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https://www.readbyqxmd.com/read/29137682/cefepime-induced-neurotoxicity-a-systematic-review
#1
Lauren E Payne, David J Gagnon, Richard R Riker, David B Seder, Elizabeth K Glisic, Jane G Morris, Gilles L Fraser
BACKGROUND: Cefepime is a widely used antibiotic with neurotoxicity attributed to its ability to cross the blood-brain barrier and exhibit concentration-dependent ϒ-aminobutyric acid (GABA) antagonism. Neurotoxic symptoms include depressed consciousness, encephalopathy, aphasia, myoclonus, seizures, and coma. Data suggest that up to 15% of ICU patients treated with cefepime may experience these adverse effects. Risk factors include renal dysfunction, excessive dosing, preexisting brain injury, and elevated serum cefepime concentrations...
November 14, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29136716/-the-impact-of-goal-directed-analgesia-on-mechanical-ventilated-patients-s-outcomes-in-intensive-care-unit-a-clinical-observational-study
#2
Q D Li, X Y Wan, Y L Zhang, S W Li, L L Han, W W Li, H Y Shi
To investigate the impact of goal directed analgesia on the outcome of patients with mechanical ventilation in intensive care unit.A total of 126 patients who needed mechanical ventilation were recruited.With a method of before and after paired comparison, they were divided into two group: (1) analgesia with empirical administration or control group; (2) goal directed analgesia based on critical-care pain observation tool (CPOT). Compared with the control group, after goal directed analgesia was applied, the consumption of midazolam significantly dropped from (368...
November 1, 2017: Zhonghua Nei Ke za Zhi [Chinese Journal of Internal Medicine]
https://www.readbyqxmd.com/read/29136301/ketamine-for-the-acute-management-of-excited-delirium-and-agitation-in-the-prehospital-setting
#3
Kyle A Weant, Lauren M Linder, Clint A Ross
BACKGROUND: Traditional first-line therapy in the prehospital setting for the acutely agitated patient includes an antipsychotic in combination with a benzodiazepine. Recently, interest has grown regarding the use of ketamine in the prehospital setting as an attempt to overcome the limitations of the traditional medications and provide a more safe and effective therapy. This review provides an overview of the pharmacology of ketamine, evaluates the literature regarding ketamine use for prehospital agitation, and proposes an algorithm that may be used within the prehospital setting...
November 14, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/29135112/symptom-triggered-alcohol-vapor-inhalation-for-postoperative-alcohol-withdrawal-syndrome-in-patients-with-gastroesophageal-carcinoma
#4
Fengwei Kong, Miao Zhang, Heng Wang, Dong Liu, Ying Wu, Ning Chai, Wenbin Wu
PURPOSE: The purpose of this study was to investigate the feasibility and efficacy of alcohol vapor inhalation during fasting time for cancer patients with alcohol withdrawal symptoms (AWS) after surgery. METHODS: The data of 51 patients after esophagectomy or gastrectomy for gastroesophageal carcinoma in two hospitals from January 2011 to December 2016 was retrospectively analyzed. These patients were diagnosed with AWS with Clinic Institute Alcohol Withdrawal Syndrome Scale (CIWA-Ar) score ≥ 9 in two hospitals during fasting time from January 2011 to December 2016, and they were accordingly divided into alcohol vapor group (n=25) and diazepam group (n=26)...
September 2017: Journal of B.U.ON.: Official Journal of the Balkan Union of Oncology
https://www.readbyqxmd.com/read/29132582/airway-management-in-trauma
#5
REVIEW
George Kovacs, Nicholas Sowers
Airway management in the trauma patient presents numerous unique challenges beyond placement of an endotracheal tube and outcomes are dependent on the provider's ability to anticipate difficulty. Airway management strategies for the care of the polytrauma patient are reviewed, with specific considerations for those presenting with traumatic brain injury, suspected c-spine injury, the contaminated airway, the agitated trauma patient, maxillofacial trauma, and the traumatized airway. An approach to airway management that considers the potential anatomic and physiologic challenges in caring for these complicated trauma patients is presented...
February 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29130141/sj%C3%A3-gren-s-syndrome-initially-presented-as-thrombotic-thrombocytopenic-purpura-in-a-male-patient-a-case-report-and-literature-review
#6
REVIEW
Xiaohan Xu, Tienan Zhu, Di Wu, Lu Zhang
Thrombotic thrombocytopenic purpura (TTP) is a potentially lethal multisystem disorder which could be caused by autoimmune diseases. However, the concomitant occurrence of TTP and Sjögren's syndrome (SS) is an extremely uncommon scenario, especially in male patients. A 56-year-old Chinese male was admitted for the appearance of diffuse ecchymosis. Then he gradually developed transient slurred speech, progressive confusion, agitation, extremity weakness, and fever. Laboratory investigations suggested anemia, thrombocytopenia, significantly increased lactic dehydrogenase, schistocytes in peripheral blood smear, and a disintegrin-like metalloproteinase with thrombospondin motif type 1 member 13 (ADAMTS13) activity deficiency with high inhibitor titers...
November 13, 2017: Clinical Rheumatology
https://www.readbyqxmd.com/read/29110954/effect-of-motor-subtypes-of-delirium-in-the-intensive-care-unit-on-fast-track-failure-after-cardiac-surgery
#7
Anna Lee, Jing Lan Mu, Chun Hung Chiu, Tony Gin, Malcolm John Underwood, Gavin Matthew Joynt
OBJECTIVE: The purpose of the study was to evaluate the association between motor subtypes of postoperative delirium in the intensive care unit and fast-track failure (a composite outcome of prolonged stay in the intensive care unit >48 hours, intensive care unit readmission, and 30-day mortality) after cardiac surgery. METHODS: This was a secondary analysis of a prospective cohort study of 600 consecutive adults undergoing cardiac surgery at a university hospital in Hong Kong (July 2013 to July 2015)...
September 30, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29109752/management-of-exaggerated-gag-reflex-in-dental-patients-using-intravenous-sedation-with-dexmedetomidine
#8
Aleksei P Reshetnikov, Anton A Kasatkin, Aleksandr L Urakov, Dmitrii Y Baimurzin
Pharmacological sedation is one of the effective ways of prevention of gag reflex development in patients experiencing anxiety and fright before dental treatment. We are reporting a case where we could successfully eliminate exaggerated gag reflex (intravenous [IV] Gagging Severity Index) in a dental patient using IV sedation with dexmedetomidine. IV administration of dexmedetomidine provided elimination of gag reflex at a depth of sedation for the patient with the Richmond Agitation-Sedation Scale score of -2 and -1...
September 2017: Dental Research Journal
https://www.readbyqxmd.com/read/29108806/cerebral-infarcts-by-nonbacterial-thrombotic-endocarditis-associated-with-adenomyosis-a-case-report
#9
Byungseok Kim, Seong-Hoon Kim, Taewon Kim
We report a case of multiple embolic cerebral infarcts associated with nonbacterial thrombotic endocarditis (NBTE) in a patient with adenomyosis. The patient presented with dysarthria, left perioral sensory change, and left-hand weakness. Magnetic resonance imaging revealed multiple vascular territory infarctions involving the bilateral cerebellum and the right precentral gyrus. Magnetic resonance angiography was normal. d-Dimer, carbohydrate antigen (CA) 19-9, and CA125 levels were elevated. Abdominal and pelvic computed tomography with iodine contrast enhancement revealed a huge adenomyosis with left ovarian cyst...
November 3, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29107460/electroconvulsive-therapy-for-agitation-and-aggression-in-dementia-a-systematic-review
#10
Julia F van den Berg, Henk C Kruithof, Rob M Kok, Esmée Verwijk, Harm-Pieter Spaans
OBJECTIVES: Many patients with dementia develop agitation or aggression in the course of their disease. In some severe cases, behavioral, environmental, and pharmacological interventions are not sufficient to alleviate these potentially life-threatening symptoms. It has been suggested that in those cases, electroconvulsive therapy (ECT) could be an option. This review summarizes the scientific literature on ECT for agitation and aggression in dementia. METHODS: We performed a systematic review in accordance with PRISMA guidelines...
September 25, 2017: American Journal of Geriatric Psychiatry
https://www.readbyqxmd.com/read/29105487/high-pitch-dual-source-paranasal-sinus-ct-in-agitated-patients-with-maxillofacial-trauma-analysis-of-image-quality-motion-artifacts-and-dose-aspects
#11
Claudia Frellesen, Julian L Wichmann, Patricia Tischendorf, Jan-Erik Scholtz, Martin Beeres, Thomas J Vogl, Ralf W Bauer
Background Image quality benefits from high-pitch scanning in agitated patients by reducing acquisition time. Purpose To compare image quality and exposure parameters in patients with maxillofacial trauma on second- and third-generation dual-source computed tomography (DSCT). Material and Methods Four groups were compared. Group 1 was examined on second-generation DSCT (120 kV/50 mAs, pitch 3.0). The other three groups were examined on third-generation DSCT. Group 2 was scanned with 120 kV/50 mAs, pitch 2...
January 1, 2017: Acta Radiologica
https://www.readbyqxmd.com/read/29105206/risk-factors-for-psychological-and-psychosomatic-symptoms-among-children-with-malignancies
#12
Kenichi Maeda, Daisuke Hasegawa, Kevin Y Urayama, Shinichi Tsujimoto, Yuriko Azami, Miwa Ozawa, Atsushi Manabe
AIM: With increasing survival rates in paediatric malignancies, the quality-of-life of children during hospitalisation should be given more attention. We aimed to identify factors associated with psychological and psychosomatic symptoms (PPS) that required medication among children hospitalised for treatment of malignancies. METHODS: We retrospectively analysed data of 190 patients aged 2-18 years old. They were diagnosed with malignant diseases and admitted for treatment at St...
November 3, 2017: Journal of Paediatrics and Child Health
https://www.readbyqxmd.com/read/29105003/anxiety-irritability-and-agitation-as-indicators-of-bipolar-mania-with-depressive-symptoms-a-post-hoc-analysis-of-two-clinical-trials
#13
Trisha Suppes, Jonas Eberhard, Ole Lemming, Allan H Young, Roger S McIntyre
BACKGROUND: Symptoms of anxiety, irritability, and agitation (AIA) are prevalent among patients with bipolar I disorder (BD-I) mania with depressive symptoms, and could potentially be used to aid physicians in the identification of this more severe form of BD-I. Using data from two clinical trials, the aims of this post hoc analysis were to describe the phenomenology of bipolar mania in terms of AIA and depressive symptoms, and to evaluate the influence of these symptoms on the likelihood of remission during treatment...
November 6, 2017: International Journal of Bipolar Disorders
https://www.readbyqxmd.com/read/29100197/using-simulated-family-presence-to-decrease-agitation-in-older-hospitalized-delirious-patients-a-randomized-controlled-trial
#14
Christine M Waszynski, Kerry A Milner, Ilene Staff, Sheila L Molony
BACKGROUND: Simulated family presence has been shown to be an effective nonpharmacological intervention to reduce agitation in persons with dementia in nursing homes. Hyperactive or mixed delirium is a common and serious complication experienced by hospitalized patients, a key feature of which is agitation. Effective nonpharmacological interventions to manage delirium are needed. OBJECTIVES: To examine the effect of simulated family presence through pre-recorded video messages on the agitation level of hospitalized, delirious, acutely agitated patients...
October 7, 2017: International Journal of Nursing Studies
https://www.readbyqxmd.com/read/29095327/cerebral-venous-sinus-thrombosis-due-to-low-molecular-weight-heparin-induced-thrombocytopenia
#15
Ezequiel Gleichgerrcht, Ming Y Lim, Tanya N Turan
INTRODUCTION: Heparin-induced thrombocytopenia (HIT) is an immune-mediated complication of heparin exposure. A limited number of studies have reported cerebral venous sinus thrombosis (CVST) as the presenting thrombotic event induced by HIT, only one of which occurred with exposure to low-molecular-weight heparin (LMWH), with death as outcome. Here, we present a unique case of LMWH-induced HIT leading to CVST but resulting in good clinical outcome. CASE REPORT: A 52-year-old woman received subcutaneous LMWH for deep vein thrombosis prophylaxis while in rehabilitation following kyphoplasty for spinal fracture related to recent trauma...
November 2017: Neurologist
https://www.readbyqxmd.com/read/29092732/searching-for-factors-that-may-reduce-the-use-of-benzodiazepines-in-hospitals-a-survey-of-hospital-doctors-and-nurses%C3%A2
#16
Stephanie Heinemann, Wolfgang Himmel
A chart review at a mid-sized German general hospital found a high usage of benzodiazepines among older patients. Therefore, all doctors and nurses of this hospital were surveyed about the benefits and risks of benzodiazepines that they considered to be the strongest and their own overall assessment of the risk-benefit ratio for their patients Response rate was 54% (63/116) for doctors and 30% (73/243) for nurses. "Reduced fear or agitation" was perceived by many doctors (71%) and nurses (49%) to be a strong benefit of benzodiazepines...
October 26, 2017: International Journal of Clinical Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/29090362/case-report-domperidone-use-as-a-galactagogue-resulting-in-withdrawal-symptoms-upon-discontinuation
#17
Marley Doyle, Mila Grossman
We present a case of domperidone withdrawal in a woman using the medication as a galactagogue. Our primary goal is to increase the literature available to providers who work with women who are breastfeeding. We evaluated a woman presenting to our reproductive psychiatry clinic for consultation regarding anxiety and agitation in the context of domperidone discontinuation. We evaluated the available literature regarding domperidone as a galactagogue, as well as the literature regarding adverse effects. The patient presented with withdrawal symptoms after gradual taper and discontinuation of domperidone...
October 31, 2017: Archives of Women's Mental Health
https://www.readbyqxmd.com/read/29079068/safety-of-risperidone-for-acute-agitation-and-alcohol-intoxication-in-emergency-department-patients
#18
Patricia A Pepa, Kelly C Lee, Hien E Huynh, Michael P Wilson
BACKGROUND: Acute agitation in the setting of alcohol intoxication is commonly encountered in the Emergency Department (ED). In this setting, expert consensus guidelines recommend haloperidol over second-generation antipsychotics due to their limited safety data in alcohol intoxication. OBJECTIVE: The primary objective was to compare vital sign changes prior to and after risperidone administration between ED patients presenting with alcohol intoxication [ETOH (+)] and without alcohol intoxication [ETOH (-)]...
October 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29076979/the-impact-of-intraoperative-magnetic-resonance-imaging-on-patient-safety-management-during-awake-craniotomy
#19
Kotoe Kamata, Takashi Maruyama, Hiroshi Iseki, Minoru Nomura, Yoshihiro Muragaki, Makoto Ozaki
BACKGROUND: Awake craniotomy paired with intraoperative magnetic resonance imaging (iMRI) is now the established technique for maximizing surgical resection, while preserving neurological function. However, leaving an unsecured airway patient in the iMRI gantry represents considerable risk. Our study aimed at identifying the incidence of critical adverse events in unsecured airway patients during iMRI as part of awake craniotomy. MATERIALS AND METHODS: We conducted a clinical chart review of consecutive awake craniotomies performed between November 1999 and December 2015...
October 25, 2017: Journal of Neurosurgical Anesthesiology
https://www.readbyqxmd.com/read/29072524/acute-side-effects-after-consumption-of-the-new-synthetic-cannabinoids-ab-chminaca-and-mdmb-chmica
#20
Maren Hermanns-Clausen, Dieter Müller, Josephine Kithinji, Verena Angerer, Florian Franz, Florian Eyer, Hartmud Neurath, Gesine Liebetrau, Volker Auwärter
INTRODUCTION: In 2014, the "European Monitoring Centre for Drugs and Drug Addiction" (EMCDDA) reported on 30 novel synthetic cannabinoids (SCs). Among these were indole- and indazole-based valine derivatives with a cyclohexylmethyl side chain (e.g., AB-CHMINACA and MDMB-CHMICA), which represent a new class of SCs. METHODS: A prospective observational study of patients treated in emergency departments (EDs) after the intake of SCs was conducted. Clinical and laboratory data were combined and reported to a poison control centre...
October 26, 2017: Clinical Toxicology
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