Assessing and responding to sudden deterioration in the adult
Nicola Neale, Joanne Sale in 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.
Return to Play Following Brain Injury
Mark R. Lovell, Ruben J. Echemendia, Jeffrey T. Barth, Michael W. Collins in Traumatic Brain Injury in Sports, 2020
Severe (Grade III) concussion occurs with a more protracted period of unconsciousness lasting over five minutes. In the past it was thought that rarely would a grade III concussion occur without a loss of consciousness but with a very protracted period of PTA lasting over twenty-four hours. In reality, prospective studies over the last several years indicate that virtually all Grade III concussions by this guideline; occur because of PTA lasting over twenty-four hours (Erlanger, 2000). A protracted period of unconsciousness lasting over five minutes is almost never seen on athletic fields. Most periods of unconsciousness last seconds to a minute. Furthermore, prospective studies over the last ten years have shown a correlation among duration of PCS, PTA and abnormal neuropsychological test data (Erlanger, Feldman et al., 2000). Therefore, a data-based modification of the original Cantu Guidelines is found in Table 26.5.
Overcoming the challenges of accurately assessing consciousness and communication in the context of pain assessment
Camille Chatelle, Steven Laureys in Assessing Pain and Communication in Disorders of Consciousness, 2015
Severe brain injury typically leads to unconsciousness (coma). Coma may be relatively brief and evolve directly into higher states of consciousness over a period of days. In the most severe cases, coma may evolve into the vegetative state and only later, if at all, transition into the minimally conscious state (MCS), the confusional state, and higher states of consciousness (Whyte, Ponsford, Watanabe, & Hart, 2010). In disorders of consciousness (DOC), the pace of recovery is highly variable, and some patients may spend prolonged intervals in a given state of consciousness or even plateau there indefinitely (Giacino & Whyte, 2005). Behavioral and physiologic responses in DOC patients are often quite variable, which makes it difficult to distinguish random fluctuations from more consistent trends in recovery or deterioration.
Childbirth Is Not a Medical Emergency: Maternal Right to Informed Consent throughout Labor and Delivery
Published in Journal of Legal Medicine, 2018
One of the four major exceptions to a physician’s requirement to obtain express informed consent is in the setting of a medical emergency.54 For the purposes of the doctrine of informed consent, a medical emergency occurs when the patient is incompetent to make medical decisions and immediate medical action is necessary to prevent significant harm or to save a human life.55 Typically, this occurs in the setting of an unconscious or incapacitated patient who is in need of urgent medical care.56 Though the state of unconsciousness is usually due to injury or trauma, such as in the setting of a car accident or a slip and fall, some courts have extended the emergency exception to include iatrogenic unconsciousness, as in the case of surgical anesthesia.57 The emergency exception is based on the presumption that were the patient competent and aware of the gravity of his or her medical condition and the relative risks and benefits of the planned intervention(s), he or she would consent to treatment.58 The courts do not want the impracticality of obtaining informed consent under emergency conditions to limit or delay the provision of life-saving treatments.59 Accordingly, the courts allow physicians to presume an implied consent and proceed with the necessary medical care.60
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
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].
Related Knowledge Centers
- Alcohol
- Cardiac Arrest
- Cerebral Hypoxia
- Consciousness
- Depressant
- Infarction
- Traumatic Brain Injury
- Stimulus
- Hypnotic
- Sedative