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Management of Severe Head Injury

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10621. The Role of Partial Reinforcement in the Long Term Management of Insomnia

Polysomnographic data indicating sleep disorders other than insomnia Assessed with PSG in collaboration with our sleep medicine consultants To assure that the insomnia is not secondary to these factors History of head injury with a sustained loss of consciousness Assessed by self report during the Intake Interview To help assure that the EEG measures are unconfounded by brain damage Evidence of active illicit substance use or fitting criteria for alcohol abuse or dependence Assessed with a structured (...) The Role of Partial Reinforcement in the Long Term Management of Insomnia The Role of Partial Reinforcement in the Long Term Management of Insomnia - 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. The Role

2008 Clinical Trials

10622. 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

10623. 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

10624. 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

10625. 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

10626. Successful life outcome and management of real-world memory demands despite profound anterograde amnesia Full Text available with Trip Pro

Successful life outcome and management of real-world memory demands despite profound anterograde amnesia We describe the case of Angie, a 50-year-old woman with profound amnesia (General Memory Index = 49, Full Scale IQ = 126) following a closed head injury in 1985. This case is unique in comparison to other cases reported in the literature in that, despite the severity of her amnesia, she has developed remarkable real-world life abilities, shows impressive self-awareness and insight

2008 Journal of clinical and experimental neuropsychology

10627. Chiropractic Management of a Patient with Post Traumatic Vertigo of Complex Origin Full Text available with Trip Pro

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

2005 Journal of chiropractic medicine

10628. Management of Acetabular Fractures in the Elderly Patient Full Text available with Trip Pro

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

2005 HSS Journal

10629. 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 Full Text available with Trip Pro

%), 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

2006 Critical Care

10630. Nonoperative management of epidural hematomas and subdural hematomas: is it safe in lesions measuring one centimeter or less? (Abstract)

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

10631. Institutional practice guidelines on management of pelvic fracture-related hemodynamic instability: do they make a difference? (Abstract)

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

10632. Intensive care unit management of the trauma patient. Full Text available with Trip Pro

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

10633. Operative management and outcomes of traumatic lung resection. (Abstract)

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

10634. Pathogenesis, diagnosis and management of pneumorrhachis. Full Text available with Trip Pro

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.

2006 European Spine Journal

10635. Impingement of spinal cord by dislocated rib in dystrophic scoliosis secondary to neurofibromatosis type 1: radiological signs and management strategies. (Abstract)

Impingement of spinal cord by dislocated rib in dystrophic scoliosis secondary to neurofibromatosis type 1: radiological signs and management strategies. Case series.To define radiologic diagnosis and treatment strategies of rib dislocation to prevent serious complications during deformity surgery.Rib dislocation into the spinal canal caused by the dystrophic changes seen in scoliotic patients with neurofibromatosis type 1 (NF-1) may cause severe complications when neglected. The risk (...) of this complication is increased by modern instrumentation techniques that produce greater correction.Three neurologically intact neurofibromatosis patients with scoliosis on whom rib dislocations were determined on convex side of the apical vertebrae were evaluated.Three cases were operated with modern instrumentation and correction techniques either with anterior and posterior approaches with or without rib head excisions, to prevent cord injury. There were no neurologic complications postoperatively.Apical

2008 Spine

10636. Tissue oxygenation during management of cerebral perfusion pressure with phenylephrine or vasopressin. (Abstract)

laboratory.Thirty-five anesthetized swine (46 +/- 1 kg).Blunt trauma to the head and bilateral chests (estimated injury severity score was 25-32) was followed by hypoventilation. Resuscitation was divided into phases to simulate treatment in a typical prehospital, emergency room, and intensive care unit. For 30-45 mins postinjury, 1 L of normal saline was administered. For 45-120 mins, normal saline maintained systolic blood pressure >100 mm Hg plus mannitol for intracranial hypertension. After 120 mins (...) Tissue oxygenation during management of cerebral perfusion pressure with phenylephrine or vasopressin. Phenylephrine is often used for management of cerebral perfusion pressure after traumatic brain injury, but can have undesirable actions. Few studies have evaluated alternatives. The hypothesis was that arginine vasopressin was as effective as phenylephrine for maintaining tissue oxygenation during cerebral perfusion pressure management.Prospective randomized, blinded animal study.University

2008 Critical Care Medicine

10637. Using advanced simulation for recognition and correction of gaps in airway and breathing management skills in prehospital trauma care. Full Text available with Trip Pro

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

2005 Anesthesia and Analgesia

10638. Nitric oxide inhalation is useful in the management of right ventricular failure caused by myocardial contusion. (Abstract)

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

10639. Endoscopic management of limited attic cholesteatoma. (Abstract)

. 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

10640. Nasal Injury and Nasal Foreign Bodies

evidence, UK and European Guidelines. You may find one of our more useful. In this article In This Article Nasal Injury and Nasal Foreign Bodies In this article Nasal injury Nasal injuries are the most common facial traumas. Assessment of these injuries aims to determine the presence of nasal fracture and associated head and facial injuries. The nasal bones are the most commonly fractured bones of the face, as they occupy a prominent, exposed position and have little structural support. Changes (...) vehicle or sports-related trauma; however, other causes such as falls and child abuse must also be considered [ ] . In the elderly, nasal fractures occur secondary to falls [ ] . Presentation [ ] Assessment of nasal injury should include a careful search of other facial injuries, since the risk of important head injury trauma increases significantly with multiple facial injuries. Once significant head injury has been excluded, the presence of nasal fracture and the need for immediate or delayed

2008 Mentor

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