scholarly journals Clinical approach to coma patients: tips and tricks

2021 ◽  
Keyword(s):  
Clinical Evidence ◽  
Primary Treatment ◽  
Clinical Approach ◽  
Loss Of Consciousness ◽  
Tips And Tricks ◽  
Secondary Complications ◽  
Reticular Activating System ◽  
Four Levels ◽  
Unconscious Patients ◽  
Normal Status

The reticular activating system (RAS) is responsible for wakefulness. The RAS projects activation to either side of the hemisphere. The dysfunction of the RAS or insufficiency of its activation results in impairment of consciousness. Physicians classify levels of awareness into four levels, from normal status to most severe unconsciousness, these being alert, drowsy, stupor, and coma, respectively. While the causes of unconsciousness are varied, physicians generally divide them into structural and metabolic etiologies upon the dominant approach. Surgical management is the primary treatment for the structural coma, while the metabolic coma requires predominantly medical treatment. The diagnosis and management of unconscious patients require extensive clinical assessment, consisting of a careful approach to history-taking and general medical and neurological examinations. Following immediate resuscitation by the ABCDE approach and proper management protocols, physicians should look for causes of loss of consciousness through clinical evidence and investigations. Appropriate management will help to avoid secondary complications related to the impairment of consciousness. The prognostication of a coma is also varied and primarily depends on its etiology. The algorithm for prognostication in a coma is helpful for poor outcome determinants.

scholarly journals Essential Thrombocythemia and Acquired von Willebrand Syndrome: The Shadowlands between Thrombosis and Bleeding

Cancers ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 1746 ◽  
Author(s):  
Hassan Awada ◽  
Maria Voso ◽  
Paola Guglielmelli ◽  
Carmelo Gurnari
Keyword(s):  
Essential Thrombocythemia ◽  
Clinical Evidence ◽  
Antiplatelet Agents ◽  
Bleeding Risk ◽  
Clinical Approach ◽  
Evidence Based ◽  
Vascular Events ◽  
Acquired Von Willebrand Syndrome ◽  
The Past ◽  
Von Willebrand

Over the past decade, new insights have emerged on the pathophysiology of essential thrombocythemia (ET), its clinical management, and associated thrombohemostatic disturbances. Here, we review the latest diagnostic and risk stratification modalities of ET and its therapeutics. Moreover, we discuss the clinical evidence-based benefits, deriving from major clinical trials, of using cytoreductive therapy and antiplatelet agents to lower the risk of fatal vascular events. Also, we focus on the condition of extreme thrombocytosis (>1000 × 109/L) and bleeding risk, the development and pathogenesis of acquired von Willebrand syndrome, and the clinical approach to this paradoxical scenario in ET.

scholarly journals Effects of Induced Muscle Tension and Auditory Stimulation on Tachistoscopic Perception

1965 ◽  
Vol 20 (3) ◽  
pp. 829-841 ◽  
Author(s):  
John L. Andreassi
Keyword(s):  
Task Difficulty ◽  
Muscle Tension ◽  
Auditory Stimulation ◽  
Pupil Dilation ◽  
Middle Level ◽  
Neurophysiological Data ◽  
Reticular Activating System ◽  
Improved Performance ◽  
Four Levels ◽  
And Performance

The effect of accessory stimulation upon tachistoscopic perception of geometric figures was studied. In Exp. I 32 Ss were tested on two successive days in a complete factorial design (Subjects × Treatments) in which degree of induced muscle tension (IMT) and level of task difficulty were manipulated. An IMT level of ½ of maximum resulted in significantly ( p < .01) improved visual perception. In Exp. II artificial pupils were employed to test the hypothesis that improved performance was due to pupil dilation. Eight Ss from Exp. I were tested on five successive days and performance at ½ of maximum IMT was again significantly ( p < .05) improved, thus precluding pupil dilation as the reason for the results obtained in Exp. I. In Exp. II performance at the middle level of task difficulty benefited significantly ( p < .05) from IMT. Exp. III investigated the effects of four levels of auditory stimulation (white noise) on tachistoscopic perception in a new group of 32 Ss. Perception was significantly ( p < .05) improved with the ¼ of maximum noise level at the easiest level of difficulty. Results were interpreted within the framework of the activation concept. Recent neurophysiological data point to the ascending reticular activating system as a possible mediator which could influence cortical and retinal areas in the facilitation of tasks such as tachistoscopic perception.

Hypotension

2018 ◽  
Author(s):  
Jonathan Timperley ◽  
Sandeep Hothi
Keyword(s):  
Blood Pressure ◽  
Arterial Pressure ◽  
Arterial Blood Pressure ◽  
Blood Supply ◽  
Clinical Evidence ◽  
Clinical Approach ◽  
Pump Failure ◽  
Diastolic Arterial Pressure ◽  
Arterial Blood ◽  
Systolic Arterial Blood Pressure

Hypotension is defined as a systolic arterial blood pressure of less than 90 mm Hg, or a diastolic arterial pressure of less than 60 mm Hg, and may lead to shock, with clinical evidence of inadequate blood supply to critical organs. It can be due to hypovolaemia, cardiac pump failure, or vasodilatation. This chapter describes the clinical approach to patient with hypotension.

Transient loss of consciousness

2018 ◽  
Author(s):  
Jonathan Timperley ◽  
Sandeep Hothi
Keyword(s):  
Cardiovascular Disease ◽  
Orthostatic Hypotension ◽  
Short Duration ◽  
Complete Recovery ◽  
Complete Loss ◽  
Cerebral Hypoperfusion ◽  
Clinical Approach ◽  
Loss Of Consciousness ◽  
Transient Loss Of Consciousness ◽  
Transient Loss

Transient loss of consciousness (TLoC) is characterized by a rapid, transient, and complete loss of consciousness of short duration with spontaneous, complete recovery. Syncope is a specific type of TLoC caused by transient, global, cerebral hypoperfusion. TLoC may be traumatic or non-traumatic. Causes of non-traumatic TLoC include syncope, epilepsy, psychogenic causes, and other, rarer causes. Syncope may be reflex (neurally mediated), due to orthostatic hypotension or to cardiovascular disease. This chapter describes the clinical approach to the patient with transient loss of consciousness.

Step-by-step illustrated guide to central neck dissection

2021 ◽  
pp. 1-6
Author(s):  
F Chu ◽  
R De Berardinis ◽  
G Pietrobon ◽  
M Tagliabue ◽  
G Giugliano ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Neck Dissection ◽  
Central Compartment ◽  
Recurrent Laryngeal Nerve Injury ◽  
Primary Treatment ◽  
Central Neck Dissection ◽  
Central Neck ◽  
Tips And Tricks ◽  
Expert Surgeon ◽  
Laryngeal Nerve Injury

Abstract Background The incidence of thyroid carcinoma has been increasing worldwide and surgery is the primary treatment. Central compartment dissection of the neck is a very delicate procedure given the risks of recurrent laryngeal nerve injury and hypoparathyroidism. Methods This paper gives a detailed description of this surgical technique in a patient affected by papillary carcinoma of the thyroid gland, supported by highly representative iconographic materials from a tertiary department. Results A stepwise description is provided, along with high-quality pictures and specific tips and tricks. Although neck dissection is a well-codified procedure, the fine details of this surgical technique are not currently available and are still the prerogative of the expert surgeon. Conclusion The central neck compartment contains several vulnerable structures; damage to these structures would affect patients’ lives, possibly permanently. Anatomical knowledge and standardisation are needed for all surgeons, particularly new surgeons (such as residents) who cannot rely simply on experience.

Sign in / Sign up

Export Citation Format

Share Document