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Neurology ICU

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https://www.readbyqxmd.com/read/29331713/repeated-attempted-homicide-by-administration-of-drugs-documented-by-hair-analysis
#1
Valérie Baillif-Couniou, Christophe Bartoli, Caroline Sastre, Marjorie Chèze, Marc Deveaux, Georges Léonetti, Anne-Laure Pélissier-Alicot
Attempted murder by repeated poisoning is quite rare. The authors describe the case of a 62-year-old man who was admitted to an intensive care unit (ICU) for neurological disturbances complicated by inhalation pneumopathy. He presented a loss of consciousness while his wife was visiting him at the ICU (H0). Forty-eight hours later (H48), police officers apprehended the patient's wife pouring a liquid into his fruit salad at the hospital. Toxicological analyses of a blood sample and the infusion equipment (H0), as well as the fruit salad and its container (H48), confirmed the attempted poisoning with cyamemazine (H0) and hydrochloric acid (H48)...
January 5, 2018: Journal of Forensic and Legal Medicine
https://www.readbyqxmd.com/read/29322987/complications-related-to-sitting-position-during-pediatric-neurosurgery-an-institutional-experience-and-review-of-literature
#2
Priyanka Gupta, Girija P Rath, Hemanshu Prabhakar, Parmod K Bithal
BACKGROUND: Sitting position is preferred during posterior fossa surgeries as it provides better anatomical orientation and a clear surgical field. However, its use has been declining due to its propensity to cause life-threatening complications. This study was carried out to analyze the perioperative complications and postoperative course of children who underwent neurosurgery in sitting position. MATERIALS AND METHODS: Medical records of 97 children (<18 years) who underwent neurosurgery in sitting position over a period of 12 years, were retrospectively analyzed...
January 2018: Neurology India
https://www.readbyqxmd.com/read/29313312/influence-of-single-dose-antibiotic-prophylaxis-for-early-onset-pneumonia-in-high-risk-intubated-patients
#3
Timothy D Lewis, Kelly A Dehne, Kathryn Morbitzer, Denise H Rhoney, Casey Olm-Shipman, J Dedrick Jordan
BACKGROUND: Early-onset pneumonia (EOP) after endotracheal intubation is common among critically ill patients with a neurologic injury and is associated with worse clinical outcomes. METHODS: This retrospective cohort study observed outcomes pre- and post-implementation of an EOP prophylaxis protocol which involved the administration of a single dose of ceftriaxone 2 g around the time of intubation. The study included patients ≥ 18 years who were admitted to the University of North Carolina Medical Center (UNCMC) neuroscience intensive care unit (NSICU) between April 1, 2014, and October 26, 2016, and intubated for ≥ 72 h...
January 8, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29305023/early-vs-late-fracture-fixation-in-severe-head-and-orthopedic-injuries
#4
Yuan Zhang, Kai Sun, Yuling Wang, Yafei Qin, Hui Li
BACKGROUND: Patients suffered from craniocerebral trauma with extermities fracture is one of the most common multiple injuries.Actually there is no comparative study demonstrating advantages of early or delayed treatment of skeletal injuries. PURPOSES: To conduct a meta-analysis with studies published in full text to demonstrate database to show the associations of perioperative, postoperative outcomes of early fracture fixation(EFF) and late fracture fixation(LFF) for patients with severe head and orthopedic injuries to provide the predictive diagnosis for clinic...
December 29, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29290677/clinical-relevance-and-cost-savings-of-levocarnitine-versus-ammonul-in-the-management-of-hyperammonemia-in-a-cancer-patient-the-impact-of-a-clinical-pharmacist
#5
Chukwuma Anyanwu, Chinonso Ezeudu, Hoa Le, Oliver Egwim
Background: Hyperammonemia, a relatively uncommon condition characterized by elevated ammonia levels in the blood, presents with varied physiological etiologies that may send patients to the intensive care unit (ICU) with encephalopathy. An immediate decrease in ammonia levels is necessary to avert neurological damage. However, due to the multifaceted nature of hyperammonemia, a definite determination of etiology is not always possible. Objective: This case report examines the clinical and economic impact of a pharmacist in managing acute hyperammonemia of unknown etiology in a 62-year-old Hispanic man who had recently been diagnosed with metastatic medullary thyroid cancer and associated hypercalcemia...
January 2018: P & T: a Peer-reviewed Journal for Formulary Management
https://www.readbyqxmd.com/read/29289386/mortality-risk-factors-in-elderly-patients-in-intensive-care-without-limitation-of-therapeutic-effort
#6
S E Giannasi, M S Venuti, A D Midley, N Roux, C Kecskes, E San Román
OUTCOME: To determine mortality prognostic factors in elderly patients who are admitted to intensive care units (ICUs) due to acute critical illness. DESIGN: A prospective cohort study was carried out. SETTING: A polyvalent Intensive Care Unit at a University Hospital in Argentina. PATIENTS OR PARTICIPANTS: We included 249 patients over 65years of age who were consecutively admitted to the ICU and required mechanical ventilation for more than 48hours, between January 2011 and December 2012...
December 27, 2017: Medicina Intensiva
https://www.readbyqxmd.com/read/29283957/early-tracheostomy-in-patients-with-traumatic-cervical-spinal-cord-injury-appears-safe-and-may-improve-outcomes
#7
Christopher Flanagan, Benjamin R Childs, Timothy A Moore, Heather A Vallier
STUDY DESIGN: Retrospective case series OBJECTIVE.: To characterize outcomes associated with tracheostomy timing following traumatic cervical spinal cord injury (CSCI). SUMMARY OF BACKGROUND DATA: The morbidity associated with cervical spine trauma is substantially increased in the setting of concomitant CSCI. Despite recent evidence, it remains uncertain if early tracheostomy following traumatic CSCI can improve outcomes. METHODS: From January 1, 2007, to December 31, 2015, retrospective chart review identified seventy (70) patients who presented to a single Level 1 trauma center with traumatic CSCI and received tracheostomy for management of respiratory compromise...
December 27, 2017: Spine
https://www.readbyqxmd.com/read/29280931/pre-injury-patient-characteristics-and-post-injury-neurological-status-are-associated-with-mortality-following-spinal-cord-injury
#8
David S Casper, Benjamin Zmistowski, Gregory D Schroeder, James C McKenzie, John Mangan, Jayanth Vatson, Alan S Hilibrand, Alexander R Vaccaro, Christopher K Kepler
STUDY DESIGN: Retrospective cohort study OBJECTIVES.: This study investigates the association between SCI and post-injury mortality. SUMMARY OF BACKGROUND DATA: Spinal Cord Injuries (SCI) are severe conditions treated in the acute trauma setting. Due to neurological deficits, unstable spinal columns, and associated injuries, these patients often have complex inpatient hospitalizations with significant morbidity and mortality. It is assumed that a high rate of post-injury mortality would follow such severe injuries; however, the effect of SCI, and its treatment on predictors of longevity remain largely unknown...
December 26, 2017: Spine
https://www.readbyqxmd.com/read/29279639/posterior-reversible-leukoencephalopathy-syndrome-pres-in-intensive-care-unit-case-series
#9
Antara Gokhale, Atheel Kimona, Sandeep Kantor, S Prakash, Yogesh Manhas
Introduction: Posterior reversible encephalopathy syndrome (PRES) is characterized by a range of clinico neuro radiological manifestation along with hypertension due to varied etiology. Contrary to its name, a small number of patients have residual neurological deficits. Patients with severe manifestation of PRES may get admitted to the Intensive Care Unit (ICU) due to coma or status epilepticus. Small case series and large multicenter studies have been reported. Materials and Methods: We report a single center series of ten cases admitted to ICU over a 5 year period in a tertiary care centre...
November 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/29277396/botulism-in-the-icu-nursing-care-plan
#10
G Zariquiey-Esteva, D Galeote-Cózar, P Santa-Candela, A Castanera-Duro
INTRODUCTION AND CASE EVALUATION: Botulism is a rare disease in Europe, caused by the bacterium Clostridium botulinum, notifiable, non-transmissible person-to-person and potentially fatal (between 5 and 10%) if not treated quickly. The favourable opinion of the Clinical Research Ethics Committee was obtained. We present the nursing care plan of a 49-year-old man with a diagnosis of bacterial intoxication caused by Clostridium botulinum, secondary to ingestion of beans in poor condition, who was admitted to the ICU for a total of 35 days...
December 22, 2017: Enfermería Intensiva
https://www.readbyqxmd.com/read/29262441/imaging-in-neurocritical-care-practice
#11
Craig Williamson, Larry Morgan, Joshua P Klein
The use of neuroimaging in conjunction with serial neurological examinations is a core component of modern neurocritical care practice. Although there is a growing role for other neuromonitoring techniques, the ability to quickly and accurately interpret images in the context of a patient's clinical status arguably remains the indispensable skill for neurocritical care practitioners. Due to its rapid acquisition time and excellent ability to detect intracerebral hemorrhage (ICH), cerebral edema, and signs of elevated intracranial pressure, computed tomography (CT) remains the most useful neuroimaging technique for intensive care unit (ICU) patients...
December 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29262438/autoimmune-encephalitis-in-critical-care-optimizing-immunosuppression
#12
Daniel B Rubin, Ayush Batra, Ivana Vodopivec, Henrikas Vaitkevicius
Autoimmune diseases affecting the nervous systems are a common cause of admission to the intensive care unit (ICU). Although there exist several well-described clinical syndromes, patients more commonly present with progressive neurologic dysfunction and laboratory and radiographic evidence of central nervous system (CNS) inflammation. In the critical care setting, the urgency to intervene to prevent permanent damage to the nervous system and secondary injury from the systemic manifestations of these syndromes often conflicts with diagnostic uncertainty...
December 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29260012/time-courses-of-plasma-il-6-and-hmgb-1-reflect-initial-severity-of-clinical-presentation-but-do-not-predict-poor-neurologic-outcome-following-subarachnoid-hemorrhage
#13
Heikki Kiiski, Jaakko Långsjö, Jyrki Tenhunen, Marika Ala-Peijari, Heini Huhtala, Mari Hämäläinen, Eeva Moilanen, Juha Öhman, Jukka Peltola
Objective: Patients with aneurysmal subarachnoid hemorrhage (aSAH) experience high mortality and morbidity. Neuroinflammation causes brain damage expansion after aSAH. Due to the complexity of the inflammatory response multiple biomarkers are needed to evaluate its' progression. We studied inflammatory process after aSAH by measuring two inflammatory biomarkers, interleukin-6 (IL-6) and high-mobility group box 1 (HMGB1) at simultaneous time-points after aSAH. Methods: In this prospective population-based study, IL-6 and HMGB1 were measured in aSAH patients (n = 47) for up to five days...
March 2017: ENeurologicalSci
https://www.readbyqxmd.com/read/29251667/procalcitonin-and-presepsin-as-prognostic-markers-after-out-of-hospital-cardiac-arrest
#14
Pirkka T Pekkarinen, Giuseppe Ristagno, Erika Wilkman, Serge Masson, Roberto Latini, Johanna Laurikkala, Stepani Bendel, Tero Ala-Kokko, Tero Varpula, Jukka Vaahersalo, Sari Karlsson, Marjaana Tiainen, Monica M Mion, Mario Plebani, Ville Pettilä, Markus B Skrifvars
BACKGROUND: Patients resuscitated from cardiac arrest commonly develop an inflammatory response called post-cardiac arrest syndrome that clinically resembles septic shock.Procalcitonin and presepsin are associated with inflammation. We hypothesized that these biomarkers reflect the severity of post-cardiac arrest syndrome and predict short-term haemodynamical instability and long-term neurological outcome after cardiac arrest. METHODS: As a subcohort analysis of a prospective, observational, multi-centre study "FINNRESUSCI", we obtained plasma from 277 intensive care unit (ICU) patients treated following out-of-hospital cardiac arrest (OHCA)...
December 14, 2017: Shock
https://www.readbyqxmd.com/read/29242058/endovascular-cooling-versus-standard-femoral-catheters-and-intravascular-complications-a-propensity-matched-cohort-study
#15
Olivier Andremont, Damien du Cheyron, Nicolas Terzi, Cedric Daubin, Amélie Seguin, Xavier Valette, Flore-Anne Lecoq, Jean-Jacques Parienti, Bertrand Sauneuf
BACKGROUND: Targeted temperature management (TTM) contributes to improved neurological outcome in adults who have been successfully resuscitated after cardiac arrest with shockable rhythm. Endovascular cooling catheters are widely used to induce and maintain targeted temperature in the ICU. The aim of the study was to compare the risk of complications with cooling catheters and standard central venous catheters. MATERIALS AND METHODS: In this prospective single-centre cohort study, we included all patients admitted to an intensive care unit for successfully resuscitated cardiac arrest that required endovascular TTM (Coolgard®, Zoll™ Medical corporation, MA, USA), between August 2012 and November 2014, inclusive...
December 11, 2017: Resuscitation
https://www.readbyqxmd.com/read/29239015/treating-hepatic-encephalopathy-in-cirrhotic-patients-admitted-to-icu-with-sodium-phenylbutyrate-a-preliminary-study
#16
Nicolas Weiss, Simona Tripon, Marion Lodey, Elsa Guiller, Helga Junot, Denis Monneret, Julien Mayaux, Hélène Brisson, Maxime Mallet, Marika Rudler, Françoise Imbert-Bismut, Dominique Thabut
Hepatic encephalopathy (HE) influences short and long-term prognosis. Recently, glycerol phenylbutyrate (PB), that lowers ammonia by providing an alternate pathway to urea for waste nitrogen excretion, has shown that it was effective in preventing the occurrence of HE in RCT. The aim was to assess the benefits of sodium PB in cirrhotic patients admitted in ICU for overt HE, in terms of ammonia levels decrease, neurological improvement and survival. Cirrhotic patients who presented with overt HE, ammonia levels >100 μmol/L, and did not display any contra-indication were included...
December 14, 2017: Fundamental & Clinical Pharmacology
https://www.readbyqxmd.com/read/29219759/does-the-obesity-paradox-predict-functional-outcome-in-intracerebral-hemorrhage
#17
Neha S Dangayach, Harpreet Singh Grewal, Gian Marco De Marchis, Roberta K Sefcik, Rachel Bruce, Aarti Chhatlani, E Sander Connolly, M Cristina Falo, Sachin Agarwal, Jan Claassen, J Michael Schmidt, Stephan A Mayer
OBJECTIVE Being overweight or mildly obese has been associated with a decreased risk of death or hospitalization in patients with cardiovascular disease. Similarly, overweight patients admitted to an intensive care unit (ICU) have improved survival up to 1 year after admission. These counterintuitive observations are examples of the "obesity paradox." Does the obesity paradox exist in patients with intracerebral hemorrhage (ICH)? In this study the authors examined whether there was an association between obesity and functional outcome in patients with ICH...
December 8, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29215400/five-year-survival-and-causes-of-death-in-children-after-intensive-care-a-national-registry-study
#18
Elina Kyösti, Janne H Liisanantti, Outi Peltoniemi, Pasi Ohtonen, Paula Rautiainen, Janne Kataja, Tero Ala-Kokko
OBJECTIVES: The aim of the study was to compare long-term mortality and causes of death in children post admission to an ICU with a control population of same age. DESIGN: Longitudinal follow-up study. SETTING: Registry study of a national ICU register and hospital registries. PATIENTS: Children admitted to an ICU in the years 2009 and 2010. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The mortality and causes of death following ICU discharge were analyzed retrospectively...
December 6, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29215368/numeracy-and-interpretation-of-prognostic-estimates-in-intracerebral-hemorrhage-among-surrogate-decision-makers-in-the-neurologic-icu
#19
Nikita Leiter, Melissa Motta, Robert M Reed, Temitope Adeyeye, Debra L Wiegand, Nirav G Shah, Avelino C Verceles, Giora Netzer
OBJECTIVE: Clinicians caring for patients with intracerebral hemorrhage must often discuss prognosis and goals of care with their patients' surrogate decision makers, and may make numeric estimates of likelihood of survival and functional independence, informed by validated prediction models. Surrogates' prognostic estimates are often discordant with physicians', suggesting that physicians' numeric statements may not be accurately interpreted. We sought to assess the relationship between numeracy and interpretation of prognostic estimates in intracerebral hemorrhage among surrogate decision makers...
December 5, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29214598/evaluation-of-a-wireless-portable-wearable-multi-parameter-vital-signs-monitor-in-hospitalized-neurological-and-neurosurgical-patients
#20
Robert S Weller, Kristina L Foard, Timothy N Harwood
Unrecognized changes in patients' vital signs can result in preventable deaths in hospitalized patients. Few publications or studies instituting routine patient monitoring have described implementation and the setting of alarm parameters for vital signs. We wanted to determine if continuous multi-parameter patient monitoring can be accomplished with an alarm rate that is acceptable to hospital floor nurses and to compare the rate of patient deterioration events to those observed with routine vital sign monitoring...
December 6, 2017: Journal of Clinical Monitoring and Computing
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