Beach lifeguard first aid
Mike Tipton, Adam Wooler in The Science of Beach Lifeguarding, 2018
Normal human body temperature is 36°C–38°C. Hypothermia is arbitrarily divided into mild (32°C–35°C), moderate (28°C–32°C) and severe (<28°C). Water is thermoneutral at 35°C, which means that any water temperature below this point will cause a naked immersed person to lose body heat and eventually become hypothermic. Drowning patients and rescued persons can become hypothermic, even if the air and water temperature seem warm. In the absence of a thermometer, all rescued persons should be assumed to have mild hypothermia if they are shivering after rescue, and moderate to severe hypothermia if they are not shivering, unconscious, in cardiac arrest or have any other neurologic symptoms after rescue. Neurologic symptoms include ataxia, decreased coordination, confusion and slurred speech. Moderate and severely hypothermic casualties (identified by their level of consciousness) should be handled carefully and as critically ill patients; rough handling (including manual handling and removing cloth-ing) can precipitate ventricular fibrillation. The presence or absence of shivering is a rough guide and not a definitive diagnostic criterion. Acutely hypothermic persons can shiver at lower temperatures, and shivering may be absent entirely in persons with chronic medical conditions, regardless of temperature.
Surgical Management of Vestibular Schwannoma
John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed in Paediatrics, The Ear, Skull Base, 2018
The cerebellum is at risk of injury during opening of the dura of the posterior fossa and during tumour removal itself. The mass effect of a large tumour will push parts of the cerebellum against the overlying dura, compressing the cerebellar surface vessels. Minor degrees of venous injury are tolerated without problems but more substantial injury is likely with prolonged cerebellar retraction during retrosigmoid surgery. A degree of encephalomalacia of the superficial lateral part of the cerebellar hemisphere is frequently noted on post-operative MR imaging, though this does not usually give rise to any clinical manifestations.40 The surface of the cerebellum may become oedematous during removal of large tumours but the historic procedure of resecting the lateral one third of the cerebellum for access and creation of space for post-operative swelling is rarely required now with modern surgical and anaesthetic techniques. Less commonly, parenchymal injury or oedema extends into the deeper parts of the cerebellum. This may signify venous insufficiency of the cerebellum or a cerebellopontine haematoma. This type of injury may well leave the patient with prolonged or permanent ataxia.
Blood and immune system disorders
Steve Hannigan in Inherited Metabolic Diseases: A Guide to 100 Conditions, 2018
Ataxia telangiectasia can be diagnosed on the basis of a physical examination, a medical family history and a range of tests, including an MRI scan, blood tests and a specialised test to demonstrate chromosome abnormalities (karyotyping). Treatment for individuals with this disorder aims to relieve any symptoms and provide support in the care of the individual. Physical and occupational therapy may help to maintain lexibility. As afected individuals have a weakened immune system, antibiotics should be given promptly for infections, and gammaglobulin injections may also be beneicial. Reducing exposure to sunlight will help to prevent the spread of skin lesions. Vitamin E may be of some benefit, and diazepam may aid speech problems and muscle contractions. Afected individuals rarely survive beyond their mid-twenties, due to their weakened immune system. Genetic counselling is recommended for those afected by this disorder.
Effects of therapeutic exercise on disease severity, balance, and functional Independence among individuals with cerebellar ataxia: A systematic review with meta-analysis
Published in Physiotherapy Theory and Practice, 2023
Stanley Winser, Ho Kwan Chan, Wing Ki Chen, Chung Yau Hau, Siu Hang Leung, Yee Hang Leung, Umar Muhammad Bello
This review has several limitations that should be considered when interpreting the findings. First, the meta-analyses were conducted on a small number of studies due to the limited number of randomized controlled trials published in this field; therefore, the statistical power of the evidence generated is limited. Second, considerable heterogeneity was detected across the examined studies, resulting in limited recommendations and insufficient information for recommending a standardized clinical protocol. Third, although the review included a wide range of participant ages, etiologies, and chronicity, most of the patients included in these studies were ambulant, with low ataxia severity. Thus, the findings of this review cannot be generalized to patients with more severe symptoms. Fourth, the generalizability of the study findings to all patients with ataxia is limited because disease progression and the response to treatment greatly varies between the ataxia presentation with different underlying causes. Last, the possibility of a language bias cannot be eliminated because studies published in languages other than English were not included in this review.
Acute epiglottitis is a rare clinical presentation of coronavirus disease 2019: a case report
Published in Infectious Diseases, 2022
Burak Gezer, Hakan Karabagli, Mert Sahinoglu, Ahmet Selim Karagoz
A 58-year-old woman presented to the neurosurgery outpatient clinic with headache and abnormal gait. Neurological examination showed ataxia. Magnetic resonance imaging revealed a heterogeneously enhancing tumour 3 × 3 cm in diameter with extensive peripheral edoema in the right temporal lobe. Since she had a history of cancer, a metastasis was suspected. She had not had any risky contact or previous COVID-19 and was hospitalised for surgical treatment. On postoperative day 6, she was scheduled for discharge but developed acute-onset respiratory distress, supraclavicular and intercostal withdrawal, and stridor. She had tachycardia, hypertension, and low oxygen saturation (85% in room air). Neurological examination was normal. An arterial blood gas analysis showed pH, 7.46, oxygen saturation 89.3%, partial pressure of carbon dioxide 37.9 mmHg and partial pressure of oxygen 60.9 mmHg. White blood cell count was 6,400/µL, C-reactive protein 35.4 mg/L and procalcitonin <0.05 µg/L. The ear, nose, and throat and chest disease departments were consulted. No specific findings of COVID-19 pneumonia were found on chest computed tomography. A SARS-CoV-2 polymerase chain reaction (PCR) test was recommended. Bronchoscopy showed finding consisten with acute epiglottitis. The SARS-CoV-2 PCR was positive. Neck computed tomography showed near-total airway obstruction due to severe edoema of the epiglottis and periepiglottis (Figure 1).
Effectiveness of Person-Environment-Occupation Model on a Pediatric Neurodegenerative Disease: A Case Report of a Child with Ataxia-Telangiectasia
Published in Occupational Therapy In Health Care, 2022
Ghodsiyeh Joveini, Mohammad Malja, Mahnaz Hejazi-Shirmard
There is no curative pharmacological treatment for ataxia-telangiectasia, and due to its complexity and severity, medication is often prescribed to alleviate symptoms. Therefore rehabilitation is the cornerstone in the management of the disease (van Os et al., 2017). In the present study, we adopted the top-down PEO model. It assumes that an appropriate fit between the person, occupation, and the environment lets the person have proper occupational performance, and conversely, the lack of congruence between the person’s abilities and environment restricts the participation in occupations. In PEO-based intervention, the goal of the intervention is to maximize this fit. PEO provides a comprehensive view of occupational performance and enables occupational therapists to analyze and intervene in each of these dynamic domains (Law et al., 1996). Adopting a top-down approach in the evaluation and intervention process and increasing the fit between this child and his environment, improved his occupational performance and participation in daily occupations. It is worth mentioning that establishing a good therapeutic relationship with the child, respecting the child’s interests, and identifying meaningful activities were critical in this process. In cerebellar neurodegenerative diseases, improvement following rehabilitation may occur through increasing the gray matter volume in the affected and non-affected areas, especially the dorsal premotor cortex, which has main connections to the primary motor cortex and cerebellar motor areas (Burciu et al., 2013).
Related Knowledge Centers
- Focal Neurologic Signs
- Motor Coordination
- Gait Abnormality
- Eye Movement
- Nervous System
- Cerebellum
- Friedreich's Ataxia
- Cerebellar Ataxia
- Motor Planning
- Lesion