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Altered mental status

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https://www.readbyqxmd.com/read/29760852/altered-mental-status-current-evidence-based-recommendations-for-prehospital-care
#1
REVIEW
Ashley Sanello, Marianne Gausche-Hill, William Mulkerin, Karl A Sporer, John F Brown, Kristi L Koenig, Eric M Rudnick, Angelo A Salvucci, Gregory H Gilbert
Introduction: In the United States emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with an acute change in mental status and to compare these recommendations against the current protocols used by the 33 EMS agencies in the State of California. Methods: We performed a literature review of the current evidence in the prehospital treatment of a patient with altered mental status (AMS) and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations...
May 2018: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29750636/outcomes-of-very-elderly-treated-with-dialysis-for-acute-kidney-injury
#2
Ezra Gabbay, Yehudit Zangi, Alon Bnayah, Jawad Atrash, Itzchak Slotki, Linda Shavit
BACKGROUND: The factors that determine prognosis in elderly patients with dialysis-requiring acute kidney injury (AKI-D) is uncertain. The purpose of this study was to examine predictors of in-hospital mortality in these patients. MATERIALS AND METHODS: A retrospective, single-center study of hospitalized patients ≥ 70 years old with AKI-D. Clinical and demographic variables were compared between survivors and non-survivors, independent predictors of hospital mortality were identified by logistic regression...
May 11, 2018: Clinical Nephrology
https://www.readbyqxmd.com/read/29741717/influenza-associated-acute-necrotizing-encephalopathy-in-siblings
#3
Ashley Howard, Timothy M Uyeki, Jaime Fergie
Encephalopathy is an important complication associated with influenza, most frequently observed in young children, with a wide range of severity. The most severe category of influenza-associated encephalopathy (IAE) is acute necrotizing encephalopathy (ANE), characterized by high frequency of neurologic sequelae and fatal outcomes. We report two young siblings who developed fever and seizures with altered mental status. Influenza A(H1N1)pdm09 virus infection was identified in upper respiratory tract specimens from both patients, and neuroimaging revealed bilateral inflammatory lesions, consistent with acute necrotizing encephalopathy...
May 4, 2018: Journal of the Pediatric Infectious Diseases Society
https://www.readbyqxmd.com/read/29732225/cortical-blindness-and-altered-mental-status-following-routine-hemodialysis-a-case-of-iatrogenic-cerebral-air-embolism
#4
Lawrence Lau, Kory London
Cerebral air embolism is a known complication from a myriad of iatrogenic causes. This case describes a 60-year-old female presenting from hemodialysis with altered mental status, bilateral homonymous hemianopia, and repetitive speech. A noncontrast head CT revealed air in the vein of Galen and the deep cerebral veins of the left thalamus and occipital sulcus, a complication from air being introduced into the patient via improper flushing of dialysis tubing. The retrograde flow of air bubbles in the upright patient during dialysis was likely responsible for the air embolus lodging in the cerebral vasculature...
2018: Case Reports in Emergency Medicine
https://www.readbyqxmd.com/read/29730659/myxedema-coma-due-to-hashimoto-thyroiditis-a-rare-but-real-presentation-of-failure-to-thrive-in-infancy
#5
Ryan A Heksch, Rohan K Henry
BACKGROUND: Hashimoto thyroiditis (HT) is uncommon in infancy, and myxedema coma (MC) is even less common. While prior reports have documented these entities separately, to our knowledge, MC in combination with HT has not been reported before in this age group. METHODS/RESULTS: A 10-month-old female presented with ptosis, lethargy, dysphagia, and failure to thrive (FTT). She developed hypotension, bradycardia, hypothermia, and apnea requiring intubation. Initial thyroid-stimulating hormone was 422 μIU/mL, and free thyroxine was < 0...
May 4, 2018: Hormone Research in Pædiatrics
https://www.readbyqxmd.com/read/29724875/unusual-case-of-anti-n-methyl-d-aspartic-acid-receptor-nmda-r-encephalitis-and-autoimmune-polyglandular-syndrome-aps
#6
Simona Frunza-Stefan, Hilary B Whitlatch, Gautam G Rao, Rana Malek
Anti-N-methyl-D-aspartic acid-receptor (NMDA-R) encephalitis is a novel disease discovered within the past 10 years. It is an autoimmune disease (AD) that has been associated with other ADs, such as Graves' disease. However, association with autoimmune polyglandular syndromes (APS) has not been previously described. A 58-year-old woman presented with altered mental status and an 8-month history of weight loss, apathy and somnolence. Laboratory evaluation confirmed Graves' disease with thyrotoxicosis and type 1 diabetes mellitus...
May 2, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29721399/emergency-management-of-spontaneous-bacterial-peritonitis-a-clinical-review
#7
REVIEW
Tracy MacIntosh
Spontaneous bacterial peritonitis (SBP) has a high mortality rate; early antimicrobial therapy is essential for improving patient outcomes. Given that cirrhotic patients are often coagulopathic, the perceived risk of bleeding may prevent providers from performing a paracentesis and ruling out this potentially deadly disease. We examine the pathophysiology and risk factors for SBP, and current guidelines for its diagnosis and treatment. We then review the time-sensitive nature of performing a paracentesis, and the current controversies and contraindications for performing this procedure in patients at risk for SBP...
March 1, 2018: Curēus
https://www.readbyqxmd.com/read/29718773/high-thiamine-diphosphate-level-as-a-protective-factor-for-alzheimer-s-disease
#8
Changpeng Wang, Guoqiang Fei, Xiaoli Pan, Shaoming Sang, Lijun Wang, Chunjiu Zhong, Lirong Jin
Objectives Thiamine diphosphate (TDP) is an indispensable coenzyme for three key enzymes in glucose metabolism. Reduced TDP levels in patients with Alzheimer's disease (AD) has been widely demonstrated and is a diagnostic biomarker for the disease. In this study, we further explored the correlation between altered TDP metabolism and AD along with other risk factors. Methods A 1:1 case-control study was employed with 90 AD patients and 90 control subjects with normal-range cognitive abilities as assayed by the Mini Mental Status Evaluation...
May 2, 2018: Neurological Research
https://www.readbyqxmd.com/read/29710871/characteristics-and-management-of-community-acquired-pneumonia-in-the-era-of-global-aging
#9
REVIEW
Catia Cillóniz, Diana Rodríguez-Hurtado, Antoni Torres
Community-acquired pneumonia (CAP) can occur at any time of life, but its incidence and risk of death are linked to increasing age. CAP in the elderly is a major health problem associated with high rates of readmission, morbidity, and mortality. Since the clinical presentation of pneumonia in the elderly may be atypical, clinicians should suspect pneumonia in older patients presenting symptoms such as falls and altered mental status, fatigue, lethargy, delirium, anorexia, in order to avoid the complications associated with delayed diagnosis and therapy...
April 30, 2018: Medical Sciences: Open Access Journal
https://www.readbyqxmd.com/read/29706818/multiple-admissions-to-the-coronary-care-unit-due-to-falsely-elevated-cardiac-troponin
#10
Mohamed Ayan, Zaid Gheith, Aneesha Ananthula, Mohsin Salih, Srikanth Vallurupalli, Jawahar L Mehta
The measurement of cardiac troponin, released from injured cardiomyocytes, is of paramount importance in the diagnosis of acute myocardial infarction. Elevated troponin can be encountered, however, in patients with cardiomyopathy, significant cardiac arrhythmias, vasculitis, right-sided heart strain, critical systemic illnesses, stroke, drug toxicity (such as Adriamycin), poisons (such as snake venoms), renal failure, seizure, and rhabdomyolysis. If the clinical picture is not consistent with any of these causes, a false-positive result should be considered...
April 2018: Proceedings of the Baylor University Medical Center
https://www.readbyqxmd.com/read/29699900/apneic-oxygenation-reduces-hypoxemia-during-endotracheal-intubation-in-the-pediatric-emergency-department
#11
Adam A Vukovic, Holly R Hanson, Shelley L Murphy, Danielle Mercurio, Craig A Sheedy, Donald H Arnold
BACKGROUND: Apneic oxygenation (AO) has been evaluated in adult patients as a means of reducing hypoxemia during endotracheal intubation (ETI). While less studied in pediatric patients, its practice has been largely adopted. OBJECTIVE: Determine association between AO and hypoxemia in pediatric patients undergoing ETI. METHODS: Observational study at an urban, tertiary children's hospital emergency department. Pediatric patients undergoing ETI were examined during eras without (January 2011-June 2011) and with (August 2014-March 2017) apneic oxygenation...
April 18, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29696555/desmopressin-induced-severe-hyponatremia-with-central-pontine-myelinolysis-a-case-report
#12
Tanzib Hossain, Marya Ghazipura, Vineet Reddy, Pedro J Rivera, Vikramjit Mukherjee
Desmopressin, a synthetic vasopressin analog, is used to treat central diabetes insipidus, hemostatic disorders such as von Willebrand's disease, and nocturnal enuresis. We present the case of a 69-year-old man who developed severe hyponatremia during treatment with intranasal desmopressin at 10 µg twice daily for chronic polyuria and nocturia thought to be due to central diabetes insipidus. After 5 months of therapy, the patient noticed progressive fatigue, anorexia, dizziness, weakness, light-headedness, decreased concentration, and new-onset falls...
April 25, 2018: Drug Safety—Case Reports
https://www.readbyqxmd.com/read/29693218/preventing-wernicke-encephalopathy-after-bariatric-surgery
#13
REVIEW
Erik Oudman, Jan W Wijnia, Mirjam van Dam, Laser Ulas Biter, Albert Postma
Half a million bariatric procedures are performed annually worldwide. Our aim was to review the signs and symptoms of Wernicke's encephalopathy (WE) after bariatric surgery. We included 118 WE cases. Descriptions involved gastric bypass (52%), but also newer procedures like the gastric sleeve. Bariatric WE patients were younger (median = 33 years) than those in a recent meta-analysis of medical procedures (mean = 39.5 years), and often presented with vomiting (87.3%), ataxia (84.7%), altered mental status (76...
April 24, 2018: Obesity Surgery
https://www.readbyqxmd.com/read/29691105/thermal-burn-resulting-from-prolonged-transcutaneous-pacing-in-a-patient-with-complete-heart-block
#14
Edgar Francisco Carrizales-Sepúlveda, Linda Ivette González-Sariñana, Alejandro Ordaz-Farías, Raymundo Vera-Pineda, Ramiro Flores-Ramírez
Temporary transcutaneous pacing devices are used to treat symptomatic bradyarrhythmias that are unresponsive to medical therapy until it resolves or a more stable pacing device is established. Pain is the most common complication. Skin burns as a complication are uncommon. A female patient presented with a complete atrioventricular block that caused altered mental status and required orotracheal intubation. A temporary transcutaneous pacing device was used to treat the bradyarrhythmia and maintained for 12 h until a temporary transvenous pacemaker was placed...
April 19, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29687030/therapeutic-effect-of-steroids-in-osmotic-demyelination-of-infancy
#15
Lalit R Bansal
An 11-month-old male presented with acute gastroenteritis, seizures, and altered mental status. Laboratory workup revealed serum sodium of 177 mmol/L. Magnetic resonance imaging of the brain showed reduced diffusion in the supratentorial white matter, T2 hyperintensities in the left central pons and midbrain, subacute stroke in the right occipital lobe, and bilateral cerebellar hemorrhagic infarcts. The child was presumed to have hypernatremia-induced central pontine and extrapontine myelinolysis. He received 5 days of high-dose methylprednisolone for persistent encephalopathy and spastic quadriparesis with rapid recovery of his cognitive function and neurological examination...
2018: Child Neurology Open
https://www.readbyqxmd.com/read/29678819/reversible-metronidazole-induced-neurotoxicity-after-10-weeks-of-therapy
#16
Wafa AlDhaleei, Ayesha AlMarzooqi, Nouran Gaber
Metronidazole is a commonly used antimicrobial worldwide. The most common side effects that have been reported are nausea, vomiting and hypersensitivity reactions. However, neurotoxicity has been reported with the use of metronidazole but rather rare. The most common neurological manifestation is peripheral neuropathy involvement in the form of sensory loss. It is worth mentioning that central neurotoxicity is a rare side effect of metronidazole use but reversible. The manifestations vary from a headache, altered mental status to focal neurological deficits...
April 20, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29678142/abnormally-low-bispectral-index-and-severe-hypoglycemia-during-maintenance-of-and-recovery-from-general-anesthesia-in-diabetic-retinopathy-surgery-two-case-reports
#17
Chunhua Xi, Chuxiong Pan, Tianzuo Li
BACKGROUND: Hypoglycemia is one of the most fatal complications during the perioperative period. General anesthesia or sedation can mask a hypoglycemia-altered mental status. Acute hypoglycemia might result in permanent brain injury. There is no way to detect hypoglycemia during general anesthesia, except for intermittent blood glucose monitoring. CASE PRESENTATION: Hypoglycemia is associated with changes in electroencephalogram readings. Here, we report two cases of patients with an abnormally low Bispectral Index (BIS) associated with diabetic retinopathy surgery, one in the recovery stage of general anesthesia and the other in the maintenance of general anesthesia...
April 20, 2018: BMC Anesthesiology
https://www.readbyqxmd.com/read/29677987/towards-unsupervised-detection-of-process-models-in-healthcare
#18
Amirah Alharbi, Andy Bulpitt, Owen A Johnson
Process mining techniques can play a significant role in understanding healthcare processes by supporting analysis of patient records in electronic health record systems. Healthcare processes are complex and patterns of care may vary considerably within similar cohorts of patients. Process mining often creates "spaghetti" models and require significant domain expert input to refine. Machine learning approaches such as Hidden Markov Models (HMM) may assist this refinement process. HMMs have been advocated for patient pathways clustering purposes; however these models can also be utilized for detecting hidden processes to help event abstraction...
2018: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/29677014/continuous-electroencephalography-in-the-critically-ill-clinical-and-continuous-electroencephalography-markers-for-targeted-monitoring
#19
Christopher R Newey, Tyler G Kinzy, Vineet Punia, Stephen Hantus
PURPOSE: Electrographic seizures detected by continuous electroencephalography (CEEG) in critically ill patients with altered mental status is becoming increasingly recognized. Data guiding the appropriate selection of patients to be monitored on CEEG are lacking. The aims of this article were to study the incidence of seizures in the critical care setting and to evaluate for clinical predictors to improve the efficiency of CEEG monitoring. METHODS: Retrospective review of the CEEG and clinical data on 1,123 consecutive patients who had continuous video EEG over a 24-month period...
April 17, 2018: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
https://www.readbyqxmd.com/read/29675363/clinical-and-imaging-features-of-pituitary-apoplexy-and-role-of-imaging-in-differentiation-of-clinical-mimics
#20
REVIEW
Pradeep Goyal, Michael Utz, Nishant Gupta, Yogesh Kumar, Manisha Mangla, Sonali Gupta, Rajiv Mangla
To discuss the clinical syndrome, review common imaging findings of pituitary apoplexy (PA) and role of imaging in therapy and follow-up. Also, to review other acute clinical scenarios with similar clinical and/or imaging findings as PA. PA is a severe and potentially life-threatening medical emergency, characterized by constellation of symptoms/signs that occur as a result of acute hemorrhage and/or infarction in pituitary gland. Patients present with acute and sudden onset of symptoms/signs, most commonly with severe headache, vision deficits/ophthalmoplegia, altered mental status, and possible pan hypopituitarism...
March 2018: Quantitative Imaging in Medicine and Surgery
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