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Neurogenic Shock

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81. Adult Urodynamics

dysfunction either early in the course of the disease or as the disease progresses. In these patients, PVR is a useful tool for assessing the possibility of significant bladder and/or outlet dysfunction. In some cases such as SCI, the neurogenic bladder condition that ensues occurs abruptly, and after an initial period of stabilization (spinal shock), the resultant bladder function tends to be fairly fixed. In other cases, there tends to be progression of bladder dysfunction as the disease progresses (e.g (...) incontinence that the absence of detrusor overactivity (DO) on a single urodynamic study does not exclude it as a causative agent for their symptoms . (Clinical Principle) Neurogenic Bladder (NGB) 9. Clinicians should perform PVR assessment, either as part of a complete urodynamic study or separately, during the initial urological evaluation of patients with relevant neurological conditions (e.g., spinal cord injury and myelomeningocele) and as part of ongoing follow-up when appropriate. ( Standard

2018 American Urological Association

83. Erectile Dysfunction

, penile venous surgery is not recommended. (Moderate Recommendation; Evidence Level: Grade C) 23. For men with ED, low-intensity extracorporeal shock wave therapy (ESWT) should be considered investigational. (Conditional Recommendation; Evidence Level: Grade C) 24. For men with ED, intracavernosal stem cell therapy should be considered investigational: (Conditional Recommendation; Evidence Level: Grade C) 25. For men with ED, platelet-rich plasma (PRP) therapy should be considered experimental

2018 American Urological Association

85. Low back pain and radicular pain: evaluation and management

nervous system. All phases of the affection are covered by the guideline: acute phase from 0 to 6 weeks, sub-acute from 6 to 12 weeks and chronic from 12 weeks. This guideline covers: ? Low back pain without serious underlying cause (red flags) ? Radicular pain (including neurogenic claudication) This guideline does not address: ? Low back pain and radicular pain in children ( 75% in nearly all studies) and a severe spectrum of disease, and cannot be generalised to populations with a lower prevalence

2017 Belgian Health Care Knowledge Centre

86. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope

: Recommendations e86 5.4. Other Reflex Conditions e86 6. Orthostatic Hypotension: Recommendations e86 6.1. Neurogenic Orthostatic Hypotension: Recommendations e86 6.2. Dehydration and Drugs: Recommendations e88 7. Orthostatic Intolerance e88 8. Pseudosyncope: Recommendations e88 9. Uncommon Conditions Associated with Syncope e89 10. Age, Lifestyle, and Special Populations: Recommendations e89 10.1. Pediatric Syncope: Recommendations e89 10.2. Adult Congenital Heart Disease: Recommendations e91 10.3. Geriatric (...) reduction of systolic BP of ≥20 mm Hg (or 30 mm Hg in patients with supine hypertension) or diastolic BP of ≥10 mm Hg that takes >3 min of upright posture to develop. The fall in BP is usually gradual until reaching the threshold. Neurogenic OH A subtype of OH that is due to dysfunction of the autonomic nervous system and not solely due to environmental triggers (eg, dehydration or drugs). , Neurogenic OH is due to lesions involving the central or peripheral autonomic nerves. Cardiac (cardiovascular

2017 American Heart Association

87. Syncope: Guideline For Evaluation and Management of Patients With

.ORTHOSTATIC HYPOTENSION: RECOMMENDATIONS . .. e73 6.1. Neurogenic Orthostatic Hypotension: Recommendations e73 6.2. Dehydration and Drugs: Recommendations e75 7.ORTHOSTATIC INTOLERANCE .. e76 8.PSEUDOSYNCOPE: RECOMMENDATIONS .. e76 9.UNCOMMON CONDITIONS ASSOCIATED WITH SYNCOPE .. e77 10.AGE, LIFESTYLE, AND SPECIAL POPULATIONS: RECOMMENDATIONS . .. e79 10.1. Pediatric Syncope: Recommendations ... e79 10.2. Adult Congenital Heart Disease: Recommendations e81 10.3. Geriatric Patients: Recommendations e81 (...) . The fall in BP is usually gradual until reaching the threshold (31). n Neurogenic OH A subtype of OH that is due to dysfunction of the autonomic nervous system and not solely due to environmental triggers (e.g., dehydration or drugs) (33,34). Neurogenic OH is due to lesions involving the central or peripheral autonomic nerves. Cardiac (cardiovascular) syncope Syncope caused by bradycardia, tachycardia, or hypotension due to low cardiac index, blood ?ow obstruction, vasodilatation, or acute vascular

2017 American College of Cardiology

88. CRACKCast E092 – Small Intestine

of small bowel obstruction: Bowel gets kinked – leads to a backup of intestinal contents and secretions. This leads to temporary increase in peristalsis (initially loose BM’s, N/V). Then the bowel becomes edematous and absorptive functions cease Then bowel develops bacterial overgrowth Development of transudative fluid loss (hypovolemia, metabolic alkalosis, shock) **in a closed loop obstruction the fluid contents increase in pressure much more rapidly (no antero/retrograde flow). This can lead (...) the classification systems; there are at least four categories of SBO. Mechanical obstruction: “presence of a physical barrier to the movement of the intestinal contents”; classified as either: External Internal ….more on these below! Neurogenic / functional obstruction: Disruption of the normal peristaltic activity in the absence of a physical blockage in the lumen. Pseudo-obstruction: poorly understood/complex syndrome, similar symptoms and signs to mechanical obstruction without a mechanical lesion. Thought

2017 CandiEM

89. CRACKCast E099 – Urological Disorders

) Urethral strictures (post trauma, infection, radiation, surgery) Prostate cancer / penis cancer Phimosis / paraphimosis Acute prostatitis / urethritis Pharmacology Anticholinergics, sympathomimetics, CCBs, NSAIDS, TCAs, antihistamines Neurogenic causes: MS Parkinson’s Diabetic peripheral neuropathy Spinal trauma / shock Strokes Epidural abscess Disk herniation Infectious/inflammatory Genital herpes Herpes zoster PROSTATE: Pharmacology that blocks the parasympathetics or increase alpha adrenergic tone (...) extravasation Hypercalcemic crisis RELATIVE Significant comorbid illness complicating outpatient management High-grade obstruction Leukocytosis Solitary kidney or intrinsic renal disease Psychosocial factors adversely affecting home management Bladder (Vesical) Calculi [1] Describe this condition and its management <5% of calculi Usually in older men with infected residual bladder urine with urea splitting organisms (Struvite stones!) Causes: Indwelling catheter BPH Neurogenic bladder Irradiation

2017 CandiEM

90. CRACKCast E106 – Spinal Cord

they are mediated by the spinal levels; examples would be: DTR’s Autonomic dysfunction: Neurogenic shock Priapism If you have a bulbocavernosus reflex = spinal shock is over; if you don’t have a BC reflex the spinal injury has likely led to spinal shock. “Spinal shock refers to the loss of muscle tone and reflexes with complete cord syndrome during the acute phase of injury. Spinal shock typically lasts less than 24 hours but has been reported occasionally to last days to weeks. A marker of spinal shock is loss (...) of the bulbocavernosus reflex, which is a normal cord-mediated reflex that may be preserved in complete cord lesions. The bulbo-cavernosus reflex involves involuntary reflex contraction of the anal sphincter in response to a squeeze of the glans penis or a tug on the Foley catheter. The termination of the spinal shock phase of injury is heralded by the return of the bulbocavernosus reflex; increased muscle tone and hyperreflexia follow later.” – Rosen’s 9 th Edition, Chapter 96 [4] Describe 3 common partial cord

2017 CandiEM

91. CRACKCast E097 – Renal Failure

Nitrates Neurogenic causes Sepsis Anaphylaxis Hypoalbuminemia Nephrotic syndrome Liver disease 4) Compare laboratory test differences between pre-renal azotemia and Intrinsic AKI Pre Renal Intrinsic Post BUN : Cr (ratio) Usually >20 10-20 10-20 Urine Na (mEq/L) <20 >30 <20 early >40 late FENa (%) <1 >2-3 < 1 early >3 late Urine Osm (mOsm/kg) >350 ~300 >400 ealry 300 late Urine Specific Gravity >1.020 ~1.010 >1.010 early <1.010 late Urine Micro Normal +/- hyaline casts ATN: Hyaline casts w/ dark (...) endocarditis Systemic vasculitis Henoch-Schonlein purpura HIV-associated nephropathy Essential mixed cryoglobinemia Goodpasture’s syndrome Primary Renal Diseases Poststreptococcal glomerulonephritis Other postinfectious glomerulonephritis Rapidly progressive glomerulonephritis Tubulointerstitial Diseases and Conditions Drugs Toxins Infections Multiple myeloma Acute Tubular Necrosis Ischemia -> Shock, sepsis, severe pre-renal azotemia Nephrotoxoins -> Antibiotics, radiographic contrast agents, myoglobinuria

2017 CandiEM

92. CRACKCast E138 – Sepsis Syndromes

trial shows qSOFA outperformed SIRS for picking up SEPSIS patients that need ICU level care (see this post for more ) Source: [4] Discuss the Surviving Sepsis Guidelines Source: [5] List doses and indications for commonly used vasoactive medications Sepsis 1st line Norepinephrine 2nd line Vasopressin 3rd Line epi if not reaching MAP Cardiogenic Shock Epinephrine Dobutamine Milrinone Neurogenic shock Epinephrine Dopamine Table 130.2 – Dosing of Vasoactive Therapy Drug Dosing Dobutamine 5 – 15 µg/kg (...) out for years. So go straight to those sources for the knowledge goodness. [1] Define SIRS, Sepsis, Severe Sepsis, and Septic Shock Bacteremia – Presence of viable bacteria in the blood, as evidenced by positive blood cultures SIRS – At least two of the following: Oral temp >38°C (100.4°F) or <35°C (95°F) Respiratory rate >20 breaths/min or PaCO 2 < 32 mmHg Heart rate >90 beats/min Leukocyte count > 12,000/dL or <4000/dL; or >10% bands Sepsis – SIRS that has a proven or suspected microbial source

2017 CandiEM

93. Low-Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction in Diabetic Patients. (Abstract)

Low-Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction in Diabetic Patients. The cause of erectile dysfunction (ED) in diabetic patients is complex and involves both neurogenic and vasculogenic components and is often hard to treat.To study the effect of low-intensity extracorporeal shock wave therapy (Li-ESWT) therapy on a subgroup of diabetic patients with ED who are responders (PDE5I-R) and non-responders (PDE5I-NR) to phosphodiesterase 5 inhibitors (PDE5I).Analysis

2019 Sexual medicine reviews Controlled trial quality: uncertain

94. Neuropathic pain in adults: pharmacological management in non-specialist settings

secondary to tumour antigens, or caused by direct invasion or compression of neural structures). Examples of conditions that can cause central neuropathic pain include stroke, spinal cord injury and multiple sclerosis. Neuropathic pain can be intermittent or constant, and spontaneous or provoked. Typical descriptions of the pain include terms such as shooting, stabbing, like an electric shock, burning, tingling, tight, numb, prickling, itching and a sensation of pins and needles. People may also (...) syndromes Facial neuralgia HIV-related neuropathy Mixed neuropathic pain Multiple sclerosis Neurogenic pain Neuropathic cancer pain/cancer pain Neuropathic pain Painful diabetic neuropathy/diabetic neuropathy Peripheral nerve injury Peripheral nervous system disease/neuropathies Phantom limb pain Polyneuropathies Post-amputation pain Post-herpetic neuralgia Post-stroke pain Post-treatment/post-surgery/post-operative pain Radiculopathies/radicular pain Spinal cord diseases Neuropathic pain in adults

2013 National Institute for Health and Clinical Excellence - Clinical Guidelines

95. Guidance for pathologists conducting post-mortem examinations on individuals with implanted electronic and medical devices

that can be incorporated into a post-mortem report or other report if necessary, in a similar way to toxicology reports. Such reports are best produced by experts in such devices. Risk assessment for the examination Attention has been drawn to hazards to the pathologist and other mortuary staff when dealing with implantable defibrillator devices, 5,6 which may deliver a shock to those who come into contact with them if not deactivated prior to a post mortem. It is therefore essential to ensure that any (...) , Jacques L. Peripheral nerve stimulation for chronic neurogenic pain. Prog Neurol Surg 2011;24:27–40. 3. Houmsse M, Ishola A, Daoud EG. Clinical utility of implantable loop recorders. Postgrad Med 2014;126:30–37. 4. Freeman JA, Trentman TL. Clinical utility of implantable neurostimulation devices in the treatment of chronic migrane. Med Devices (Auckl) 2013;6:195–201. 5. Prahlow JA, Guileyardo JM, Barnard JJ. The implantable cardioverter-defibrillator. A potential hazard for autopsy pathologists. Arch

2015 Royal College of Pathologists

97. Erectile dysfunction

Erectile dysfunction Erectile dysfunction - NICE CKS Share Erectile dysfunction: Summary Erectile dysfunction is the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance. It is a complicated disorder with several possible organic and/or psychogenic causes. It can also be drug induced. Organic causes may be vasculogenic (for example cardiovascular disease [CVD], hypertension, hyperlipidaemia, diabetes mellitus); neurogenic (for example (...) are the causes? Erectile dysfunction is a symptom and not a disease [ ] . It may have an organic and/or a psychogenic cause. It can also be caused by certain drugs. Organic causes of erectile dysfunction may be [ ; ; ; ; ; ; ] : Vasculogenic (the most common cause) [ ] — cardiovascular disease (CVD), hypertension, hyperlipidaemia, diabetes mellitus, smoking, major pelvic surgery (radical prostatectomy, radiotherapy (pelvis or retroperitoneum). Neurogenic (central) — degenerative disorders (such as multiple

2019 NICE Clinical Knowledge Summaries

98. LUTS in men

). Diabetic autonomic neuropathy and neurogenic bladder. Urethral stricture and phimosis (constriction of the foreskin). Cancer of the prostate, bladder, or rectum. [ ; ] Overactive bladder syndrome What are the causes of an overactive bladder syndrome? Overactive bladder syndrome is the set of symptoms that include urgency, with or without urgency incontinence, and the sensation of needing to pass urine again just after urinating. Overactive bladder symptoms have underlying sensory or motor causes (...) online, for example from the Royal United Hospital Bath NHS trust website ( ). [ ; ] Basis for recommendation Basis for recommendation These recommendations are based largely on the National Institute for Health and Clinical Excellence (NICE) guidelines The management of lower urinary tract symptoms in men (full NICE guideline) [ ] and Lower urinary tract symptoms in men: management [ ], and the European Association of Urology (EAU) guideline Management of Non-neurogenic Male LUTS [ ]. History

2019 NICE Clinical Knowledge Summaries

100. The Risk of Erectile Dysfunction Following Pelvic Angiographic Embolization in Pelvic Fracture Patients: A Nationwide Population-Based Cohort Study in Taiwan (Abstract)

The Risk of Erectile Dysfunction Following Pelvic Angiographic Embolization in Pelvic Fracture Patients: A Nationwide Population-Based Cohort Study in Taiwan Pelvic fracture with hypovolemic shock is a known crucial injury in trauma patients. Pelvic fracture with vessel injury often leads to hemodynamic complications; in a trauma scenario, evidence of other systems being affected is often absent. Bleeding cessation and resuscitation are important for these types of trauma patients (...) . For this purpose, pelvic angiographic embolization is frequently used. Multiple studies have reported that angiographic embolization may cause erectile dysfunction (ED) in hemodynamically stable patients with pelvic fracture. However, no study has evaluated a large patient cohort with a long-term follow-up. We hypothesized that angiographic embolization to control bleeding may compromise blood supply to the genitourinary organs or cause secondary neurogenic injury that increases the risk of ED. Our goal

2018 EvidenceUpdates

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