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Altered mental status

Richard J Hamilton, Vadim Keyfes, Sahil S Banka
BACKGROUND: Synthetic cannabinoids (SC) are recreational designer drugs intended to mimic delta-9-tetrahydrocannabinol while surreptitiously circumventing classification by the Drug Enforcement Administration. CASE REPORT: A 50-year-old black male arrived in the Emergency Department transported by Emergency Medical Services (EMS) for altered mental status after complaining of chest pain associated with smoking SCs. EMS found the patient with an empty foil pack labeled "Scooby Snax Limited Edition Blueberry Potpourri...
October 19, 2016: Journal of Emergency Medicine
Mehmet Ali Aslaner, Mustafa Boz, Ali Çelik, Asliddin Ahmedali, Sercan Eroğlu, Nalan Metin Aksu, Serkan Emre Eroğlu
OBJECTIVES: Altered mental status (AMS) is a challenging diagnosis in older patients and has a large range of etiologies. The aim of this study was to investigate the nature of such etiologies for physicians to be better aware of AMS backgrounds and hence improve outcomes and mortality rates. METHODS: This prospective observational study was conducted at 4 emergency departments. Patients 65 years and older who presented to the emergency department with acute AMS (≤1 week), with symptoms ranging from comas and combativeness, were eligible for inclusion in this study...
October 5, 2016: American Journal of Emergency Medicine
Christian Geier, Jessica Davis, Marc Siegel
A previously healthy 66-year-old woman living in the Mid-Atlantic USA presented to the hospital with lethargy, ataxia and slurred speech. 2 weeks prior she had removed a tick from her right groin. She reported malaise, fevers, diarrhoea, cough and a rash. Physical examination revealed a maculopapular rash on her chest, and lung auscultation revealed bi-basilar rales. Laboratory tests were remarkable for hyponatraemia, leucopenia and thrombocytopenia. Chest X-ray demonstrated bilateral pleural effusions with pulmonary oedema...
October 6, 2016: BMJ Case Reports
Michael S Toce, Michele M Burns, Katherine A O'Donnell
CONTEXT: Exploratory buprenorphine ingestions in young children have been associated with clinically significant toxicity. However, detailed data on the clinical presentation and management of these patients are lacking. In an attempt to obtain more comprehensive data, we sought to examine a single center cohort of patients with report of buprenorphine exposure and provide descriptive analysis of rates of respiratory depression, time to respiratory depression, interventions, disposition, and outcomes...
October 19, 2016: Clinical Toxicology
Susan Peters, Venerina Johnston, Sonia Hines, Mark Ross, Michel Coppieters
BACKGROUND: Carpal tunnel syndrome (CTS) is a common problem, that can be effectively managed by surgery. Screening for prognostic factors is important to identify workers who are at a greater risk of a poor work outcome in order to implement tailored interventions to facilitate their return-to-work. OBJECTIVE: To synthesize the best available evidence on the association of preoperative prognostic factors with work-related outcomes in people who have undergone carpal tunnel surgery...
September 2016: JBI Database of Systematic Reviews and Implementation Reports
Lin Shi
According to the seventh report of Joint National Committee (JNC 7), hypertensive emergency (HE), a kind of hypertensive crisis, is defined as a sudden and abrupt elevation in blood pressure so as to cause acute target organ dysfunctions, including central nervous system, cardiovascular system or kidneys. Patients with HE require immediate reduction in markedly elevated blood pressure. Currently, there are no international guidelines for children HE, so the JNC definition is commonly used. Hypertensive emergency in children is rare but a life-threatening emergency...
September 2016: Journal of Hypertension
Adriana Yock-Corrales, Flory Varela-Bulgarelli, Cary Barboza, Alfonso Gutierrez-Mata, Mark T Mackay, Franz Babl
OBJECTIVES: The aim was to describe clinical presentation, management, and outcomes of stroke in a tertiary emergency department (ED) of a developing country. METHODOLOGY: Retrospective case series of patients aged 1 month to 18 years presenting to an ED with radiological confirmed acute stroke during a 7-year period were studied. RESULTS: Ninety-five patients were identified. Twenty-five patients were excluded because of incomplete records (8) or not presenting via ED (17)...
October 4, 2016: Pediatric Emergency Care
Ligia J Dominguez, Mario Barbagallo
PURPOSE OF REVIEW: Physical and cognitive frailty are interrelated and synergistic syndromes more frequently seen in old age, which represent intermediate stages between aging successfully and disability. Poor nutrition is a fundamental determinant for both conditions, while various dietary components are proposed to prevent and/or improve them. This updated review discusses the possible influence of nutritional factors on cognitive frailty and its potential mediators. RECENT FINDINGS: Oxidative stress, low-grade systemic inflammation, neuroinflammation, and altered autophagy, all associated with obesity, metabolic syndrome and insulin resistance, are proposed mechanisms to explain the influence of nutrition on cognitive health...
September 28, 2016: Current Opinion in Clinical Nutrition and Metabolic Care
Santoshi Billakota, Saurabh R Sinha
INTRODUCTION: Continuous EEG (cEEG) monitoring is used in the intensive care unit (ICU) setting to detect seizures, especially nonconvulsive seizures and status epilepticus. The utility and impact of such monitoring in non-ICU patients are largely unknown. METHODS: Hospitalized patients who were not in an ICU and underwent cEEG monitoring in the first half of 2011 and 2014 were identified. Reason for admission, admitting service (neurologic and nonneurologic), indication for cEEG, comorbid conditions, duration of recording, EEG findings, whether an event/seizure was recorded, and impact of EEG findings on management were reviewed...
October 2016: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
David S Mathai, Christopher D Verrico, Daryl Shorter, John H Coverdale, Thomas R Kosten
BACKGROUND/OBJECTIVES: Certain medical consequences seem unique to synthetic cannabinoid (SC) and not cannabis use. We report the case of an adolescent, whose drug expectancies appear to minimize the severity of SC-related adverse events. METHODS/RESULTS: An 18-year-old male presented with altered mental status and seizure, complicated by respiratory failure. He was stabilized and on discharge, despite counseling on the harms of SC usage, the patient planned to resume use, insisting that the hospitalization was "just one bad high"...
October 17, 2016: American Journal on Addictions
Robert T Granata, Edward M Castillo, Gary M Vilke
BACKGROUND: Patients presenting to the emergency department (ED) with altered mental status and alcohol intoxication can clinically resemble patients with an intracranial hemorrhage. Although intracranial hemorrhage is quickly excluded with a head computed tomographic (CT) scan, it is common practice to defer imaging and allow the patient to metabolize to spare ED resources and minimize radiation exposure to the patient. Although this reduces unnecessary scans, it may delay treatment in patients with occult intracranial hemorrhage, which some fear may increase morbidity and mortality...
September 30, 2016: American Journal of Emergency Medicine
Maia Dorsett, Stephen Y Liang
Central nervous system (CNS) infections, including meningitis, encephalitis, and brain abscess, are rare but time-sensitive emergency department (ED) diagnoses. Patients with CNS infection can present to the ED with nonspecific signs and symptoms, including headache, fever, altered mental status, and behavioral changes. Neuroimaging and CSF fluid analysis can appear benign early in the course of disease. Delaying therapy negatively impacts outcomes, particularly with bacterial meningitis and herpes simplex virus encephalitis...
November 2016: Emergency Medicine Clinics of North America
Ashley Blanchard, Keven I Cabrera, Nathan Kuppermann, Peter S Dayan
OBJECTIVES: We aimed to determine the prevalence of and adverse outcomes caused by pneumocephali in children with minor blunt head trauma who had no other intracranial injuries (ie, isolated pneumocephali). METHODS: We conducted a secondary analysis of a public use dataset from a multicenter prospective study of pediatric minor head trauma. We included children younger than 18 years with Glasgow Coma Scale (GCS) scores of 14 or 15 and non-trivial mechanisms of injury who had cranial computed tomographies obtained...
October 6, 2016: Pediatric Emergency Care
Silvana Arciniegas Rodriguez, Tony Zitek, Richard Sterett, David G Nelson
In the pediatric population, cardiac tamponade may present with altered mental status without any clear signs of trauma. Bedside ultrasound is essential to the early diagnosis of this condition. We describe the case of a 5-year-old boy who sustained a potentially fatal, unrecognized trauma to his chest resulting in cardiac tamponade.
October 6, 2016: Pediatric Emergency Care
Kimberly Giraud, Megan Pontin, Linda D Sharples, Paul Fletcher, Tim Dalgleish, Allaina Eden, David P Jenkins, Alain Vuylsteke
Introduction: Post-operative delirium remains a significant problem, particularly in the older surgical patient. Previous evidence suggests that the provision of supplementary visual feedback about ones environment via the use of a mirror may positively impact on mental status and attention (core delirium diagnostic domains). We aimed to explore whether use of an evidence-based mirrors intervention could be effective in reducing delirium and improving post-operative outcomes such as factual memory encoding of the Intensive Care Unit (ICU) environment in older cardiac surgical patients...
2016: Frontiers in Aging Neuroscience
Brenda Han, Cristin Grant
With an increasing number of older people using emergency services, researchers have raised concerns about the quality of care in an environment that is not designed to address older patients' specific needs and conditions. The comprehensive geriatric assessment (CGA) model was developed to address these issues, and to optimise healthcare delivery to older adults. This article introduces a complementary mnemonic, FRAIL, that refers to important elements of health information to consider before initiating care for older patients - falls/functional decline, reactions, altered mental status, illnesses, and living situation...
October 6, 2016: Emergency Nurse: the Journal of the RCN Accident and Emergency Nursing Association
Jenny X Chen, Blake C Alkire, Allen C Lam, William T Curry, Eric H Holbrook
Objectives While bacterial meningitis is a concerning complication after endoscopic skull base surgery, the diagnosis can be made without consideration for aseptic meningitis. This article aims to (1) present a patient with recurrent craniopharyngioma and multiple postoperative episodes of aseptic meningitis and (2) discuss the diagnosis and management of aseptic meningitis. Design Case report and literature review. Results A 65-year-old female patient with a symptomatic craniopharyngioma underwent transsphenoidal resection...
October 2016: Journal of Neurological Surgery Reports
Tory J Andrews, Robert D Cox, Christina Parker, James Kolb
BACKGROUND: Sodium-glucose cotransporter-2 (SGLT2) inhibitor medications are a class of antihyperglycemic agents that increase urinary glucose excretion by interfering with the reabsorption of glucose in the proximal renal tubules. In May of 2015, the U.S. Food and Drug Administration released a warning concerning a potential increased risk of ketoacidosis and ketosis in patients taking these medications. CASE REPORT: We present a case of a 57-year-old woman with type 2 diabetes mellitus taking a combination of canagliflozin and metformin who presented with progressive altered mental status over the previous 2 days...
October 4, 2016: Journal of Emergency Medicine
Jae-Bum Jun, Yunsuk Choi, Hawk Kim, Sun Ho Lee, Joseph Jeong, Jiwon Jung
To date, only 1 case of BK polyomavirus (BKPyV) encephalitis combined with transplant-associated thrombotic microangiopathy has been reported in a hematopoietic stem cell transplantation (HCT) recipient. We report the case of a HCT recipient who developed thrombotic microangiopathy and subsequent BKPyV encephalitis. She died despite treatment with cidofovir, ciprofloxacin, and intravenous immunoglobulin without improvement in mental status. Early suspicion of BKPyV encephalitis in a HCT recipient presenting with altered mentality and hemorrhagic cystitis is important...
October 1, 2016: Transplant Infectious Disease: An Official Journal of the Transplantation Society
Farrukh Jamal, Quazi S Haque, Sangram Singh
BACKGROUND: Diverse group of agro-chemicals are indiscriminately sprayed by the farmers for pest control to enhance crop yield. About 25 million agricultural workers in the developing world suffer from at least one episode of poisoning each year, mainly by anticholinesterase- like organophosphates (OPs). OBJECTIVE: The present study was aimed to establish the OP toxicity in 187 occupationally exposed pesticide sprayers of mango plantation in rural Malihabad, Lucknow, in terms of neuro-cognitive impairment, mental health status, clinical symptoms, diabetes, and hematological factors...
2016: Open Biochemistry Journal
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