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Assessing and responding to sudden deterioration in the adult
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
Our awake state is known as consciousness, while unconsciousness is defined as when an individual’s awareness no longer exists. Normal reflexes protecting conscious individuals are lost and so healthcare professionals must maintain their safety and provide all care needed. For initial assessment of an unconscious person, look back to Chapter 4 for an overview of how to carry out a neurological assessment – ACVPU and the GCS – and ensure that you can conduct these assessments before continuing with this section as they are necessary for anyone with altered conscious level. There are many causes of unconsciousness including abnormal temperature, oxygen or blood glucose levels, infection (e.g. encephalitis, meningitis), drug intoxication, seizures, focal head injury (trauma), hypoxia, hypercarbia (high levels of carbon dioxide in the circulating blood) or vascular events (shock, stroke). Investigations will be conducted to determine the underlying cause. In this section, general care of an unconscious person is considered, followed by a review of blood glucose monitoring, which will be carried out for a person with altered consciousness and also management of seizures.
The patient with acute neurological problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Consciousness refers to a state of awareness of oneself and one’s surroundings. An acute episode of unconsciousness is a medical emergency, irrespective of the cause. Unconsciousness has many potential causes, not all of which are neurological, but the treatment of the patient will be the same until the diagnosis has been made. Common causes of acute unconsciousness can be found in Table 9.2.
Clinical Manifestations and Histological Characteristics
Published in Kirsti Kauppinen, Kristiina Alanko, Matti Hannuksela, Howard Maibach, Skin Reactions to Drugs, 2020
Kirsti Kauppinen, Arja-Leena Kariniemi
Anaphylaxis may follow abruptly after starting the medication, often even in minutes. Injected agents cause anaphylaxis more frequently but this phenomenon can also be triggered by oral medication. At first the skin becomes reddish and itchy, and urticaria and/or angioedema may follow afterwards. Hypotension, tachycardia, nausea, vomiting, and diarrhea may occur. Unconsciousness occurs in the most severe cases (see Chapter 11).
Microsurgical treatment of blood blister–like aneurysms: efficacy of clip-on-wrapping with autologous dura mater
Published in British Journal of Neurosurgery, 2023
Chunli Lu, Huanting Li, Shifang Li, Zhaojian Li, Yugong Feng
A 35-year-old female patient without unconsciousness was admitted due to the sudden onset of severe headache, nausea, and vomiting that had lasted for three days. The preoperative CT scan revealed a large amount of clot in the suprasellar cistern and right sylvian fissure (Figure 1(A)). The CTA and 3D-DSA examination identified a small cystic bulge on the medial wall of right ICA (Figure 1(B,C)). We performed aneurysm clipping surgery via right pterional approach. During operation, we found the aneurysm was located at the origin of the AChA and its wall was quite thin (Figure 1(D)). We used a piece of dura mater to wrap around the wall of the ICA (Figure 1(E)), and an aneurysm clip was placed to slide down the ICA wall along the dura mater wrapping, then a transvascular aneurysm clip was placed from the back of the first aneurysm clip, so the aneurysm was successfully clipped (Figure 1(F)). The postoperative CT examination did not reveal any cerebral infarctions in the brain tissue (Figure 1(G)). A follow-up angiogram was performed at six months after surgical treatment and did not show any aneurysm recurrence (Figure 1(H)). The patient was followed up for two years after the operation and had restored completely normal neurological functions and a mRS 0.
The clinical toxicity of imidacloprid self-poisoning following the introduction of newer formulations
Published in Clinical Toxicology, 2021
Varan Perananthan, Fahim Mohamed, Seyed Shahmy, Indika Gawarammana, Andrew Dawson, Nicholas Buckley
The low case-fatality of imidacloprid is due to neonicotinoids possessing high selectivity for insect over mammalian nicotinic acetylcholine receptors (nAChRs). Neonicotinoids are also highly polar reducing their ability to cross the lipid blood-brain barrier [3]. Concentrations in systemic circulation are estimated to be twice that in cerebrospinal fluid [7]. Yet despite this, we observed neurological symptoms mainly drowsiness, confusion, incoherence, lack of orientation and unconsciousness in 17.6% of cases post 2010 compared to 3.6% in the 2002–07 cohort. Reduced consciousness and inability to maintain airway was the main reason for mechanical ventilation in the post 2010 cohort. Other case reports of imidacloprid toxicity have certainly described reduced GCS and other neuropsychiatric symptoms [4,12,13].
Analysis of biochemical laboratory values to determine etiology and prognosis in patients with subarachnoid hemorrhage: a clinical study
Published in Neurological Research, 2019
Mustafa Ogden, Bulent Bakar, Mustafa Ilker Karagedik, Ibrahim Umud Bulut, Cansel Cetin, Gulcin Aydin, Ucler Kisa, Mehmet Faik Ozveren
Determination of the etiology in unconsciousness patients with SAH is often difficult in clinical practice. In some patients, loss of consciousness can occur after spontaneous SAH, while loss of consciousness associated with the SAH can develop after concomitant head trauma in some patients. In addition, CT and MRI images alone sometimes fail to reveal the cause of SAH, and even in cerebral angiography, aneurysm may not be shown in some patients as mentioned above. Therefore, in addition to the clinical findings and radiological images (for which the Fisher’s grading scale has already been used), it was thought that the laboratory tests may determine the etiological cause and also have a predictive effect on the prognosis in these patients. In conclusion, this study was conducted for two purposes: The first aim was to establish the predictive markers for the prognosis of the patients with SAH using simple laboratory methods.The second purpose was to establish the relationship between the etiological factors of the SAH and laboratory findings in these patients and to provide predictive markers for the determination of the etiological factor causing this relationship