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Neurological Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
The level of consciousness is assessed using the Glasgow Coma Scale. Where coma was preceded by focal neurological symptoms (e.g. focal seizures, hemiparesis), there is usually a focal cause (e.g. subdural haematoma), but hypoglycaemia can cause focal disturbances which resolve when the blood glucose is normalized. A focal cause is also more likely where there are asymmetrical pupils or conjugate deviation of the eyes, or asymmetry of the oculocephalic reflex, the caloric responses, the limb response to pain or the plantar response. Common ‘medical’ causes of coma include drugs and alcohol intoxication and diabetic hypoglycaemia.
Assessing and responding to sudden deterioration in the adult
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
A decreased level of consciousness may indicate cerebral injury. Factors such as hypoxaemia, hypovolaemia, alcohol and/or drugs may also alter the level of consciousness. Generally, if the GCS is less than 8, the level of consciousness is severely compromised, and they will require help to maintain their airway. It is also important to undertake a blood glucose recording (discussed later in this chapter).
Disorders of Consciousness
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Level of consciousness: Glasgow Coma Scale (see Table 4.1).Noxious stimuli above (e.g. supraorbital and temporomandibular joint pressure) and below (e.g. sternal rub and nail-bed pressure) the neck: observe for facial grimacing and the amplitude, quality, and symmetry of extremity movement (e.g. localization, flexion, extension, or withdrawal).
Is a hyperosmolar pump prime for cardiopulmonary bypass a risk factor for postoperative delirium? A double blinded randomised controlled trial
Published in Scandinavian Cardiovascular Journal, 2023
Helena Claesson Lingehall, Yngve Gustafson, Staffan Svenmarker, Micael Appelblad, Fredrik Davidsson, Fredrik Holmner, Alexander Wahba, Birgitta Olofsson
Assessments were performed preoperatively and repeated after extubation on day 1 (+1) and day 3 (±1) postoperatively. Five persons blinded to group assignment were after formal training assigned to administer the test instruments. The test battery included: (1) The Mini Mental State Examination Second Edition Standard Version (MMSE-2 SV) to assess cognition [11]. (2) The Organic Brain Syndrome Scale (OBS) to assess disturbances of awareness and orientation and fluctuations of cognition and degree of emotional reactions and psychotic symptoms [12]. (3) The Nursing Delirium Screening Scale (Nu-DESC) to assess disorientation, inappropriate behaviour, inappropriate communication, illusions or hallucinations and psychomotor retardation [13]. This is a routine procedure repeated three times every day from admittance to ICU until discharge from hospital. (4) Richmond Agitation Sedation Scale (RASS) to assess degree of agitation or sedation [14]. (5) Glasgow Coma Scale (GCS) to assess level of consciousness [15]. (6) Geriatric Depression Scale (GDS-15) to assess depressive symptoms [16]. (7) Activities of Daily Living (ADL) to assess functional ability based on the Katz [17] and Barthel index [18].
Elevated sTREM2 and NFL levels in patients with sepsis associated encephalopathy
Published in International Journal of Neuroscience, 2023
Günseli Orhun, Figen Esen, Vuslat Yilmaz, Canan Ulusoy, Elif Şanlı, Elif Yıldırım, Hakan Gürvit, Perihan Ergin Özcan, Serra Sencer, Nerses Bebek, Erdem Tüzün
Detailed clinical and demographic features of SAE patients (8 men, 3 women; average age ± standard deviation, 50.3 ± 11.9) are listed in Table 1. All patients developed alterations in the level of consciousness and behavioral symptoms. The most common neurological symptom was delirium (9 patients). Other clinical presentations included coma in one patient and generalized tonic-clonic seizures in one patient. None of the patients had focal neurological deficits. Brain MRI was normal in 2 patients, showed white matter lesions in 6 patients and brain atrophy in 3 patients. EEG was performed in 6 patients revealing diffuse slow waves in all examinations. Days between the onset of sepsis and the development of acute encephalopathy ranged between 2 and 12 (7.5 ± 3.8) days. All patients underwent mechanical ventilation and sedation. During their follow-up, all patients developed septic shock (with an average duration of 7.0 ± 5.1 days). Two patients died after discharge and 5 patients were lost to follow-up.
The onset and severity of acute opioid toxicity in heroin overdose cases: a retrospective cohort study at a supervised injecting facility in Melbourne, Australia
Published in Clinical Toxicology, 2022
Nathan C. Stam, Shelley Cogger, Jennifer L. Schumann, Anthony Weeks, Amanda Roxburgh, Paul M. Dietze, Nicolas Clark
There were a further 2% (n = 19) of cases where transport to hospital by emergency ambulance was required and they were classified as complicated heroin overdoses cases. Three of these cases involved significant tonic-clonic seizure activity. There were also five cases transported to hospital that involved complex multidrug toxicity presentations. A further 11 cases were transported to hospital that involved a decreased level of consciousness that persisted for between 2 and 6 h in duration and did not respond to standard clinical interventions. This included five cases that were transported to hospital for ongoing monitoring due to closure of the service and two cases involving the inadequate response to naloxone dosing at the maximum or in excess of the maximum standard dosing regimens with 2 and 3.2 mg of naloxone administered through IMI in these cases, respectively. The remaining four cases were transported to hospital following consultation with the medical supervisor due to atypical clinical presentations.