Disorders of vitamin B6 metabolism
William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop in Atlas of Inherited Metabolic Diseases, 2020
With more patients known, it became obvious that the clinical presentation of PNPO deficiency and antiquitin deficiency were overlapping if not identical [4, 7, 33, 34]. Patients suffering from PNPO deficiency tend to present with a more severe and complex symptomatology. Clinical responsiveness to pyridoxine does not exclude PNPO deficiency. Thus, patients with pyridoxine dependency negative for antiquitin deficiency should be tested for PNPO deficiency and if negative for mutations in PROSC. PNP administered by nasogastric tube is mostly dramatically effective in stopping the seizures and improving the EEG. First administration may result in respiratory arrest in responders, and thus treatment should be performed with support of respiratory management [4]. Patients with PNPO deficiency usually require more frequent and equally spaced administration of PNP than patients with antiquitin deficiency, e.g. every three to four hours. This can be guided well by EEG monitoring which normal at first, shows generalized rhythmic fast activity. After PLP symptoms resolve within minutes, and the EEG normalizes. Cranial MR is mostly normal early in the disease course or shows unspecific findings of encephalopathy (Figure 100.4). Later, MRI scans may reveal severe diffuse cerebral atrophy in untreated or only partially treated patients.
Record-keeping
Barbara Smith, Linda Field in Nursing Care, 2019
Inadequate record-keeping impacts upon the patient in many ways, including the following (Nursing and Midwifery Council, 2004a): If medication or other treatment is not recorded, it may be duplicated or omitted.Continuity of care between shifts and different nursing staff can be impaired if accurate records are not maintained.There can be a breakdown in communication between staff if all care and treatment is not recorded, ultimately leading to patients receiving fragmented care.Significant observations and conclusions can be missed if they are not recorded on the patient’s observation chart, leading to a delay or omission in the giving of necessary treatment or care.Failure to detect early signs of deterioration in a patient’s condition can occur if vital signs are not recorded correctly. This can have serious outcomes for the patient, such as cardiac or respiratory arrest.
Common Office Tests and Procedures for the Allergist
Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial in Textbook of Allergy for the Clinician, 2021
Technician Training. The technician administering the treatment should be skilled at detecting adverse reactions to bronchodilators. The following adverse reactions may occur: Increase in pulse rate. Bronchodilators may cause a significant increase in pulse rate. In some clinics, pulse rates are checked regularly and treatment is discontinued if the pulse rate increases by 50% from baseline. In such a case, note the reason for discontinuing aerosol therapy and notify the physician.Chest pain. If the patient complains of sudden chest pain during aerosol therapy, stop the treatment immediately, listen for bilateral breath sounds, monitor pulse for rate and regularity and report your findings to the physician.Cardiac or respiratory arrest. If the patient experiences cardiac or respiratory arrest during treatment, immediately call the physician, begin cardiopulmonary resuscitation and summon assistance to call 911.
Exploring the role of botulinum toxin in critical care
Published in Expert Review of Neurotherapeutics, 2021
Muhammad Ubaid Hafeez, Michael Moore, Komal Hafeez, Joseph Jankovic
The systemic AEs can include a flu-like syndrome, manifesting as severe malaise and myalgias [85]. On the other hand, despite a foreign protein injection, true allergic reactions are extremely rare [86]. Isolated occurrences of myocardial infarction (MI), pulmonary embolism (PE) and stroke have been reported suggesting a possible prothrombotic or embolic mechanism [87]. Seizures have been reported however, majority of such patients had a history or pre-morbid condition predisposing to seizures [87]. From 1989 to 2005, 28 possible BoNT-related deaths were reported to FDA. The causes were attributed to respiratory arrest, MI, stroke, PE, pneumonia, and unknown etiologies [87]. It is hard to establish if these events represent a temporal coincidence or a true causal relationship due to low incidence and paucity of supporting evidence from larger studies. A closer monitoring for these AEs in future clinical trials can provide a better insight into true incidence of such events [88,89].
Methods and Implementation of the 2019 EMS Practice Analysis
Published in Prehospital Emergency Care, 2022
Ashish R. Panchal, Madison K. Rivard, Rebecca E. Cash, John P. Corley, Marjorie Jean-Baptiste, Kirsten Chrzan, Mihaiela R. Gugiu
Events that had a disposition where no patient interaction occurred (e.g., no patient found or cancelled) were excluded. Events that had both a primary and a secondary impression of a “not value” (not applicable, not recorded, not reporting, not known, or not available) were considered uninformative and, thus, also excluded. Events that had only a primary or a secondary impression of a “not value”, however, were retained. Inhalation injury (toxic gas) and smoke inhalation impressions were combined. Respiratory distress and respiratory arrest impressions were also combined due to encompassing similar domains. Events were classified into categories by impression, with an event being included in the respective category if the primary or secondary impression included that impression. After the exclusion of “not value” impressions, there were a total of 25 impressions that were considered informative.
Cost utility analysis of continuous and intermittent versus intermittent vital signs monitoring in patients admitted to surgical wards
Published in Journal of Medical Economics, 2020
Mehdi Javanbakht, Atefeh Mashayekhi, Miranda Trevor, Mohsen Rezaei Hemami, Candice L. Downey, Michael Branagan-Harris, Jowan Atkinson
The National Early Warning Score (NEWS) is a system for vital signs monitoring for the early detection of deterioration in patients. It is the early warning score recommended by the Royal College of Physicians and has been widely adopted throughout the UK. Patients are monitored intermittently at frequencies determined by the NEWS protocol, based on their existing physiological measurements and their likelihood of deterioration, and any evidence of physiological decline is escalated to the appropriate clinical level. A patient might show the first signs of deterioration 6 to 8 h before a cardiac or respiratory arrest; these variations in vital signs may not be detected by typical, intermittent monitoring regimes5. The potential for continuous measurement and monitoring of vital signs has been identified as a potential approach to ensure consistent, early identification of deterioration6.
Related Knowledge Centers
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