Evidence-based eye care protocol for ICU patients with altered level of consciousness

2009 ◽  
Author(s):  
Wai-yi Yim
Keyword(s):  
Evidence Based ◽  
Eye Care ◽  
Icu Patients ◽  
Altered Level ◽  
Care Protocol ◽  
Level Of Consciousness

scholarly journals Nursing Strategies on the Prevention of Ocular Complications Among Patients with Altered Level of Consciousness

2017 ◽  
Vol 07 (01) ◽  
pp. 029-033
Author(s):  
A. Seethalakshmi ◽  
A. Porkodi ◽  
Keyword(s):  
Ocular Trauma ◽  
Cross Infection ◽  
Control Group ◽  
Ocular Complication ◽  
Main Study ◽  
Eye Care ◽  
Ocular Complications ◽  
Altered Level ◽  
Significant Difference ◽  
Level Of Consciousness

Abstract Background: Ocular trauma is the cause of blindness in more than half a million people worldwide. A lack of attention to the eye or poor eye care can lead to cross infection and may cause damage to the eye. This investigation aimed to determine the effectiveness of nursing strategies on prevention of ocular complications among patients with altered level of consciousness (GCS <8) and associate the occurrence of ocular complications with clinical variables. Method: The research design adopted for this study was true experimental. A pilot study was initially under taken. Eight samples, four in each group were selected. The main study was conducted for over a period of 4 weeks. A total of 40 samples were selected, 20 in each group. Ocular complication assessment scale developed by the author was used to assess the effectiveness of nursing strategies on prevention of ocular complication. Results: There was a significant difference in the ocular complication prevention in the study group patients who received planned sequential eye care as compared to that of the control group patients who received the routine eye care. Discussion: Increasing the frequency of eye care Q4th hourly from routine eye care was found to be effective in reducing the ocular complications among the patients with altered level of consciousness.

Neonatal Intravenous Extravasation Injuries: Evaluation of a Wound Care Protocol

2006 ◽  
Vol 25 (1) ◽  
pp. 13-19 ◽  
Author(s):  
Doris Sawatzky-Dickson ◽  
Karen Bodnaryk
Keyword(s):  
Wound Healing ◽  
Birth Weight ◽  
Wound Infection ◽  
Gestational Age ◽  
Wound Care ◽  
Systemic Infection ◽  
Coagulase Negative Staphylococcus ◽  
Evidence Based ◽  
Infection Rates ◽  
Care Protocol

Purpose:To evaluate an evidence-based wound protocol for intravenous extravasation injuries in neonates.Sample:Nine newborns with intravenous extravasation injuries. Birth weight: 582–4,404 gm, gestational age: 24–40 weeks.Results:Five wounds were colonized with coagulase-negative Staphylococcus species, two with diphtheroids, three with Enterococcus. There was no evidence of wound infection or systemic infection. Rates of wound healing ranged from one to six weeks.

Direct ophthalmoscopy for the acute physicia – papilloedema and other abnormalities of the optic nerve head

2002 ◽  
Vol 1 (2) ◽  
pp. 60-63
Author(s):  
B Edmunds ◽  
◽  
P J Francis ◽  
Keyword(s):  
Optic Nerve ◽  
Optic Nerve Head ◽  
Visual Disturbance ◽  
Medical Setting ◽  
Altered Level ◽  
Level Of Consciousness ◽  
Systemic Disorder ◽  
Systemic Examination ◽  
Direct Ophthalmoscopy

Direct ophthalmoscopy is an essential part of the full systemic examination. However, the technique is challenging and time-consuming. In the acute medical setting therefore, it is advisable for the physician to identify the subgroup of patients in whom examination of the fundus is most likely to be helpful. Ophthalmoscopy should be performed where papilloedema is suspected, in those with an altered level of consciousness or other focal neurology, those with an unknown systemic disorder, and those complaining of visual disturbance.

scholarly journals Altered Mental Status and Cyanosis in a Pediatric Patient with Methemoglobinemia

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Phillip M. Grenz ◽  
Robert N. Ray Jr. ◽  
Olivia A. Hardy ◽  
Andrew L. Koons ◽  
Kenneth D. Katz ◽  
...  
Keyword(s):  
Mental Status ◽  
Clinical Manifestations ◽  
Altered Mental Status ◽  
Pediatric Emergency ◽  
Abrupt Onset ◽  
Altered Level ◽  
Sustained Improvement ◽  
Oxygen Dissociation ◽  
Nail Polish ◽  
Level Of Consciousness

Methemoglobinemia results from increased amounts of oxidized hemoglobin in the blood with an ensuing change in oxygen dissociation curve and lack of oxygen delivery to tissue. A previously well, male toddler was brought to the Pediatric Emergency Department (PED) by Emergency Medical Services (EMS) with abrupt onset of altered mental status and cyanosis after a suspected ingestion of “Rush” nail polish remover. He was quickly diagnosed with methemoglobinemia by both clinical presentation and chocolate-colored blood appearance. He emergently received intravenous (IV) methylene blue (MB) with immediate and sustained improvement requiring no further doses. Though inhalation of nitrites and subsequent methemoglobinemia is frequently reported in adolescents, we were unable to find any cases in the literature detailing ingestion of this product and the resulting clinical manifestations. Our objective with this report is to describe a rare case of a toddler with an accidental ingestion of “Rush” nail polish remover, a nitrite compound. Our patient presented to the PED with abrupt onset of altered level of consciousness, hypotension, and cyanosis resulting from acquired methemoglobinemia. This case report demonstrates the importance of emergency clinicians being able to make clinical judgements and decisions based on the history and physical exam when methemoglobinemia is suspected.

scholarly journals Evidence-based Clinical Practice Guidelines for the Periodic Eye Exam in Children Aged 0 to 5 Years in Canada

2019 ◽  
Vol 81 (4) ◽  
pp. 9-28
Author(s):  
Walter Delpero ◽  
Barbara Robinson ◽  
Rhona Lahey
Keyword(s):  
Clinical Practice ◽  
Early Detection ◽  
Practice Guidelines ◽  
School System ◽  
Healthcare Providers ◽  
Evidence Based ◽  
Vision Screening ◽  
Eye Care ◽  
Timely Fashion ◽  
Primary Healthcare Providers

Vision screening performed by primary healthcare providers during routine well-baby/child visits and scheduled vaccinations is an essential part of the detection of ocular disease. However, this early detection potential is limited and a full oculovisual assessment is also recommended prior to the child entering the school system. If amblyopia, strabismus or other eye pathology is detected or suspected that is beyond the scope of the eye care professional examining the patient, a referral to the appropriate specialist can be made, allowing treatment to be initiated in a timely fashion.

scholarly journals Brain Catastrophe presented with endocrine disruption

2020 ◽  
Vol 8 (5) ◽  
pp. 104-110
Author(s):  
Saadi JS AlJadir
Keyword(s):  
Dynamic Testing ◽  
Hemodynamic Instability ◽  
Major Surgery ◽  
Initial Manifestation ◽  
Altered Level ◽  
Identifiable Risk Factor ◽  
Conflicting Evidence ◽  
Level Of Consciousness ◽  
Threatening Condition ◽  
Life Threatening

Pituitary Apoplexy (PA) is an acute critical endocrine condition that is infrequently encountered in daily medical practice. Its life-threatening condition that mandates prompt diagnosis and urgent treatment and may be neurosurgical intervention. Majority of cases are attributed to ischemic infarction or hemorrhage of the pituitary gland usually in the vicinity of pituitary adenoma, and in most cases could be the initial manifestation of these tumors! In reviewing the literatures there is conflicting evidence of which are the predominant, non-functional, or functional adenomas, some reports were showed that prolactin-secreting are at highest risk. There are recognizable risk factors that might precipitate this endocrine emergency like hypertension, medications, major surgery, head injury, radiation, or dynamic testing, but in majority of cases at presentation no identifiable risk factor could be detected. The typical clinical scenario includes persistent worsening headache, vomiting, and altered level of consciousness, visual defect or loss with extreme hormonal derangements which are shown by hemodynamic instability, adrenal crises with variable hormonal deficiencies.

scholarly journals Automated pupillometry to detect command following in neurological patients: a proof-of-concept study

PeerJ ◽  
2019 ◽  
Vol 7 ◽  
pp. e6929 ◽  
Author(s):  
Alexandra Vassilieva ◽  
Markus Harboe Olsen ◽  
Costanza Peinkhofer ◽  
Gitte Moos Knudsen ◽  
Daniel Kondziella
Keyword(s):  
Brain Injury ◽  
Healthy Volunteers ◽  
Neurological Disorders ◽  
Mental Arithmetic ◽  
Proof Of Concept ◽  
Icu Patients ◽  
Wide Range ◽  
Level Of Consciousness ◽  
Neurological Patients ◽  
Command Following

Background Levels of consciousness in patients with acute and chronic brain injury are notoriously underestimated. Paradigms based on electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) may detect covert consciousness in clinically unresponsive patients but are subject to logistical challenges and the need for advanced statistical analysis. Methods To assess the feasibility of automated pupillometry for the detection of command following, we enrolled 20 healthy volunteers and 48 patients with a wide range of neurological disorders, including seven patients in the intensive care unit (ICU), who were asked to engage in mental arithmetic. Results Fourteen of 20 (70%) healthy volunteers and 17 of 43 (39.5%) neurological patients, including 1 in the ICU, fulfilled prespecified criteria for command following by showing pupillary dilations during ≥4 of five arithmetic tasks. None of the five sedated and unconscious ICU patients passed this threshold. Conclusions Automated pupillometry combined with mental arithmetic appears to be a promising paradigm for the detection of covert consciousness in people with brain injury. We plan to build on this study by focusing on non-communicating ICU patients in whom the level of consciousness is unknown. If some of these patients show reproducible pupillary dilation during mental arithmetic, this would suggest that the present paradigm can reveal covert consciousness in unresponsive patients in whom standard investigations have failed to detect signs of consciousness.

scholarly journals Spectrum of Intracerebral Hemorrhage in Children: A Report from PICU of a Resource Limited Country

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Qalab Abbas ◽  
Qurat ul Ain Merchant ◽  
Bushra Nasir ◽  
Anwar ul Haque ◽  
Basit Salam ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Medical Records ◽  
Vascular Malformations ◽  
Pediatric Intensive Care ◽  
Conventional Angiography ◽  
Altered Level ◽  
Vascular Intervention ◽  
Resource Limited ◽  
Level Of Consciousness ◽  
Gender Presentation

Intracerebral hemorrhage (ICH) in children is a rare but disabling disease that accounts for almost half cases of stroke. We report our experience of ICH in children. Retrospective review of medical records of children (1 month-16 years) admitted in Pediatric Intensive Care Unit between January 2007 and December 2014 was done. Data collected included age, gender, presentation, examination findings, neuroimaging done (CT, MRI, and angiography) management (conservative/intervention), and outcome. Results are presented as frequency and percentages. Of the total 50 patients, 58% were male and 26% were <1 year. On presentation 44% had vomiting, 42% had seizures, and GCS < 8 while 40% had altered level of consciousness. Single bleed was present in 88%, 94% had supratentorial bleed, and 32% had intraventricular extension. 72% had bleed volume of <30 mL and 8% had >60 mL. CT scan was done in 98% patients and MRI in 34%, while 6% underwent conventional angiography. 60% patients were managed conservatively, 36% underwent neurosurgical intervention, and 6% underwent radiological vascular intervention. Hematologic causes were identified in 52% patients and vascular malformations in 14% and in 26% no cause could be identified. 26% of patients expired.

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