Thoracic Trauma
Ian Greaves, Keith Porter, Jeff Garner in Trauma Care Manual, 2021
Initially, patients may be confused and combative due to hypoxia or hypercarbia. However, a primary head injury may also cause an altered mental state, which is compounded by the hypoxia or hypercarbia. The Glasgow Coma Scale (GCS) score should be recorded routinely. In the case of pre-hospital assessment, the AVPU (alert, voice, pain, unresponsive) scale is appropriate (see Chapter 6). Peripheral neurological features may also be present, such as in the case of a high cervical spinal injury. Their recognition is important, as paralysis of the diaphragm will further diminish an already reduced respiratory effort, necessitating respiratory support to prevent hypoxia and hypercarbia.
Traumatic brain injury
Quentin Spender, Judith Barnsley, Alison Davies, Jenny Murphy in Primary Child and Adolescent Mental Health, 2018
This can be loosely defined as bruising of the brain without large-scale structural damage, and the term may be used in a non-professional sense to refer to a brief loss of consciousness. It is the mildest form of head injury and can also be known as mild traumatic brain injury. Loss of consciousness may or may not occur. More severe head injury is likely to be accompanied by longer periods of unconsciousness or coma (defined inclusively as a sleep-like state in which a person is not conscious)3 Another more formal definition of concussion is: The common result of a blow to the head or sudden deceleration usually causing an altered mental state, either temporary or prolonged. Physiological and/or anatomical disruption of connections between some nerve cells in the brain may occur.4
Wernicke-Korsakoff Syndrome
Jenny Svanberg, Adrienne Withall, Brian Draper, Stephen Bowden in Alcohol and the Adult Brain, 2014
In 1881, Carl Wernicke first described the encephalopathy that now bears his name. In his original article, he provided detailed descriptions of the clinical presentation and pathology of the disease (Wernicke, 1881, as translated in Thomson et al., 2008a). These initial observations have proved enduring, including the initial description of the “classic triad” of diagnostic signs. The classic triad, as currently conceived, consists of (i) oculomotor abnormalities, namely ophthalmoplegia and nystagmus, (ii) cerebellar dysfunction, especially gait ataxia, and (iii) altered mental state, ranging from subtle cognitive impairment to a global confusional state or coma (Caine et al., 1997; Galvin et al., 2010; Thomson et al., 2008a).
Therapeutic Potential Ascribed to Ayahuasca by Users in the Czech Republic
Published in Journal of Psychoactive Drugs, 2018
Miroslav Horák, Lea Hasíková, Nahanga Verter
Ayahuasca may be considered a safe therapeutic tool only if is administered in ritual context by an experienced facilitator who supervises its preparation and use. However, no context setting is 100% safe. According to Zinberg (1984), an individual’s mental state always influences the experience in an altered state of consciousness. In the process of integrating personal experience, the quality of information provided to users before the ritual and during aftercare is inherent. Ignoring the rules of the ritual may lead to undesirable effects (Riba and Barbanoj 2005; Gable 2007). The so-called diet (i.e., a set of specific dietary prescriptions avoiding tyramines, accompanied by sexual abstinence) plays an important role in the organization of the ayahuasca ritual. Kavenská and Simonová (2015) argue that possible risks associated with the use of ayahuasca may also be influenced by certain personality styles of participants.
Listeria monocytogenes sepsis in the nursing home community: a case report and short review of the literature
Published in Acta Clinica Belgica, 2018
Griet Buyck, Veronique Devriendt, Anne-Marie Van den Abeele, Christian Bachmann
A retrospective observational study was conducted in Denmark by Thønnings et al. to investigate the clinical characteristics and risk factors for a fatal outcome with emphasis on the impact of the chosen antibiotic treatment [1]. All patients with Listeria monocytogenes isolated from blood or CSF cultures in a 15-year study period were identified, and the outcome was all-cause mortality within 30 days after the positive cultures were taken. 229 patients were included in the study cohort, and most patients were older people (mean age 71) or immunocompromised. The most frequent focus of infection was meningitis, followed by gastroenteritis, endocarditis, osteomyelitis, and septic arthritis. There was no significant difference in mortality between bacteremia and meningitis cases. However, the mortality rate was significantly higher in patients treated with inadequate empiric antibiotic therapy compared with patients treated with adequate empiric antibiotic therapy. Other significant risk factors for fatal outcome were altered mental state, septic shock, and low temperature. For the definitive antibiotic treatment, an increased mortality rate was seen in patients treated with meropenem compared with benzylpenicillin and aminopenicillins [1].
Fronto-parietal coherence response to tDCS modulation in patients with disorders of consciousness
Published in International Journal of Neuroscience, 2018
Yang Bai, Xiaoyu Xia, Yong Wang, Yongkun Guo, Yi Yang, Jianghong He, Xiaoli Li
Newer resuscitation techniques have led to a considerable increase in the number of patients who survive severe brain injuries. However, patients with focal injuries that induce widespread functional changes or with more global injuries can develop disorders of consciousness (DoC). Due to severe brain damage, patients in such a dramatically altered state of consciousness pose a challenge to diagnosis, prognosis and daily care. Among patients with DoC, those in an unresponsive wakefulness syndrome (UWS) are in a condition of wakeful unconsciousness featuring spontaneous eye-opening re-emergences despite the absence of discernible evidence of language comprehension, verbal or gestural communication or reproducible purposeful behavioural responses to visual, auditory, tactile or noxious stimuli [1]. Patients in a minimally conscious state (MCS) are characterised by minimal but definite behavioural evidence of self or environmental awareness [2]. Although many studies of pharmacological and non-pharmacological interventions have been conducted, there is still no effective standardised treatment for patients with DoC [3].
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