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Oculovestibular Testing

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1. Oculovestibular Testing

Oculovestibular Testing Oculovestibular Testing Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Oculovestibular Testing (...) Oculovestibular Testing Aka: Oculovestibular Testing , Cold Calorics , Caloric Response II. Technique Patient supine with head at 30 degrees elevation Isolates input of horizontal semicircular canals Instill 10-20 ml iced saline into auditory canal Use 20 cc syringe Use butterfly tubing with needle cut off Cools mastoid bone and alters endolymphatic flow Stimulates vestibular nuclei as if head turned rapidly to opposite side III. Interpretation both eyes slow toward cold, fast to midline Not comatose Both

2018 FP Notebook

2. Oculovestibular Testing

Oculovestibular Testing Oculovestibular Testing Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Oculovestibular Testing (...) Oculovestibular Testing Aka: Oculovestibular Testing , Cold Calorics , Caloric Response II. Technique Patient supine with head at 30 degrees elevation Isolates input of horizontal semicircular canals Instill 10-20 ml iced saline into auditory canal Use 20 cc syringe Use butterfly tubing with needle cut off Cools mastoid bone and alters endolymphatic flow Stimulates vestibular nuclei as if head turned rapidly to opposite side III. Interpretation both eyes slow toward cold, fast to midline Not comatose Both

2015 FP Notebook

3. Test-Retest Reliability and Interpretation of Common Concussion Assessment Tools: Findings from the NCAA-DoD CARE Consortium (PubMed)

Test-Retest Reliability and Interpretation of Common Concussion Assessment Tools: Findings from the NCAA-DoD CARE Consortium Concussion diagnosis is typically made through clinical examination and supported by performance on clinical assessment tools. Performance on commonly implemented and emerging assessment tools is known to vary between administrations, in the absence of concussion.To evaluate the test-retest reliability of commonly implemented and emerging concussion assessment tools (...) across a large nationally representative sample of student-athletes.Participants (n = 4874) from the Concussion Assessment, Research, and Education Consortium completed annual baseline assessments on two or three occasions. Each assessment included measures of self-reported concussion symptoms, motor control, brief and extended neurocognitive function, reaction time, oculomotor/oculovestibular function, and quality of life. Consistency between years 1 and 2 and 1 and 3 were estimated using intraclass

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2017 Sports medicine (Auckland, N.Z.)

4. CRACKCast E016 – Depressed Consciousness and Coma

to know this! Glasgow Coma score <8 intubate. Remember change >2 points is significant change. Recent SMACC talk (Mark Wilson SMACC Chicago) discusses need to describe specifically what E, M and V are. See: Note that for Verbal Response: Adult and pediatric scoring varies “V” for 5 possible scores 3) Describe the oculocephalic and oculovestibular reflex Important tests, as if they give a normal response then a structural lesion in brainstem is unlikely Oculo-Cephalic – Doll’s eyes . Make sure

2016 CandiEM

5. Determining brain death in adults

glass should be used. Absence of ocular movements using oculocephalic testing and oculovestibular reflex testing. Once the integrity of the cervical spine is ensured, the head is briskly rotated horizontally and vertically. There should be no movement of the eyes relative to head movement. The oculovestibular reflex is tested by irrigating each ear with ice water (caloric testing) after the patency of the external auditory canal is confirmed. The head is elevated to 30 degrees. Each external (...) integrity ensured) □ Oculovestibular reflex absent □ No facial movement to noxious stimuli at supraorbital nerve, temporomandibular joint □ Gag reflex absent □ Cough reflex absent to tracheal suctioning □ Absence of motor response to noxious stimuli in all 4 limbs (spinally mediated reflexes are permissible) Apnea testing (all must be checked) □ Patient is hemodynamically stable □ Ventilator adjusted to provide normocarbia (PaCo 2 34–45 mm Hg) □ Patient preoxygenated with 100% FiO 2 for > 10 minutes

2010 American Academy of Neurology

6. Brain Death in Children (Follow-up)

Cerebral functions are absent (ie, unresponsiveness) The following brainstem functions are absent: pupillary light reflex, corneal reflex, oculocephalic/oculovestibular reflex, oropharyngeal reflex, and respiratory (apnea using an accepted apnea testing procedure) [ ] Irreversibility of brain function cessation is recognized The cause of coma is established and is sufficient to account for the loss of brain function The possibility of recovery of any brain function is excluded Cessation of brain (...) with accepted medical standards." This consensus was based on the fact that in no cases was return of brain function after a 6-hour absence documented by clinical examination and then confirmatory EEG. In the absence of confirmatory tests, a period of observation of at least 12 hours is recommended. For anoxic injury, the observation period may be increased to 24hours. The criteria for brain death of the President's Commission are listed below. The commission's recommendations for children were similar

2014 eMedicine.com

7. Heart Preservation (Diagnosis)

respirations (apnea) No oculovestibular reflexes No oculocephalic reflexes No corneal and pupillary reflexes No cough and gag reflexes Identifiable cause for the coma Irreversibility over a 12- to 24-hour observation period Cause of death In patients who become cardiac donors in urban United States, the usual mechanism of brain death is penetrating or blunt head trauma. Most deaths in these patients are secondary to motor vehicle collisions, gunshot wounds to the head, or . Intracranial bleeding, drug (...) findings, ECG findings, echocardiography findings (obtained during resting or dobutamine stress testing), and cineangiography findings. The team then identifies potential absolute or relative contraindications to donation and coordinates the donor's clinical treatment. Adverse issues are always considered in relation to the clinical needs of the potential recipient. The team may be dispatched to the donor's hospital to complete this formal evaluation and to stabilize the donor's condition if problems

2014 eMedicine Pediatrics

8. Cocaine (Follow-up)

weights, convulsions, infarcts, cerebral hemorrhages, hypertonicity, motor restlessness, and absence of saccadic movements on oculovestibular stimuli are more common than in newborns of mothers who do not use the drug. Congenital malformations are postulated to result from fetal ischemia during the first trimester, and occlusive stroke is a consequence of ischemia during the third trimester. Respiratory anomalies in newborns are more noticeable during sleep. Severe respiratory difficulty syndromes (...) the detection of cocaine, methamphetamine, and THC by ELISA urine testing. J Anal Toxicol . 2011 Jul. 35(6):333-40. . Warner TD, Behnke M, Eyler FD, et al. Diffusion tensor imaging of frontal white matter and executive functioning in cocaine-exposed children. Pediatrics . 2006. 118(5):2014-24. . Tumeh SS, Nagel JS, English RJ, Holman BL. Cerebral abnormalities in cocaine abusers: demonstration by SPECT perfusion brain scintigraphy. Work in progress. Radiology . 1990 Sep. 176(3):821-4. . Leung IY, Lai S, Ren

2014 eMedicine.com

9. Brain Death in Children (Diagnosis)

Cerebral functions are absent (ie, unresponsiveness) The following brainstem functions are absent: pupillary light reflex, corneal reflex, oculocephalic/oculovestibular reflex, oropharyngeal reflex, and respiratory (apnea using an accepted apnea testing procedure) [ ] Irreversibility of brain function cessation is recognized The cause of coma is established and is sufficient to account for the loss of brain function The possibility of recovery of any brain function is excluded Cessation of brain (...) with accepted medical standards." This consensus was based on the fact that in no cases was return of brain function after a 6-hour absence documented by clinical examination and then confirmatory EEG. In the absence of confirmatory tests, a period of observation of at least 12 hours is recommended. For anoxic injury, the observation period may be increased to 24hours. The criteria for brain death of the President's Commission are listed below. The commission's recommendations for children were similar

2014 eMedicine.com

10. Brain Death in Children (Treatment)

Cerebral functions are absent (ie, unresponsiveness) The following brainstem functions are absent: pupillary light reflex, corneal reflex, oculocephalic/oculovestibular reflex, oropharyngeal reflex, and respiratory (apnea using an accepted apnea testing procedure) [ ] Irreversibility of brain function cessation is recognized The cause of coma is established and is sufficient to account for the loss of brain function The possibility of recovery of any brain function is excluded Cessation of brain (...) with accepted medical standards." This consensus was based on the fact that in no cases was return of brain function after a 6-hour absence documented by clinical examination and then confirmatory EEG. In the absence of confirmatory tests, a period of observation of at least 12 hours is recommended. For anoxic injury, the observation period may be increased to 24hours. The criteria for brain death of the President's Commission are listed below. The commission's recommendations for children were similar

2014 eMedicine.com

11. Brain Death in Children (Overview)

Cerebral functions are absent (ie, unresponsiveness) The following brainstem functions are absent: pupillary light reflex, corneal reflex, oculocephalic/oculovestibular reflex, oropharyngeal reflex, and respiratory (apnea using an accepted apnea testing procedure) [ ] Irreversibility of brain function cessation is recognized The cause of coma is established and is sufficient to account for the loss of brain function The possibility of recovery of any brain function is excluded Cessation of brain (...) with accepted medical standards." This consensus was based on the fact that in no cases was return of brain function after a 6-hour absence documented by clinical examination and then confirmatory EEG. In the absence of confirmatory tests, a period of observation of at least 12 hours is recommended. For anoxic injury, the observation period may be increased to 24hours. The criteria for brain death of the President's Commission are listed below. The commission's recommendations for children were similar

2014 eMedicine.com

12. Hypoxic-Ischemic Brain Injury in the Newborn (Overview)

Arterial blood gas - Blood gas monitoring is used to assess acid-base status and to avoid hyperoxia and hypoxia, as well as hypercapnia and hypocapnia Imaging studies Magnetic resonance imaging (MRI) of the brain Cranial ultrasonography Echocardiography Additional studies Electroencephalography (EEG) - Standard and amplitude-integrated EEG Hearing test - An increased incidence of deafness has been found among infants with hypoxic-ischemic encephalopathy who require assisted ventilation Retinal (...) of Consciousness Alternating (hyperalert, lethargic,irritable) Lethargic or obtunded Stuporous Neuromuscular Control Muscle tone Normal Hypotonia Flaccid Posture Normal Decorticate (arms flexed/legs extended) Intermittent decerebration (arms and legs extended) Stretch reflexes Normal or hyperactive Hyperactive or decreased Absent Segmental myoclonus Present Present Absent Complex Reflexes Suck Weak Weak or absent Absent Moro Strong; low threshold Weak; incomplete; high threshold Absent Oculovestibular Normal

2014 eMedicine.com

13. Hypoxic-Ischemic Brain Injury in the Newborn (Treatment)

hypoxic-ischemic encephalopathy. Subgroup analysis indicated that only infants with moderate disability benefited from this therapy. [ ] Currently being evaluated in NCT 01913340. Allopurinol: Slight improvements in survival and cerebral blood flow (CBF) were noted in a small group of infants tested with this free-radical scavenger in one clinical trial. [ ] Excitatory amino acid (EAA) antagonists: MK-801, an EAA antagonist, has shown promising results in experimental animals and in a limited number (...) to the posterovisual cortex can occur. Standard hearing test screening should occur prior to NICU discharge. A repeat hearing screen is also recommended in the first 2 years of life. If therapeutic hypothermia was used in the neonatal period, follow-up is recommended for the continued evaluation of the long-term efficacy of this therapy. Data should be entered into the available registries, local databases, or both, whenever possible. Infants with mild HIE generally do well and do not require specialized follow-up

2014 eMedicine.com

14. Hypoxic-Ischemic Brain Injury in the Newborn (Follow-up)

hypoxic-ischemic encephalopathy. Subgroup analysis indicated that only infants with moderate disability benefited from this therapy. [ ] Currently being evaluated in NCT 01913340. Allopurinol: Slight improvements in survival and cerebral blood flow (CBF) were noted in a small group of infants tested with this free-radical scavenger in one clinical trial. [ ] Excitatory amino acid (EAA) antagonists: MK-801, an EAA antagonist, has shown promising results in experimental animals and in a limited number (...) to the posterovisual cortex can occur. Standard hearing test screening should occur prior to NICU discharge. A repeat hearing screen is also recommended in the first 2 years of life. If therapeutic hypothermia was used in the neonatal period, follow-up is recommended for the continued evaluation of the long-term efficacy of this therapy. Data should be entered into the available registries, local databases, or both, whenever possible. Infants with mild HIE generally do well and do not require specialized follow-up

2014 eMedicine.com

15. Hypoxic-Ischemic Encephalopathy (Diagnosis)

Arterial blood gas - Blood gas monitoring is used to assess acid-base status and to avoid hyperoxia and hypoxia, as well as hypercapnia and hypocapnia Imaging studies Magnetic resonance imaging (MRI) of the brain Cranial ultrasonography Echocardiography Additional studies Electroencephalography (EEG) - Standard and amplitude-integrated EEG Hearing test - An increased incidence of deafness has been found among infants with hypoxic-ischemic encephalopathy who require assisted ventilation Retinal (...) of Consciousness Alternating (hyperalert, lethargic,irritable) Lethargic or obtunded Stuporous Neuromuscular Control Muscle tone Normal Hypotonia Flaccid Posture Normal Decorticate (arms flexed/legs extended) Intermittent decerebration (arms and legs extended) Stretch reflexes Normal or hyperactive Hyperactive or decreased Absent Segmental myoclonus Present Present Absent Complex Reflexes Suck Weak Weak or absent Absent Moro Strong; low threshold Weak; incomplete; high threshold Absent Oculovestibular Normal

2014 eMedicine Pediatrics

16. Heart Preservation (Treatment)

respirations (apnea) No oculovestibular reflexes No oculocephalic reflexes No corneal and pupillary reflexes No cough and gag reflexes Identifiable cause for the coma Irreversibility over a 12- to 24-hour observation period Cause of death In patients who become cardiac donors in urban United States, the usual mechanism of brain death is penetrating or blunt head trauma. Most deaths in these patients are secondary to motor vehicle collisions, gunshot wounds to the head, or . Intracranial bleeding, drug (...) findings, ECG findings, echocardiography findings (obtained during resting or dobutamine stress testing), and cineangiography findings. The team then identifies potential absolute or relative contraindications to donation and coordinates the donor's clinical treatment. Adverse issues are always considered in relation to the clinical needs of the potential recipient. The team may be dispatched to the donor's hospital to complete this formal evaluation and to stabilize the donor's condition if problems

2014 eMedicine Pediatrics

17. Hypoxic-Ischemic Encephalopathy (Treatment)

hypoxic-ischemic encephalopathy. Subgroup analysis indicated that only infants with moderate disability benefited from this therapy. [ ] Currently being evaluated in NCT 01913340. Allopurinol: Slight improvements in survival and cerebral blood flow (CBF) were noted in a small group of infants tested with this free-radical scavenger in one clinical trial. [ ] Excitatory amino acid (EAA) antagonists: MK-801, an EAA antagonist, has shown promising results in experimental animals and in a limited number (...) to the posterovisual cortex can occur. Standard hearing test screening should occur prior to NICU discharge. A repeat hearing screen is also recommended in the first 2 years of life. If therapeutic hypothermia was used in the neonatal period, follow-up is recommended for the continued evaluation of the long-term efficacy of this therapy. Data should be entered into the available registries, local databases, or both, whenever possible. Infants with mild HIE generally do well and do not require specialized follow-up

2014 eMedicine Pediatrics

18. Hypoxic-Ischemic Encephalopathy (Overview)

Arterial blood gas - Blood gas monitoring is used to assess acid-base status and to avoid hyperoxia and hypoxia, as well as hypercapnia and hypocapnia Imaging studies Magnetic resonance imaging (MRI) of the brain Cranial ultrasonography Echocardiography Additional studies Electroencephalography (EEG) - Standard and amplitude-integrated EEG Hearing test - An increased incidence of deafness has been found among infants with hypoxic-ischemic encephalopathy who require assisted ventilation Retinal (...) of Consciousness Alternating (hyperalert, lethargic,irritable) Lethargic or obtunded Stuporous Neuromuscular Control Muscle tone Normal Hypotonia Flaccid Posture Normal Decorticate (arms flexed/legs extended) Intermittent decerebration (arms and legs extended) Stretch reflexes Normal or hyperactive Hyperactive or decreased Absent Segmental myoclonus Present Present Absent Complex Reflexes Suck Weak Weak or absent Absent Moro Strong; low threshold Weak; incomplete; high threshold Absent Oculovestibular Normal

2014 eMedicine Pediatrics

19. Heart Preservation (Overview)

respirations (apnea) No oculovestibular reflexes No oculocephalic reflexes No corneal and pupillary reflexes No cough and gag reflexes Identifiable cause for the coma Irreversibility over a 12- to 24-hour observation period Cause of death In patients who become cardiac donors in urban United States, the usual mechanism of brain death is penetrating or blunt head trauma. Most deaths in these patients are secondary to motor vehicle collisions, gunshot wounds to the head, or . Intracranial bleeding, drug (...) findings, ECG findings, echocardiography findings (obtained during resting or dobutamine stress testing), and cineangiography findings. The team then identifies potential absolute or relative contraindications to donation and coordinates the donor's clinical treatment. Adverse issues are always considered in relation to the clinical needs of the potential recipient. The team may be dispatched to the donor's hospital to complete this formal evaluation and to stabilize the donor's condition if problems

2014 eMedicine Pediatrics

20. Organ Procurement Considerations in Trauma

brain death, the physician must demonstrate the following: Correction of potentially reversible causes of coma Hypothermia Sedating medications Metabolic disturbances Endocrine disturbances Hypoxia or hypercarbia Absence of brainstem reflexes (eg, cornea, pupillary light, oculovestibular, gag, oculocephalic) Lack of respiratory effort (apnea test, ie, absence of respiratory movement after disconnection from respirator for sufficient duration to have pCO 2 rise to >50-60 mm Hg) To confirm (...) contraindications Malignancy other than in the central nervous system (CNS) or skin that is in remission (>5 y) Hypertension Diabetes mellitus (DM) Physiologic age older than 70 years Hepatitis B or C History of smoking Previous Next: Brain and Cardiac Death Determination of brain death No defined consensus exists on the most appropriate manner in which to determine brain death. The diagnosis is based principally on the clinical examination, but diagnostic tests often are used for confirmation. The success

2014 eMedicine Surgery

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