalent prothrombin time is excluded. Patients without history or suspicion of coagulopathy do not require INR or prothrombin time (...) Interventional Management of Stroke (IMS) III Trial Interventional Management of Stroke (IMS) III Trial - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Interventional Management of Stroke (IMS) III Trial

2006 Clinical Trials

10350. Operative management and outcomes of traumatic lung resection. (PubMed)

toward higher mortality (38% versus 30%, p = 0.07). Patients undergoing pneumonectomy had a higher mortality (62%) and more complications (48%) compared with patients undergoing lobectomy (35% mortality, 33% complications) and wedge resection (22% and 8%, all p < 0.05). After excluding patients with severe associated injuries (head, abdomen, heart, great vessels), there were 535 patients with "isolated" lung injury. There was again a stepwise increase in mortality by extent of resection, 19 (...) Operative management and outcomes of traumatic lung resection. To analyze the presentation, injury patterns, and outcomes among a large cohort of patients requiring lung resection for trauma, and to compare outcomes stratified by the extent of resection.Review of all adult patients undergoing lung resections in the National Trauma Data Bank. Patients were categorized by extent of lung resection; wedge resection, lobectomy, or pneumonectomy. Patient factors, injury data, and outcomes were

2006 Journal of the American College of Surgeons

10351. Pathogenesis, diagnosis and management of pneumorrhachis. (PubMed)

Pathogenesis, diagnosis and management of pneumorrhachis. Pneumorrhachis (PR), the presence of intraspinal air, is an exceptional but eminent radiographic finding, accompanied by different aetiologies and possible pathways of air entry into the spinal canal. By reviewing the literature and analysing a personal case of traumatic cervical PR after head injury, we present current data regarding the pathoanatomy, clinical and radiological presentation, diagnosis and differential diagnosis (...) an asymptomatic epiphenomenon but can also be symptomatic by itself as well as by its underlying pathology. The latter, although often severe, might be concealed and has to be examined carefully to enable adequate patient treatment. The management of PR has to be individualized and frequently requires a multidisciplinary regime.

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2006 European Spine Journal

10352. Endoscopic management of limited attic cholesteatoma. (PubMed)

. Disease was dissected off the head of the malleus and the body of incus with preservation of both in 24 ears. Mean follow-up was 43 months. Five ears required revision for recurrent disease, and eight were revised for failed ossicular reconstruction or persistent perforation. Moderate to severe retraction in other areas of the tympanic membrane was evident in 28 cases; none of these required further intervention.An endoscopic technique allows transcanal, minimally invasive, eradication of limited (...) Endoscopic management of limited attic cholesteatoma. Microscopic postauricular tympanomastoidectomy provides a limited exposure to the attic, especially anteriorly. In contrast, the endoscope offers wide transcanal access to the attic, allowing for complete removal of limited attic disease, possibly without interrupting the ossicular chain. This report evaluates 8 years of experience with transcanal endoscopic management of limited attic cholesteatoma.Case series.Seventy-three ears

2004 Laryngoscope

10353. Intensive care unit management of the trauma patient. (PubMed)

of traumatic brain injury were identified on PubMed.The intensive care unit care of the trauma patient differs from that of other intensive care unit patients in many ways, one of the most important being the need to continuously integrate operative and nonoperative therapy. Although progress in the care of the injured has been made, death due to uncontrolled bleeding, severe head injury, or the development of multiple organ dysfunction syndrome remains all too common in this patient population (...) Intensive care unit management of the trauma patient. The goal of this concise review is to provide an overview of some of the most important intensive care unit issues and approaches that are unique to trauma patients as compared with the general intensive care unit population.Clinical trials in trauma patients focusing on hemorrhage control, issues in resuscitation, staged operative repair of multiple injuries, the diagnosis and therapy of the abdominal compartment syndrome, and the treatment

2006 Critical Care Medicine

10354. Nitric oxide inhalation is useful in the management of right ventricular failure caused by myocardial contusion. (PubMed)

Nitric oxide inhalation is useful in the management of right ventricular failure caused by myocardial contusion. We report a severe head injury and blunt chest trauma with sternal and multiple rib fractures with high-energy impact in a 22-year-old man. Twelve hours after the accident, haemodynamic status of the patient rapidly worsened because of right ventricular (RV) failure due to myocardial contusion, requiring increasing doses of catecholamine. Nitric oxide inhalation was used to decrease

2005 Acta Anaesthesiologica Scandinavica

10355. Using advanced simulation for recognition and correction of gaps in airway and breathing management skills in prehospital trauma care. (PubMed)

Using advanced simulation for recognition and correction of gaps in airway and breathing management skills in prehospital trauma care. In this prospective study, we used two full-scale prehospital trauma scenarios (severe chest injury and severe head injury) and checklists of specific actions, reflecting essential actions for a safe treatment and successful outcome, were used to assess performance of postinternship physician graduates of the Advanced Trauma Life Support (ATLS) course (...) intubation decreased from 55% (20 of 36) to 8% (3 of 36) and from 42% (15 of 36) to 11% (4 of 36), respectively (P < 0.05). The number of participants not holding the tube properly before fixation decreased from 28% (10 of 36) to 0% (0 of 36) (P < 0.05). In the severe head trauma scenario, performed by 15 of 36 participants in each group, the incidence of mistakes in the management of secondary airway or breathing problems after initial intubation decreased from 60% (9 of 15) to 0% (0 of 15) (P < 0.05

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2005 Anesthesia and Analgesia

10356. One year ago not business as usual: Wound management, infection and psychoemotional control during tertiary medical care following the 2004 Tsunami disaster in southeast Asia (PubMed)

%), followed by upper extremities (29%), and head (18%). Two-thirds of patients presented with combined injuries to the thorax or fractures. Near-drowning involved the aspiration of immersion fluids, marine and soil debris into the respiratory tract and all patients displayed signs of pneumonitis and pneumonia upon arrival. Three patients presented with severe sinusitis. Microbiology identified a variety of common but also uncommon isolates that were often multi-resistant. Wound management included (...) injuries to head, chest, and limbs that were often contaminated with highly resistant bacteria. Transferred patients from disaster areas should be isolated until their microbial flora is identified as they may introduce new pathogens into an ICU. Successful wound management, including aggressive debridement combined with vacuum-assisted closure was effective. Initial anti-infective therapy using quinolones combined with clindamycin was a good first-line choice. Psychoemotional intervention alleviated

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2006 Critical Care

10357. Management of Acetabular Fractures in the Elderly Patient (PubMed)

Management of Acetabular Fractures in the Elderly Patient Operative management of displaced acetabular fractures yields better results than nonoperative management. Over the past decade, surgical approaches to the acetabulum and the surgical tactic for repair of common fracture patterns have been advanced. Excellent outcomes after repair of these injuries can be achieved. In some cases, as in the elderly, or in those cases in which there is significant destruction of the articular cartilage (...) not be anatomically reduced. Multiholed acetabular shells can be used as internal fixation devices by placing screws into the columns enhancing the stability of the repair. In older individuals with severe osteoporosis, a typical fracture pattern results in intrapelvic dislocation of the femoral head with a blowout fracture of the anterior column and medial wall. Reinforcement rings with cemented acetabular fixation can be used in these cases. The femoral head can be used as bulk bone graft to replace

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2005 HSS Journal

10358. Nonoperative management of epidural hematomas and subdural hematomas: is it safe in lesions measuring one centimeter or less? (PubMed)

Nonoperative management of epidural hematomas and subdural hematomas: is it safe in lesions measuring one centimeter or less? Management of a patient with a closed head injury is based on neurologic status and computerized tomography scan results. We hypothesized that those patients with an epidural hematoma (EDH) or subdural hematoma (SDH) <1 cm in thickness could safely be treated nonoperatively.We retrospectively reviewed charts of 204 consecutive patients with either an EDH or SDH.There (...) were 122 lesions < or =1 cm and 82 lesions >1 cm. In the first group, 115 were managed nonoperatively, with 111 good outcomes (minimal deficit with a Rancho Los Amigos score [RLAS] > or =3), two poor outcomes (severely disabled with RLAS <3), and two deaths. Twenty-eight patients with lesions greater than 1 cm had concomitant cerebral edema (CE) with an 89% mortality rate. The mortality rate in this group without CE was 20%, demonstrating the presence of CE in this group may have adversely affected

2007 Journal of Trauma

10359. Institutional practice guidelines on management of pelvic fracture-related hemodynamic instability: do they make a difference? (PubMed)

their implementation.Major blunt trauma patients (Injury Severity Score [ISS] > 15) with hemodynamic instability (initial base deficit > 6 mEq/L or received > 6 units of packed red blood cells [PRBCs] during the first 12 hours) related to pelvic fracture were investigated. Patients presenting with ongoing bleeding from other regions or with severe head injury (Glasgow Coma Scale score < 9) were excluded. The pre-PG group (n = 17) were patients managed during the 18 months ending on December 31, 2001. The post-PG group (...) (n = 14) consisted of patients managed during the subsequent 18 months. Demographics, ISS, shock severity, resuscitation, and outcome data were prospectively collected. The adherence to the key steps of PG was evaluated retrospectively in the pre-PG and prospectively in the post-PG group, including abdominal clearance (AC) with diagnostic peritoneal aspiration/lavage or ultrasound (<15 minutes), noninvasive pelvic binding (PB) (<15 minutes), pelvic angiography (PA) (<90 minutes after admission

2005 Journal of Trauma

10360. Effect of patients' age on management of acute intracranial haematoma: prospective national study. (PubMed)

Effect of patients' age on management of acute intracranial haematoma: prospective national study. To determine whether the management of head injuries differs between patients aged > or =65 years and those <65.Prospective observational national study over four years.25 Scottish hospitals that admit trauma patients.527 trauma patients with extradural or acute subdural haematomas.Time to cranial computed tomography in the first hospital attended, rates of transfer to neurosurgical care, rates (...) %) for subdural haematoma (P=0.004)). There was no significant difference between age groups in the incidence of neurosurgical interventions in patients who were transferred. Logistic regression analysis showed that age had a significant independent effect on transfer and on survival. Older patients had higher rates of coexisting medical conditions than younger patients, but when severity of injury, initial physiological status at presentation, or previous health were controlled for in a log linear analysis

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2002 BMJ

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