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Neurogenic Shock

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141. Infants and children. Acute management of bacterial meningitis (third edition)

count and biochemistry) are not significantly influenced; – The relationship between polymorphonuclear cells and lymphocytes in CSF may be reversed. n The time to diagnosis of acute bacterial meningitis may be delayed in children pre-treated with antibiotics but the complication rate is not necessarily increased. 16 1.3. Complications n Patients may uncommonly present with early complications of sepsis or raised intracranial pressure which include: – Septic shock; – Disseminated intravascular (...) coagulopathy (DIC); – Purpura fulminans; – Waterhouse-Friderichsen syndrome; – Cerebral herniation; – Neurogenic pulmonary oedema (rare). 17,18 About 83% of appropriately treated children will have an uncomplicated recovery. However, later complications include cerebrovascular events, subdural effusions, hearing deficits and a range of neurological sequelae. 1 2. Minimise delay in diagnosis To avoid a delay in the diagnosis of meningitis, the following important points must be noted: n The early diagnosis

2014 Clinical Practice Guidelines Portal

143. Management of Acute Traumatic Central Cord Syndrome (ATCCS)

Reson Imaging . 2002 ; 15 ( 3 ): 308 – 314 . 89. Guha A , Tator CH , Smith CR , Piper I Improvement in post-traumatic spinal cord blood flow with a combination of a calcium channel blocker and a vasopressor . J Trauma . 1989 ; 29 ( 10 ): 1440 – 1447 . 90. Guly HR , Bouamra O , Lecky FE The incidence of neurogenic shock in patients with isolated spinal cord injury in the emergency department . Resuscitation . 2008 ; 76 ( 1 ): 57 – 62 . 91. Blood pressure management after acute spinal cord injury

2013 Congress of Neurological Surgeons

144. The Acute Cardiopulmonary Management of Patients With Cervical Spinal Cord Injuries

the patient manifest any evidence of respiratory failure. Guly et al found an incidence of neurogenic shock (systolic blood pressure < 100 mm Hg and heart rate < 80 bpm) of 19.3% (95% confidence interval, 14.8-23.7) in a series of 490 patients with acute SCI. In 2006, Franga et al described an incidence of cardiovascular instability of 17%, including bradyarrhythmias requiring permanent pacemaker placement among 30 acute complete cervical SCI patients. Neumann et al 37 performed a retrospective review (...) The incidence of neurogenic shock in patients with isolated spinal cord injury in the emergency department . Resuscitation . 2008 ; 76 ( 1 ): 57 – 62 . 36. Franga DL , Hawkins ML , Medeiros RS , Adewumi D Recurrent asystole resulting from high cervical spinal cord injuries . Am Surg . 2006 ; 72 ( 6 ): 525 – 529 . 37. Neumann CR , Brasil AV , Albers F Risk factors for mortality in traumatic cervical spinal cord injury: Brazilian data . J Trauma . 2009 ; 67 ( 1 ): 67 – 70 . 38. Macias CA , Rosengart MR

2013 Congress of Neurological Surgeons

145. Neuropathic pain - a management update

Neuropathic pain - a management update Pain 92 Reprinted from AustRAliAn F Amily PhysiciAn Vol. 42, no. 1/2, jAnuARy/FebRuARy 2013 Neuropathic pain A management update Background Neuropathic pain is described as burning, painful, cold or electric shocks and may be associated with tingling, pins and needles, numbness or itching. Objective This article summaries the diagnosis and management of four common neuropathic pain presentations. Discussion A validated diagnostic screening tool can help (...) may be useful (see Resources). these verbal reports provide valuable information to the practitioner regarding pain quality: neuropathic pain is usually described as burning, painful, cold or electric shocks and may be associated with tingling, pins and needles, numbness or itching. these screening tools also serve as a good clinical record for follow up post-treatment initiation. they are not onerous to use and can be administered by the practice nurse or completed by the patient before

2013 Clinical Practice Guidelines Portal

147. Adult Urodynamics: AUA/SUFU Guideline

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 (...) obstruction. (Expert Opinion) 8. Clinicians should counsel patients with urgency incontinence and mixed 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

2012 Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction

148. Adult Urodynamics: AUA/SUFU Guideline

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 (...) counsel patients with urgency incontinence and mixed 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

2012 American Urological Association

149. Management of Atrial Fibrillation

apnoea Atrial ischemia Coronary artery disease Inflammatory or infiltrative atrial disease Myocarditis or pericarditis Amyloidosis Age-induced atrial fibrosis Primary or metastatic cancer in/or adjacent to the atrial wall Drugs Alcohol Caffeine Endocrine disorders Hyperthyroidism Phaeochromocytoma Changes in autonomic tone Increased sympathetic tone Increased parasympathetic tone Postoperative Cardiothoracic surgery Oesophageal surgery Neurogenic Subarchnoid haemorrhage Haemorrhagic stroke Ischemic

2012 Ministry of Health, Malaysia

151. Evidence of a Cell Surface Role for Hsp90 Complex Proteins Mediating Neuroblast Migration in the Subventricular Zone Full Text available with Trip Pro

Evidence of a Cell Surface Role for Hsp90 Complex Proteins Mediating Neuroblast Migration in the Subventricular Zone In most mammalian brains, the subventricular zone (SVZ) is a germinative layer that maintains neurogenic activity throughout adulthood. Neuronal precursors arising from this region migrate through the rostral migratory stream (RMS) and reach the olfactory bulbs where they differentiate and integrate into the local circuitry. Recently, studies have shown that heat shock proteins

2017 Frontiers in cellular neuroscience

152. A Case of MDMA-Associated Cerebral and Pulmonary Edema Requiring ECMO Full Text available with Trip Pro

A Case of MDMA-Associated Cerebral and Pulmonary Edema Requiring ECMO A 20-year-old female presented with confusion, generalized tonic-clonic seizures, and severe hyponatremia after ingesting 3,4-methylenedioxymethamphetamine (MDMA). Brain computed tomography (CT) demonstrated cerebral edema. Her hospital course was rapidly complicated by respiratory failure and shock requiring intubation and vasopressors. Refractory acute respiratory distress syndrome (ARDS) was diagnosed which (...) antidiuretic hormone (SIADH) secretion. A common but often unrecognized complication of severe hyponatremia is the Ayus-Arieff syndrome where cerebral edema causes neurogenic pulmonary edema via centrally mediated increases in catecholamine release and capillary injury. For our patient, ECMO was required for three days while the hyponatremia was corrected which led to rapid clearing of the cerebral edema and neurogenic pulmonary edema. This case illustrates that, in selecting patients with refractory ARDS

2017 Case reports in critical care

153. Fracture-dislocation at C6-C7 level with Quadriplegia after Traditional Massage in a Patient with Ankylosing Spondylitis: A Case Report Full Text available with Trip Pro

at cervical level in 81% of patients with ankylosing spondylitis, are complicated by neurological lesions in 65% of patients, due to the high inherent instability of these fractures. Traditional massage is an ancient practice in many parts of Asia. It has many benefits that are currently recognized world-wide. However, it can be dangerous and even lethal if practised without adequate knowledge and skill. We report a case of C6-C7 fracture-dislocation with complete neurology and neurogenic shock

2017 Malaysian orthopaedic journal

154. Flos Farfarae Inhibits Enterovirus 71-Induced Cell Injury by Preventing Viral Replication and Structural Protein Expression. (Abstract)

Flos Farfarae Inhibits Enterovirus 71-Induced Cell Injury by Preventing Viral Replication and Structural Protein Expression. Enterovirus 71 (EV71) infection can cause airway symptoms, brainstem encephalitis, neurogenic shock, and neurogenic pulmonary edema with high morbidity and mortality. There is no proven therapeutic modality. Flos Farfarae is the dried flower bud of Tussilago farfara L. that has been used to manage airway illnesses for thousands of years. It has neuro-protective activity

2017 American Journal of Chinese Medicine

155. Urinary Retention

Central causes (CNS) CVA more commonly causes lesions may instead cause Urinary Retention (often resolves during acute recovery period) Up to 25% of patients with MS intermittently catheterize Shy-Drage Syndrome Brain neoplasm Spinal cord Spinal cord Urinary Retention may resolve after 1-12 months of initial spinal cord shock Spinal cord mass (spinal cord hematoma) (related to spinal stenosis, intervertebral disc) (e.g. , ) Transverse myelitis V. Causes: Miscellaneous in both Men and Women Iatrogentic (...) (urologic emergency) Significant pain and distress Urine urgency Mild urine Chronic Urinary Retention Often asymptomatic IX. Examination exam is percussable when >150 ml is palpable when >200 ml Genitourinary exam size (and tenderness in the case of ) or rectal mass Anal sphincter tone : Evaluate for neurogenic Reflexes Anal reflex ( ) Muscle tone Anal sphincter tone Pelvic floor voluntary contractions Sensation S2 Nerve sensation: Evaluate for saddle anesthesia S3-S5 Nerve sensation: Evaluate

2018 FP Notebook

156. Acute Respiratory Distress Syndrome

Respiratory Distress Syndrome Acute Respiratory Distress Syndrome Aka: Acute Respiratory Distress Syndrome , Adult Respiratory Distress Syndrome , Acute Lung Injury , ARDS , Traumatic Wet Lung , Shock Lung , Congestive Atelectasis , PaO2/FIO2 Ratio From Related Chapters II. Definition Acute Respiratory Distress Syndrome (ARDS) Acute onset of , , , and bilateral s Rapidly progresses to Non-cardiogenic pulmonary edema (contrast with ) Acute Lung Injury (ALI) Slightly less severe form of ARDS in hospitalized (...) % of cases) Multiple (high risk) Cardiopulmonary bypass ( ) Drug ( , ) Ingestion Hydrocarbon ingestion Ethchlorvynol (Placidyl) Non-cardiac pulmonary edema Neurogenic pulmonary edema -induced pulmonary edema Infection (often in immunocompromised patients) Diffuse fungal infection Cryptococcosis s species ( ) Plasmodium species ( ) (Threadworm) VII. Symptoms Onset within 24-72 hours of triggering event Progressive VIII. Signs Early Later Diffuse lung rhonchi IX. Labs: Arterial Blood Gas Critical

2018 FP Notebook

157. Abdominal Compartment Syndrome

, with ) V. Symptoms Malaise VI. Signs ral Critically ill appearing patient Marked, firm, tense Cardiopulmonary findings , shock state (reduced from IVC compression) and (reduced diaphragm excursion) Renal findings and (decreased renal perfusion) VII. Diagnosis: Abdominal Compartment Pressure Measurement Insert Drain the catheter and clamp the tubing Instill 25-60 cc sterile water into side port and clamp Pressure measurement Technique Patient lies supine Keep head and body in same position each time (...) pressure consistent with Abdominal Compartment Syndrome: >20-25 mmHg Compartment pressure <10mmHg is unlikely to be Abdominal Compartment Syndrome Compartment pressure may be inaccurate in neurogenic VIII. Management Emergent surgical decompression with exploratory laparotomy Avoid excessive fluid infusions Use adequate s and sedation (may help relax the abdominal wall) Temporizing measures of may be attempted if significant surgery delay Escharotomy in a burn patient when indicated IX. Prognosis

2018 FP Notebook

160. Maternal Collapse in Pregnancy and the Puerperium

of dense spinal block; septic or neurogenic shock Hypoxia Pregnant patients can become hypoxic more quickly Cardiac events: peripartum cardiomyopathy, myocardial infarction, aortic dissection, large-vessel aneurysms Hypo/hyperkalaemia and other No more likely electrolyte disturbances Hypothermia No more likely 4 T’s Thromboembolism Amniotic fluid embolus, pulmonary embolus, air embolus, myocardial infarction Toxicity Local anaesthetic, magnesium, other Tension pneumothorax Following trauma/suicide (...) and mortality, and substandard care continues to feature in the cases that result in death. 1 Bacteraemia, which can be present in the absence of pyrexia or a raised white cell count, can progress rapidly to severe sepsis and septic shock leading to collapse; 33 the most common organisms implicated in obstetrics are the streptococcal groups A, B and D, pneumococcus and Escherichia coli. 4.2.6 Drug toxicity/overdose Drug toxicity/overdose should be considered in all cases of collapse, and illicit drug

2011 Royal College of Obstetricians and Gynaecologists

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