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https://www.readbyqxmd.com/read/29668025/general-movements-a-behavioral-biomarker-of-later-motor-and-cognitive-dysfunction-in-nicu-graduates
#1
Colleen Peyton, Christa Einspieler
Infants who have graduated from a neonatal intensive care unit require close follow-up because they have a greater chance of experiencing later motor and cognitive difficulties; however, these difficulties are often challenging to identify at an early age. The General Movement Assessment is a low-cost and highly reliable tool that can indicate abnormal neurological development in young high-risk infants, but it has not yet been widely implemented in the United States. In this review, we discuss the literature about the use of the General Movement Assessment in high-risk infants and how to implement the tool in a clinical setting...
April 1, 2018: Pediatric Annals
https://www.readbyqxmd.com/read/29666716/survival-after-cardiac-arrest-secondary-to-massive-pulmonary-embolism
#2
Abdullah E Laher, Muhammed Moolla, Feroza Motara, Fathima Paruk, Guy Richards
Introduction: It is estimated that the diagnosis of pulmonary embolism (PE) is missed in as many as 84% of all cases of PE. Cardiac arrest following PE is generally associated with poor outcomes. Case Report: A 43-year-old man presented to the Emergency Department (ED) in cardiac arrest. Swelling of his right lower limb was noted on arrival. Point of care ultrasound was performed during ongoing cardiopulmonary resuscitation (CPR) and showed a thrombus in the right iliofemoral vein as well as dilatation of the right ventricle...
2018: Case Reports in Emergency Medicine
https://www.readbyqxmd.com/read/29666075/rogue-one-a-story-of-tophaceous-gout-in-the-spine
#3
Karthik Dwarki, Andy Dothard, Bryan Abadie, Matthew C Miles
A 26-year-old man with history of extensive tophaceous gout presented to the referring facility with decreased bilateral lower extremity sensation and motor function that began acutely 1 week prior to admission and had progressed to urinary incontinence. The patient was admitted to the intensive care unit due to concern for sepsis secondary to epidural abscess. The patient was started on empiric vancomycin and cefepime. Neurosurgery did not recommend acute neurosurgical intervention given the lack of a compressive lesion...
April 17, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29663283/eeg-artifact-versus-subclinical-status-epilepticus-in-a-patient-following-cardiac-arrest
#4
Jean E Cibula, Daniel S Demos, Brenda G Fahy
BACKGROUND: A challenge in ICU EEG interpretation is identifying subclinical status epilepticus versus patterns on the ictal-interictal continuum versus other repetitive patterns. In the electrically noisy intensive care unit, identifying and eliminating interference and artifact allow accurate diagnoses from the EEG, avoiding unnecessary treatment or sedation. METHODS: We present a case during Impella (Abiomed Inc, Danvers, MA) continuous flow left ventricular assist device use where the EEG artifact was initially misinterpreted as seizure by the resident and treated as status epilepticus because of the "focal" sharply contoured repetitive pattern...
April 16, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29652876/rehabilitation-of-sucking-and-swallowing-alterations-in-premature-newborn-at-the-neonatal-intensive-care-unit
#5
Edda Aguilar-Vázquez, M Lucía Pérez-Padilla, M de Lourdes Martín-López, Adriana Abigail Romero-Hernández
Over the last 20 years, 640 premature newborns with alterations in suction-deglution have been taken care of in the neonatal intensive care unit at the Hospital Infantil de México Federico Gómez, using techniques for patients with immaturity, and neurological, gastrointestinal, cardiologic and respiratory pathologies. This descriptive study includes the treatment employed mainly in premature newborns during this period. Suction, swallowing and breathing coordination are some of the most complex abilities that premature newborns face, due to their anatomofunctional immaturity and improper sensoriomotor integration for the high energy requirements they must meet...
2018: Boletín Médico del Hospital Infantil de México
https://www.readbyqxmd.com/read/29651626/current-topics-in-the-management-of-acute-traumatic-spinal-cord-injury
#6
Christopher D Shank, Beverly C Walters, Mark N Hadley
Acute traumatic spinal cord injury (SCI) affects more than 250,000 people in the USA, with approximately 17,000 new cases each year. It continues to be one of the most significant causes of trauma-related morbidity and mortality. Despite the introduction of primary injury prevention education and vehicle safety devices, such as airbags and passive restraint systems, traumatic SCI continues to have a substantial impact on the healthcare system. Over the last three decades, there have been considerable advancements in the management of patients with traumatic SCI...
April 12, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29651625/clinical-characteristics-and-prognosis-of-severe-anti-n-methyl-d-aspartate-receptor-encephalitis-patients
#7
Yan Zhang, Gang Liu, Mengdi Jiang, Weibi Chen, Yanbo He, Yingying Su
BACKGROUND AND PURPOSE: Data concerning the characteristics and duration of the critical manifestations, treatment response, and long-term outcomes of severe anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis patients compared to those of non-severe patients are limited. This observational study was performed to explore the clinical characteristics and long-term outcomes of severe anti-NMDAR encephalitis patients. METHODS: According to their characteristics on admission to the neurology intensive care unit, patients with anti-NMDAR encephalitis were divided into a severe group and a non-severe group...
April 12, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29651510/-vomiting-and-collapse-of-a-28-year-old-male-long-distance-runner-in-middle-european-summer
#8
J Herold, A Mitrasch, E Lorenz, U Lodes, I Tanev, R Braun-Dullaeus, F Meyer
BACKGROUND: Hyperthermia often ends fatally and must therefore be promptly recognized and adequately treated. CASE: A 28-year-old man participated in a long-distance race (3 km) on a hot summer day (28 °C). The runner collapsed, had to vomit but continued the run and reached the finish. Neurologically, the patient presented with intermittent cerebral seizures. External cooling batteries were immediately applied and cold infusions were started. The patient was admitted to the intensive care unit of the university hospital (body temperature 40...
April 12, 2018: Der Internist
https://www.readbyqxmd.com/read/29649955/repair-of-tevar-associated-type-a-dissection-in-the-elderly-is-possible-with-reasonable-morbidity-and-mortality
#9
Angela Kornberger, Risteski Petar, Hazem El Beyrouti, Mahmud Khalil, Iris Burck, Nancy Halloum, Andres Beiras-Fernandez, Christian-Friedrich Vahl
BACKGROUND: Type A aortic dissection (AAD) is a devastating complication of thoracic endovascular repair (TEVAR). In elderly patients, surgery for AAD carries considerable morbidity and mortality. Repair of AAD after previous TEVAR is an even greater challenge as it usually requires the arch to be addressed and a preexisting stent graft to be included into the aortic repair. METHODS: A case series of 5 elderly patients who presented with acute AAD after previous TEVAR was reviewed...
January 1, 2018: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/29644402/-a-case-of-sole-supportive-care-of-severe-neuroparalytic-foodborne-botulism-due-to-homemade-pesto
#10
M Kuratle, R Baldinger, B Lienhardt Nobbe, P Dreessen, B Yuen
In this article, a case of severe foodborne botulism in a 78-year-old man due to homemade pesto is presented. His initial symptoms were gastrointestinal problems. Later he suffered of cranial nerve palsies, muscle weakness of the upper extremities and respiratory failure, so he had to be admitted to the intensive care unit for mechanical ventilation. The botulism was confirmed by serology and culture. Because of spontaneously improving neurological deficits, we decided not to treat with the botulism antitoxin and the patient had complete clinical remission...
April 11, 2018: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/29629988/early-evidence-of-sepsis-associated-hyperperfusion-a-study-of-cerebral-blood-flow-measured-with-mri-arterial-spin-labeling-in-critically-ill-septic-patients-and-control-subjects
#11
Marie-Hélène Masse, Marie Anne Richard, Frédérick D'Aragon, Charles St-Arnaud, Michael Mayette, Neill K J Adhikari, William Fraser, André Carpentier, Steven Palanchuck, David Gauthier, Luc Lanthier, Matthieu Touchette, Albert Lamontagne, Jean Chénard, Sangeeta Mehta, Yanick Sansoucy, Etienne Croteau, Martin Lepage, François Lamontagne
OBJECTIVES: Mechanisms underlying sepsis-associated encephalopathy remain unclear, but reduced cerebral blood flow, alone or in conjunction with altered autoregulation, is reported as a potential contributor. We compared cerebral blood flow of control subjects and vasopressor-dependent septic patients. DESIGN: Randomized crossover study. SETTING: MRI with arterial spin labeling. PATIENTS: Ten sedated septic patients on mechanical ventilation (four with controlled chronic hypertension) and 12 control subjects (six with controlled chronic hypertension) were enrolled...
April 6, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29629983/impact-of-icu-structure-and-processes-of-care-on-outcomes-after-severe-traumatic-brain-injury-a-multicenter-cohort-study
#12
Victoria A McCredie, Aziz S Alali, Damon C Scales, Gordon D Rubenfeld, Brian H Cuthbertson, Avery B Nathens
OBJECTIVES: It is uncertain whether dedicated neurocritical care units are associated with improved outcomes for critically ill neurologically injured patients in the era of collaborative protocol-driven care. We examined the association between dedicated neurocritical care units and mortality and the effects of standardized management protocols for severe traumatic brain injury. DESIGN: We surveyed trauma medical directors from centers participating in the American College of Surgeons Trauma Quality Improvement Program to obtain information about ICU structure and processes of care...
April 6, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29629931/magnetic-resonance-imaging-in-neurocritically-ill-patients-who-fails-and-how
#13
Joong-Goo Kim, Myung-Ah Ko, Han-Bin Lee, Sang-Beom Jeon
OBJECTIVES: Performing magnetic resonance imaging (MRI) in neurocritically ill patients is challenging because it often requires sedation and withholding care in the neurological intensive care unit. This study investigated the incidence of and reasons for failed or complicated MRI (MRI-FC) in such patients. METHODS: A consecutive series of 218 neurocritically ill patients who underwent brain MRI were retrospectively evaluated. Failed or complicated MRI included failure to obtain all ordered sequences, unscheduled sedative administration, decrease in oxygen saturation to less than 90%, hypotension (≥40-mm Hg decrease and/or use of inotropic agents), and cardiac or respiratory arrest...
April 6, 2018: Journal of Patient Safety
https://www.readbyqxmd.com/read/29629575/adult-hospital-admissions-associated-with-multiple-sclerosis-in-finland-in-2004-2014
#14
Anna-Leena Pirttisalo, Jussi O T Sipilä, Merja Soilu-Hänninen, Päivi Rautava, Ville Kytö
INTRODUCTION: Treatment of multiple sclerosis (MS) has developed significantly and several new immunotherapeutic drugs have become available in Finland since 2004. We studied whether this is associated with changes in hospital admission frequencies and healthcare costs and whether admission rates due to infection have increased. METHODS: The national Care Register for Health Care was searched for all discharges from neurological, medical, surgical, neurosurgical and intensive care units with MS as a primary diagnosis or an auxiliary diagnosis for primary infection diagnosis in 2004-2014...
April 9, 2018: Annals of Medicine
https://www.readbyqxmd.com/read/29628837/factors-affecting-reintubations-after-cardiac-and-thoracic-surgeries-in-cardiac-intensive-care-unit-of-a-tertiary-care-hospital
#15
Khalid Maudood Siddiqui, Khalid Samad, Faisal Jonejo, Muhammad Faisal Khan, Khalid Ahsan
Background: Reintubation and readmission after cardiothoracic surgeries are not uncommon, and its reasons are multifactorial. The study goal was to identify the factors that contribute reintubation after cardiac and thoracic surgery in tertiary care hospital and to compare the outcome with international benchmark. Methodology: A prospective, observational study was planned in Cardiac Intensive Care Unit (CICU). The study included all those patients who required readmission in CICU due to endotracheal intubation following cardiac and thoracic surgeries...
April 2018: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/29628833/efficacy-and-safety-of-dexmedetomidine-infusion-for-patients-undergoing-awake-craniotomy-an-observational-study
#16
Charu Mahajan, Girija Prasad Rath, Gyaninder Pal Singh, Nitasha Mishra, Suman Sokhal, Parmod Kumar Bithal
Background: The goal of awake craniotomy is to maintain adequate sedation, analgesia, respiratory, and hemodynamic stability and also to provide a cooperative patient for neurologic testing. An observational study carried out to evaluate the efficacy of dexmedetomidine sedation for awake craniotomy. Materials and Methods: Adult patients with age >18 year who underwent awake craniotomy for intracranial tumor surgery were enrolled. Those who were uncooperative and had difficult airway were excluded from the study...
April 2018: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/29627883/platelet-transfusion-increases-risk-for-acute-respiratory-distress-syndrome-in-non-massively-transfused-blunt-trauma-patients
#17
George Kasotakis, Nichole Starr, Erek Nelson, Bedabrata Sarkar, Peter Ashley Burke, Daniel George Remick, Ronald Gary Tompkins
PURPOSE: While damage control resuscitation is known to confer a survival advantage in severely injured patients, high-ratio blood component therapy should be initiated only in carefully selected trauma patients, due to the morbidity associated with blood product use. With this project, we aim to identify the effect of platelet transfusion in non-massively transfused bluntly injured patients. METHODS: The Glue Grant database was retrospectively queried and severely injured blunt trauma patients who underwent non-massive transfusion were identified...
April 7, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/29623156/prognostic-value-of-the-neurological-examination-in-cardiac-arrest-patients-after-therapeutic-hypothermia
#18
Elizabeth A Matthews, Jessica Magid-Bernstein, Evie Sobczak, Angela Velazquez, Cristina Maria Falo, Soojin Park, Jan Claassen, Sachin Agarwal
Objectives: Current prognostication guidelines for cardiac arrest (CA) survivors predate the use of therapeutic hypothermia (TH). The prognostic value and ideal timing of the neurological examination remain unknown in the setting of TH. Design: Patients (N = 291) admitted between 2007 and 2015 to Columbia University intensive care units for TH following CA had neurological examinations performed on days 1, 3, 5, and 7 postarrest. Absent pupillary light response (PLR), absent corneal reflexes (CRs), and Glasgow coma scores motor (GCS-M) no better than extension were considered poor examinations...
April 2018: Neurohospitalist
https://www.readbyqxmd.com/read/29621337/serial-evaluation-of-sofa-and-apache-ii-scores-to-predict-neurologic-outcomes-of-out-of-hospital-cardiac-arrest-survivors-with-targeted-temperature-management
#19
Jae Chol Yoon, Youn-Jung Kim, You-Jin Lee, Seung Mok Ryoo, Chang Hwan Sohn, Dong-Woo Seo, Yoon-Seon Lee, Jae Ho Lee, Kyoung Soo Lim, Won Young Kim
OBJECTIVE: This study was aimed at a serial evaluation and comparison of the prognostic values of Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores for neurologic outcomes in comatose, out-of-hospital cardiac arrest (OHCA) survivors, treated with targeted temperature management (TTM). METHODS: We analysed a prospective cohort of comatose OHCA patients, with TTM, admitted to an emergency intensive care unit (ICU), between January 2010 and December 2015...
2018: PloS One
https://www.readbyqxmd.com/read/29621235/survival-after-picu-admission-the-impact-of-multiple-admissions-and-complex-chronic-conditions
#20
Håkan Kalzén, Björn Larsson, Staffan Eksborg, Lars Lindberg, Karl Erik Edberg, Claes Frostell
OBJECTIVE: Factors predicting survival over time after pediatric intensive care unit (PICU) admissions are not fully understood. The primary aim of the current study was to investigate whether multiple admissions (MADM) compared to single PICU admissions (SADM) were associated with poor survival over time after being admitted to PICU facilities. Our secondary aim was to investigate if the presence of a complex chronic condition (CCC) would further impair prognosis. DESIGN: A closed cohort of all children up to 16 years of age admitted to the three PICUs in Sweden between 2008 and 2010 was prospectively collected and followed until 2012, providing survival data for at least one but up to four years of follow-up...
2018: PloS One
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