Montelukast is a leukotriene receptor antagonist used as a maintenance treatment for asthma and seasonal allergies. It works by blocking the action of leukotriene D4 on cysteinyl leukotriene receptors in the lungs and other tissues, inhibiting inflammation. Montelukast is FDA approved for chronic asthma and exercise-induced bronchoconstriction. It is commonly used off-label for allergic rhinitis, chronic urticaria, and other conditions. Studies have shown montelukast can improve chronic urticaria and atopic dermatitis when used as an add-on treatment. The drug is generally well tolerated, with headache and abdominal pain being the most common side effects
Levetiracetam is a white powder that is wholly soluble in water. It is the S-enantiomer form which has anticonvulsant properties, while the R-enantiomer does not. It inhibits calcium channels and prevents the release of calcium from intracellular stores. It is rapidly absorbed after oral administration, has a high bioavailability, and is excreted unchanged in the urine. Common side effects include somnolence, asthenia, and nausea. It is indicated as an adjunctive treatment for partial onset seizures, myoclonus, and primary generalized tonic-clonic seizures in adults and children.
This document discusses skeletal muscle relaxants and their reversal. It begins by defining neuromuscular blocking drugs as those that act at the neuromuscular junction to block neuromuscular transmission, in order to facilitate muscle relaxation for surgery. It then covers the history, classification, and mechanisms of action of both depolarizing drugs like succinylcholine and non-depolarizing drugs. It discusses the pharmacology, clinical uses, and side effects of various muscle relaxants. It concludes by addressing the reversal of neuromuscular blockade using anticholinesterase drugs like neostigmine and strategies to minimize their muscarinic side effects.
Tranexamic acid is an antifibrinolytic drug that inhibits fibrinolysis by reversibly binding to plasminogen. It is effective at reducing surgical bleeding across many procedures like cardiac, orthopedic, and cranial surgery. It also reduces bleeding in gynecological conditions like heavy menstrual bleeding and postpartum hemorrhage. Tranexamic acid is generally well tolerated with side effects including headache, nausea, and diarrhea. It is given orally, intravenously, or topically depending on the condition being treated.
The Glasgow Coma Scale is used to assess the depth and duration of coma and impaired consciousness. It evaluates three criteria: eye opening response, verbal response, and motor response, with scores ranging from 3-15, with lower scores indicating a worse neurological state. Head injuries are classified as mild (13-15), moderate (9-12), or severe (8 or less) based on the Glasgow Coma Scale score. While the scale has limitations, it provides a practical assessment of neurological function that is widely used by healthcare practitioners.
This document summarizes information about the anti-seizure medications gabapentin and pregabalin. It discusses gabapentin's mechanism of action, approved uses, dosing, pharmacokinetics, interactions, adverse effects and overdose treatment. It then summarizes a clinical study comparing the dose-response relationship of pregabalin and gabapentin in patients with partial seizures, finding that pregabalin was more potent and effective at reducing seizure frequency.
This document provides information on multimodal regiments for acute pain management. It discusses the goals of multimodal analgesia including reducing opioid use through additive or synergistic effects. Key points:
- Multimodal analgesia involves using two or more analgesics with different mechanisms to better treat multiple pain sources and reduce side effects.
- Postoperative pain involves peripheral and central sensitization, so multimodal regiments target both levels.
- Common regiments discussed include paracetamol, NSAIDs, COXIBs, ketamine, gabapentinoids, clonidine and opioids. Low dose ketamine and gabapentinoids are highlighted for their anti-hyperalgesic effects.
- Combining
Montelukast is a leukotriene receptor antagonist used as a maintenance treatment for asthma and seasonal allergies. It works by blocking the action of leukotriene D4 on cysteinyl leukotriene receptors in the lungs and other tissues, inhibiting inflammation. Montelukast is FDA approved for chronic asthma and exercise-induced bronchoconstriction. It is commonly used off-label for allergic rhinitis, chronic urticaria, and other conditions. Studies have shown montelukast can improve chronic urticaria and atopic dermatitis when used as an add-on treatment. The drug is generally well tolerated, with headache and abdominal pain being the most common side effects
Levetiracetam is a white powder that is wholly soluble in water. It is the S-enantiomer form which has anticonvulsant properties, while the R-enantiomer does not. It inhibits calcium channels and prevents the release of calcium from intracellular stores. It is rapidly absorbed after oral administration, has a high bioavailability, and is excreted unchanged in the urine. Common side effects include somnolence, asthenia, and nausea. It is indicated as an adjunctive treatment for partial onset seizures, myoclonus, and primary generalized tonic-clonic seizures in adults and children.
This document discusses skeletal muscle relaxants and their reversal. It begins by defining neuromuscular blocking drugs as those that act at the neuromuscular junction to block neuromuscular transmission, in order to facilitate muscle relaxation for surgery. It then covers the history, classification, and mechanisms of action of both depolarizing drugs like succinylcholine and non-depolarizing drugs. It discusses the pharmacology, clinical uses, and side effects of various muscle relaxants. It concludes by addressing the reversal of neuromuscular blockade using anticholinesterase drugs like neostigmine and strategies to minimize their muscarinic side effects.
Tranexamic acid is an antifibrinolytic drug that inhibits fibrinolysis by reversibly binding to plasminogen. It is effective at reducing surgical bleeding across many procedures like cardiac, orthopedic, and cranial surgery. It also reduces bleeding in gynecological conditions like heavy menstrual bleeding and postpartum hemorrhage. Tranexamic acid is generally well tolerated with side effects including headache, nausea, and diarrhea. It is given orally, intravenously, or topically depending on the condition being treated.
The Glasgow Coma Scale is used to assess the depth and duration of coma and impaired consciousness. It evaluates three criteria: eye opening response, verbal response, and motor response, with scores ranging from 3-15, with lower scores indicating a worse neurological state. Head injuries are classified as mild (13-15), moderate (9-12), or severe (8 or less) based on the Glasgow Coma Scale score. While the scale has limitations, it provides a practical assessment of neurological function that is widely used by healthcare practitioners.
This document summarizes information about the anti-seizure medications gabapentin and pregabalin. It discusses gabapentin's mechanism of action, approved uses, dosing, pharmacokinetics, interactions, adverse effects and overdose treatment. It then summarizes a clinical study comparing the dose-response relationship of pregabalin and gabapentin in patients with partial seizures, finding that pregabalin was more potent and effective at reducing seizure frequency.
This document provides information on multimodal regiments for acute pain management. It discusses the goals of multimodal analgesia including reducing opioid use through additive or synergistic effects. Key points:
- Multimodal analgesia involves using two or more analgesics with different mechanisms to better treat multiple pain sources and reduce side effects.
- Postoperative pain involves peripheral and central sensitization, so multimodal regiments target both levels.
- Common regiments discussed include paracetamol, NSAIDs, COXIBs, ketamine, gabapentinoids, clonidine and opioids. Low dose ketamine and gabapentinoids are highlighted for their anti-hyperalgesic effects.
- Combining
Ketamine produces dissociative anesthesia and has hypnotic, analgesic, and amnesic effects. It works by binding to NMDA receptors and other sites like opioid receptors. Ketamine has a rapid onset after IV or IM administration, with effects seen within 1-5 minutes. It causes increased blood pressure and heart rate by stimulating the sympathetic nervous system. Ketamine can also increase respiratory rate and salivation, dilate pupils, and has short-term side effects like confusion and out of body experiences. It has various indications like analgesia, anesthesia induction, and improving psychiatric disorders.
This document summarizes the classification, mechanisms of action, pharmacokinetics, and clinical uses of α-adrenergic receptor antagonists (α-blockers). It discusses non-selective α-blockers that block both α1 and α2 receptors like phentolamine and phenoxybenzamine, as well as selective α1-blockers like prazosin, doxazosin, tamsulosin, and selective α2-blockers like yohimbine. The major uses of α-blockers include treatment of pheochromocytoma, hypertension, peripheral vascular disease, benign prostatic hyperplasia, migraine, and congestive heart failure. Common side effects include hypotension
A General Anaesthetic is a drug that produces a reversible state of unconscious with absence of pain sensation over the entire body; such agents have been described as drugs that remove the most precious human attributes ---- Conscious.
Ketamine
Brand name: KETALAR
Phencyclidine derivative
Shorting acting
Mainly used in children and elderly adults for short procedures such as burns dressing.
ABUSIVE DRUG
Is a dissociative anaesthetic as it produces a cataleptic state in which the patient appears to be awake but is detached from the environment and is unresponsive to pain.
Please also refer to other reference books for clarity.
Methylprednisolone is a potent corticosteroid used to treat conditions requiring its anti-inflammatory and immunosuppressive effects. It is slightly more potent than prednisolone. Methylprednisolone is indicated for diseases like rheumatoid arthritis, systemic lupus erythematosus, asthma, and inflammatory bowel disease. Common side effects include weight gain, mood changes, and increased risk of infection. It can interact with other drugs like NSAIDs and antibiotics.
Propofol is an intravenous sedative used for inducing and maintaining general anesthesia. It works by enhancing the effect of the inhibitory neurotransmitter GABA in the brain. Propofol is formulated as a 1% aqueous solution containing soybean oil, glycerol, and egg lecithin. It has a rapid onset of 15-30 seconds, short duration of 5-10 minutes, and is metabolized in the liver. Common uses include anesthesia induction, sedation, and ventilation in ICU patients. Side effects include nausea, cough, and confusion.
Anesthesia complications range from minor to catastrophic.
complications of general anesthesia might be due to difficulty in airway management or ventilation.
Also the complication might be due to cardiac arrhythmias and poor response to anesthetic effect during induction or maintenance or even the emergence from anesthesia.
So, the the systematic response to the effect of the anesthesia may occur at any time during surgery.
Some of the complications:
Hypoxia, arrhythmia, hypotension , hypertension, regurgitation and aspiration, hypothermia hypoglycemia, coronary ischemia, embolism, persistent apnea delayed recovery , and many others.
also regional anesthesia has its complications like nerve injury, post spinal headache.
Toxicity from local anesthesia is one of the important complication might occur during local infiltration.
Morphine and fentanyl are potent opioid analgesics that act on mu-opioid receptors in the central nervous system. Morphine is a naturally occurring substance extracted from poppy plants, while fentanyl is a synthetic opioid. Both drugs are used medicinally to treat moderate to severe pain. Common side effects include respiratory depression, nausea, constipation, and euphoria. Withdrawal from long-term opioid use can cause pain, irritability, and dysphoria.
Skeletal muscle relaxants work by blocking acetylcholine receptors at the neuromuscular junction, relaxing muscles. There are two main types - depolarizing and non-depolarizing. Succinylcholine is the only depolarizing drug used clinically. It causes initial fasciculations before prolonged muscle relaxation. Non-depolarizing drugs like tubocurarine and vecuronium are competitive antagonists that do not activate acetylcholine receptors, preventing muscle contraction. They have short, intermediate, or long durations of action and differ in side effects and metabolism. Dantrolene works via a different mechanism by preventing calcium release in muscles.
The document discusses evaluating and managing penicillin allergy. It finds that over 90% of patients labeled penicillin-allergic can tolerate penicillin after skin testing by an allergist. Skin testing is the best way to diagnose IgE-mediated allergy and has a high negative predictive value. If skin testing is negative, a graded challenge is recommended. If positive, an alternative antibiotic should be used or desensitization considered. Cross-reactivity between penicillin and cephalosporins is low at around 3%. Proper evaluation can help identify patients able to safely receive penicillin-class antibiotics.
Propofol is a commonly used intravenous anesthetic with the following properties:
- It acts by enhancing the effects of the inhibitory neurotransmitter GABA at GABA-A receptors in the brain, causing sedation and hypnosis.
- It has a rapid onset and context-sensitive half-life, distributing quickly throughout the body before being metabolized in the liver.
- It can be used for induction and maintenance of general anesthesia, as well as for sedation in the ICU. Common side effects include hypotension, respiratory depression, and pain at the injection site. Rare but serious complications include propofol infusion syndrome.
This document discusses antiepileptic drugs, including their mechanisms of action, classifications, pharmacokinetics, indications, and adverse effects. It classifies antiepileptic drugs based on their actions on ion channels and neurotransmitter systems. The main mechanisms of action are enhancement of GABA transmission, inhibition of sodium channels, and inhibition of calcium channels. Common antiepileptic drugs like phenytoin, carbamazepine, valproic acid, lamotrigine, ethosuximide, gabapentin, vigabatrin, and tiagabine are described in terms of their pharmacological properties and clinical uses.
Local anesthetics work by blocking sodium channels and interrupting nerve conduction. They are classified based on their chemical structure as esters or amides. Amides like lidocaine and bupivacaine are metabolized in the liver and have a lower risk of allergic reactions compared to esters. The potency, onset, and duration of local anesthetics depends on factors like lipid solubility, dose, pH, and addition of vasoconstrictors. Toxicity from local anesthetics is related to the dose administered and rate of absorption. Early symptoms of toxicity involve the central nervous system like agitation and seizures. Later, cardiovascular symptoms like arrhythmias and hypotension can occur. Treatment involves stopping administration, managing
1) Anaphylaxis is an acute hypersensitivity reaction that occurs within minutes and can be caused by any substance like antibiotics, stings, or contrast dye.
2) Symptoms vary in severity from mild to fatal and commonly involve the respiratory and dermatological systems. Initial symptoms do not necessarily correlate with severity or progression.
3) Treatment involves recognition of the reaction and prompt resuscitation with epinephrine, oxygen, IV fluids, and monitoring for respiratory distress, hypotension, and cardiac issues.
Metoclopramide is a prokinetic agent that increases stomach and upper intestine movements. It is used to treat certain stomach problems, nausea, and vomiting caused by chemotherapy. Metoclopramide works by antagonizing dopamine, stimulating upper GI tract motility, and accelerating gastric emptying and intestinal transit. It is available as tablets, injections, and oral solutions. Common uses include nausea and vomiting in adults, diabetic gastroparesis, GERD, and preventing postoperative nausea. Usual dosing is 15-30mg per day divided into three doses with at least 6 hours between doses.
Omalizumab is an anti-IgE monoclonal antibody approved for treating allergic asthma, chronic urticaria, and other allergic diseases. It binds to IgE and forms complexes that are cleared, reducing free IgE levels and decreasing FcεRI expression on mast cells and basophils. For asthma, omalizumab improves symptoms and lung function and reduces exacerbations and steroid use. It may be more effective in patients with elevated type 2 biomarkers. Omalizumab also improves symptoms of chronic urticaria by decreasing mediators released in response to autoantibodies. Other anti-IgE biologics in development have distinct binding properties from omalizumab.
Mannitol is a non-electrolyte diuretic used to promote diuresis, prevent and treat oliguric acute renal failure, reduce elevated intraocular and intracranial pressure, promote toxic substance excretion, and as a therapeutic measure in cystic fibrosis and asthma tests in children. It has a half-life of 45-100 minutes and onset of action ranges from 15-30 minutes for ICP reduction to 1-3 hours for diuresis. Dosages vary from 50-200g per 24 hours in geriatrics to 1-5g/kg in pediatric patients depending on the condition being treated. Mannitol has many drug interactions and adverse effects that require monitoring like hypersensitivity
Induction of anaesthesia can be done through inhalational or intravenous routes. Common inhalational inducing agents include sevoflurane, halothane and nitrous oxide. Sevoflurane provides a smooth induction while halothane causes more cardiovascular depression. Intravenous agents like propofol and thiopentone provide rapid onset and recovery but may cause pain on injection. The ideal properties of inducing agents include rapid onset and offset of action, minimal side effects and ease of administration.
This document provides an overview of ketamine, including its history, pharmacology, effects, uses, and advantages for resource-poor settings. Some key points:
- Ketamine is a dissociative anesthetic and NMDA receptor antagonist first synthesized in 1962 and approved for use in 1970.
- It produces dissociative anesthesia while maintaining airway reflexes and cardiovascular stimulation.
- Ketamine has various uses including anesthesia, analgesia, and recently as a rapid-acting antidepressant at sub-anesthetic doses.
- Its safety profile and maintenance of airway reflexes make it advantageous for use in resource-poor settings without respiratory support.
This document discusses anaphylaxis, a severe and potentially life-threatening allergic reaction. It defines anaphylaxis and explains that it is a type 1 hypersensitivity reaction caused by the immune system overreacting to harmless substances. Symptoms can affect multiple body systems like the skin, respiratory and digestive systems. Prompt treatment with epinephrine and other emergency measures is needed. Prevention involves avoiding triggers and carrying epinephrine auto-injectors if at risk.
Mannitol is an osmotic diuretic that is freely filtered by the glomerulus but not reabsorbed by renal tubules. It works by increasing the osmolarity of renal tubular fluid and drawing fluid from intracellular to extracellular spaces. Main uses include prophylaxis of acute renal failure, treatment of acute oliguria and increased intracranial pressure. While it reduces ICP, mannitol provides limited benefit for oxygenation compared to hypertonic saline and risks cardiac failure and electrolyte imbalance with higher doses.
The document provides guidance on performing a neurological assessment. It discusses assessing level of consciousness, cranial nerves, movement, sensation, and reflexes. The neurological exam establishes baseline data to monitor any changes in the patient's condition. The assessment of cranial nerves includes testing each nerve's sensory and motor functions.
gcs(Glasgow Coma Scale) ppt to understand.pptxjkm36403
The Glasgow Coma Scale (GCS) is a standardized system used to assess consciousness by evaluating eye opening, verbal response, and motor response. Each category is scored from 1 to 4 or 6 and the total score ranges from 3 to 15, with lower scores indicating worse neurological function or coma. The GCS is used to assess patients with impaired consciousness due to head injuries, seizures, overdoses, or other neurological impairments. It provides important information about a patient's brain functioning that can help determine if their condition is stable, improving, or deteriorating over time.
Ketamine produces dissociative anesthesia and has hypnotic, analgesic, and amnesic effects. It works by binding to NMDA receptors and other sites like opioid receptors. Ketamine has a rapid onset after IV or IM administration, with effects seen within 1-5 minutes. It causes increased blood pressure and heart rate by stimulating the sympathetic nervous system. Ketamine can also increase respiratory rate and salivation, dilate pupils, and has short-term side effects like confusion and out of body experiences. It has various indications like analgesia, anesthesia induction, and improving psychiatric disorders.
This document summarizes the classification, mechanisms of action, pharmacokinetics, and clinical uses of α-adrenergic receptor antagonists (α-blockers). It discusses non-selective α-blockers that block both α1 and α2 receptors like phentolamine and phenoxybenzamine, as well as selective α1-blockers like prazosin, doxazosin, tamsulosin, and selective α2-blockers like yohimbine. The major uses of α-blockers include treatment of pheochromocytoma, hypertension, peripheral vascular disease, benign prostatic hyperplasia, migraine, and congestive heart failure. Common side effects include hypotension
A General Anaesthetic is a drug that produces a reversible state of unconscious with absence of pain sensation over the entire body; such agents have been described as drugs that remove the most precious human attributes ---- Conscious.
Ketamine
Brand name: KETALAR
Phencyclidine derivative
Shorting acting
Mainly used in children and elderly adults for short procedures such as burns dressing.
ABUSIVE DRUG
Is a dissociative anaesthetic as it produces a cataleptic state in which the patient appears to be awake but is detached from the environment and is unresponsive to pain.
Please also refer to other reference books for clarity.
Methylprednisolone is a potent corticosteroid used to treat conditions requiring its anti-inflammatory and immunosuppressive effects. It is slightly more potent than prednisolone. Methylprednisolone is indicated for diseases like rheumatoid arthritis, systemic lupus erythematosus, asthma, and inflammatory bowel disease. Common side effects include weight gain, mood changes, and increased risk of infection. It can interact with other drugs like NSAIDs and antibiotics.
Propofol is an intravenous sedative used for inducing and maintaining general anesthesia. It works by enhancing the effect of the inhibitory neurotransmitter GABA in the brain. Propofol is formulated as a 1% aqueous solution containing soybean oil, glycerol, and egg lecithin. It has a rapid onset of 15-30 seconds, short duration of 5-10 minutes, and is metabolized in the liver. Common uses include anesthesia induction, sedation, and ventilation in ICU patients. Side effects include nausea, cough, and confusion.
Anesthesia complications range from minor to catastrophic.
complications of general anesthesia might be due to difficulty in airway management or ventilation.
Also the complication might be due to cardiac arrhythmias and poor response to anesthetic effect during induction or maintenance or even the emergence from anesthesia.
So, the the systematic response to the effect of the anesthesia may occur at any time during surgery.
Some of the complications:
Hypoxia, arrhythmia, hypotension , hypertension, regurgitation and aspiration, hypothermia hypoglycemia, coronary ischemia, embolism, persistent apnea delayed recovery , and many others.
also regional anesthesia has its complications like nerve injury, post spinal headache.
Toxicity from local anesthesia is one of the important complication might occur during local infiltration.
Morphine and fentanyl are potent opioid analgesics that act on mu-opioid receptors in the central nervous system. Morphine is a naturally occurring substance extracted from poppy plants, while fentanyl is a synthetic opioid. Both drugs are used medicinally to treat moderate to severe pain. Common side effects include respiratory depression, nausea, constipation, and euphoria. Withdrawal from long-term opioid use can cause pain, irritability, and dysphoria.
Skeletal muscle relaxants work by blocking acetylcholine receptors at the neuromuscular junction, relaxing muscles. There are two main types - depolarizing and non-depolarizing. Succinylcholine is the only depolarizing drug used clinically. It causes initial fasciculations before prolonged muscle relaxation. Non-depolarizing drugs like tubocurarine and vecuronium are competitive antagonists that do not activate acetylcholine receptors, preventing muscle contraction. They have short, intermediate, or long durations of action and differ in side effects and metabolism. Dantrolene works via a different mechanism by preventing calcium release in muscles.
The document discusses evaluating and managing penicillin allergy. It finds that over 90% of patients labeled penicillin-allergic can tolerate penicillin after skin testing by an allergist. Skin testing is the best way to diagnose IgE-mediated allergy and has a high negative predictive value. If skin testing is negative, a graded challenge is recommended. If positive, an alternative antibiotic should be used or desensitization considered. Cross-reactivity between penicillin and cephalosporins is low at around 3%. Proper evaluation can help identify patients able to safely receive penicillin-class antibiotics.
Propofol is a commonly used intravenous anesthetic with the following properties:
- It acts by enhancing the effects of the inhibitory neurotransmitter GABA at GABA-A receptors in the brain, causing sedation and hypnosis.
- It has a rapid onset and context-sensitive half-life, distributing quickly throughout the body before being metabolized in the liver.
- It can be used for induction and maintenance of general anesthesia, as well as for sedation in the ICU. Common side effects include hypotension, respiratory depression, and pain at the injection site. Rare but serious complications include propofol infusion syndrome.
This document discusses antiepileptic drugs, including their mechanisms of action, classifications, pharmacokinetics, indications, and adverse effects. It classifies antiepileptic drugs based on their actions on ion channels and neurotransmitter systems. The main mechanisms of action are enhancement of GABA transmission, inhibition of sodium channels, and inhibition of calcium channels. Common antiepileptic drugs like phenytoin, carbamazepine, valproic acid, lamotrigine, ethosuximide, gabapentin, vigabatrin, and tiagabine are described in terms of their pharmacological properties and clinical uses.
Local anesthetics work by blocking sodium channels and interrupting nerve conduction. They are classified based on their chemical structure as esters or amides. Amides like lidocaine and bupivacaine are metabolized in the liver and have a lower risk of allergic reactions compared to esters. The potency, onset, and duration of local anesthetics depends on factors like lipid solubility, dose, pH, and addition of vasoconstrictors. Toxicity from local anesthetics is related to the dose administered and rate of absorption. Early symptoms of toxicity involve the central nervous system like agitation and seizures. Later, cardiovascular symptoms like arrhythmias and hypotension can occur. Treatment involves stopping administration, managing
1) Anaphylaxis is an acute hypersensitivity reaction that occurs within minutes and can be caused by any substance like antibiotics, stings, or contrast dye.
2) Symptoms vary in severity from mild to fatal and commonly involve the respiratory and dermatological systems. Initial symptoms do not necessarily correlate with severity or progression.
3) Treatment involves recognition of the reaction and prompt resuscitation with epinephrine, oxygen, IV fluids, and monitoring for respiratory distress, hypotension, and cardiac issues.
Metoclopramide is a prokinetic agent that increases stomach and upper intestine movements. It is used to treat certain stomach problems, nausea, and vomiting caused by chemotherapy. Metoclopramide works by antagonizing dopamine, stimulating upper GI tract motility, and accelerating gastric emptying and intestinal transit. It is available as tablets, injections, and oral solutions. Common uses include nausea and vomiting in adults, diabetic gastroparesis, GERD, and preventing postoperative nausea. Usual dosing is 15-30mg per day divided into three doses with at least 6 hours between doses.
Omalizumab is an anti-IgE monoclonal antibody approved for treating allergic asthma, chronic urticaria, and other allergic diseases. It binds to IgE and forms complexes that are cleared, reducing free IgE levels and decreasing FcεRI expression on mast cells and basophils. For asthma, omalizumab improves symptoms and lung function and reduces exacerbations and steroid use. It may be more effective in patients with elevated type 2 biomarkers. Omalizumab also improves symptoms of chronic urticaria by decreasing mediators released in response to autoantibodies. Other anti-IgE biologics in development have distinct binding properties from omalizumab.
Mannitol is a non-electrolyte diuretic used to promote diuresis, prevent and treat oliguric acute renal failure, reduce elevated intraocular and intracranial pressure, promote toxic substance excretion, and as a therapeutic measure in cystic fibrosis and asthma tests in children. It has a half-life of 45-100 minutes and onset of action ranges from 15-30 minutes for ICP reduction to 1-3 hours for diuresis. Dosages vary from 50-200g per 24 hours in geriatrics to 1-5g/kg in pediatric patients depending on the condition being treated. Mannitol has many drug interactions and adverse effects that require monitoring like hypersensitivity
Induction of anaesthesia can be done through inhalational or intravenous routes. Common inhalational inducing agents include sevoflurane, halothane and nitrous oxide. Sevoflurane provides a smooth induction while halothane causes more cardiovascular depression. Intravenous agents like propofol and thiopentone provide rapid onset and recovery but may cause pain on injection. The ideal properties of inducing agents include rapid onset and offset of action, minimal side effects and ease of administration.
This document provides an overview of ketamine, including its history, pharmacology, effects, uses, and advantages for resource-poor settings. Some key points:
- Ketamine is a dissociative anesthetic and NMDA receptor antagonist first synthesized in 1962 and approved for use in 1970.
- It produces dissociative anesthesia while maintaining airway reflexes and cardiovascular stimulation.
- Ketamine has various uses including anesthesia, analgesia, and recently as a rapid-acting antidepressant at sub-anesthetic doses.
- Its safety profile and maintenance of airway reflexes make it advantageous for use in resource-poor settings without respiratory support.
This document discusses anaphylaxis, a severe and potentially life-threatening allergic reaction. It defines anaphylaxis and explains that it is a type 1 hypersensitivity reaction caused by the immune system overreacting to harmless substances. Symptoms can affect multiple body systems like the skin, respiratory and digestive systems. Prompt treatment with epinephrine and other emergency measures is needed. Prevention involves avoiding triggers and carrying epinephrine auto-injectors if at risk.
Mannitol is an osmotic diuretic that is freely filtered by the glomerulus but not reabsorbed by renal tubules. It works by increasing the osmolarity of renal tubular fluid and drawing fluid from intracellular to extracellular spaces. Main uses include prophylaxis of acute renal failure, treatment of acute oliguria and increased intracranial pressure. While it reduces ICP, mannitol provides limited benefit for oxygenation compared to hypertonic saline and risks cardiac failure and electrolyte imbalance with higher doses.
The document provides guidance on performing a neurological assessment. It discusses assessing level of consciousness, cranial nerves, movement, sensation, and reflexes. The neurological exam establishes baseline data to monitor any changes in the patient's condition. The assessment of cranial nerves includes testing each nerve's sensory and motor functions.
gcs(Glasgow Coma Scale) ppt to understand.pptxjkm36403
The Glasgow Coma Scale (GCS) is a standardized system used to assess consciousness by evaluating eye opening, verbal response, and motor response. Each category is scored from 1 to 4 or 6 and the total score ranges from 3 to 15, with lower scores indicating worse neurological function or coma. The GCS is used to assess patients with impaired consciousness due to head injuries, seizures, overdoses, or other neurological impairments. It provides important information about a patient's brain functioning that can help determine if their condition is stable, improving, or deteriorating over time.
This document provides guidance on performing a neurological exam, including assessment of level of consciousness, motor function, sensation, reflexes, and cranial nerves. It emphasizes the importance of establishing a baseline, monitoring for subtle changes, and comparing findings to prior exams. Performing a thorough yet focused neuro exam allows for early detection of deterioration, which is critical for stroke patients. Consistent documentation and communication between caregivers helps ensure any changes are properly identified and addressed.
A neurological examination is the assessment of sensory neuron and motor responses, especially reflexes, to determine whether the nervous system is impaired. This typically includes a physical examination and a review of the patient's medical history, but not deeper investigation such as neuroimaging.
This document provides guidance on performing a neurological assessment. It defines a neurological exam and explains that it is used to evaluate a patient's brain function and motor response. The assessment includes checking the patient's level of consciousness using the Glasgow Coma Scale, pupillary response, limb movement, strength, and vital signs. It outlines how to perform each part of the exam and what to note for things like eye opening, best verbal response, motor response, and limb movement. The neurological observation form is used to record the assessment findings. Any changes in neurological status should be reported immediately to the physician.
The document discusses the Glasgow Coma Scale (GCS) and its use in assessing level of consciousness. The GCS evaluates three criteria: eye opening, verbal response, and motor response on a scale of 1 to 6. It is commonly used to evaluate head injuries and monitor for changes in consciousness. A score of 12 for the patient described indicates a moderate head injury with intact brainstem function.
A neurological examination evaluates the functioning of the nervous system, including sensory, motor, and cognitive abilities. It involves tests of mental status, cranial nerves, motor skills, sensation, reflexes, and cerebellar function. The purposes are to identify or rule out nervous system diseases, aid diagnosis, guide treatment, and monitor changes over time. Nurses are responsible for ensuring a calm environment, accurately documenting exam findings, and informing doctors of any changes.
This document provides details on performing a neurological assessment, including assessing various aspects of consciousness, cranial nerves, sensation, and reflexes. It describes how to test orientation, memory, intellectual function, thought content, affect, and language. It also provides steps for examining each of the 12 cranial nerves, including smell, vision, eye movement, facial expression, hearing/balance, swallowing, shoulder shrugging, and tongue movement. Sensation tests are outlined for touch, pain, temperature, position, and vibration.
Unconsciousness - Advance Nursing PracticeJaice Mary Joy
Unconsciousness is a state of depressed cerebral functioning and unresponsiveness. It can be caused by neurological, toxicological, or metabolic factors that disturb the reticular activating system in the brainstem. There are different levels of unconsciousness ranging from excitatory to vegetative. Assessment tools like the Glasgow Coma Scale and FOUR Score are used to evaluate level of consciousness. The medical management aims to preserve brain function while nursing management focuses on airway protection, injury prevention, fluid balance, skin integrity, and oral care.
This document provides information on unconsciousness, including its definition, causes, assessment, and nursing care. It defines unconsciousness as an unresponsive state to sensory stimuli where the individual is not oriented to time, place or person. Common causes include head injuries, hemorrhages, poisoning, and hypoxic events. Assessment involves monitoring alertness, verbal responses, and motor functions using the Glasgow Coma Scale. Nursing care focuses on airway maintenance, frequent neurological assessments, skin care, nutrition, and involving family members by providing information and teaching stimulation techniques. The goal is for the patient to maintain their neurological baseline and other vital functions with no complications.
The document provides information on performing a neurologic examination, including:
1) Obtaining a health history to understand the onset and progression of symptoms.
2) Assessing mental status, cranial nerves, motor function, sensory function, and reflexes.
3) Common clinical manifestations of neurologic diseases include pain, seizures, dizziness, visual disturbances, weakness, and abnormal sensation.
This document provides information on neurologic assessment. It begins by outlining the learning objectives which focus on describing the structure and function of the central and peripheral nervous systems, differentiating between pathologic changes that affect motor and sensory function, and comparing the sympathetic and parasympathetic nervous systems. It then provides detailed descriptions of the assessment of mental status, cranial nerves, motor function, sensation, and diagnostic tests for neurologic disorders. The assessments are aimed at identifying neurologic dysfunction.
- An experienced clinician uses the history and physical exam findings to focus their examination and form a differential diagnosis for the patient's chief complaint. A thorough history and physical exam are essential to properly diagnose the patient.
- When taking a history, it is important to ask open-ended questions without leading the patient to avoid influencing their responses. Focusing questions can help obtain relevant details efficiently.
- The physical exam should systematically evaluate symptoms, signs, and test results to further elucidate potential neurological or medical issues raised in the history. Key aspects include evaluating strength, reflexes, sensation, and cranial nerves.
This document provides information about the National Institutes of Health Stroke Scale (NIHSS), including how to administer and score it. The NIHSS is an 11-item neurological examination used to evaluate stroke severity. It assesses different functional domains, with higher scores indicating more severe strokes. An increase of 2 points or more on serial NIHSS exams indicates stroke progression. NIHSS scores can help predict outcomes and guide treatment decisions. The presenter reviews the components and administration of the full NIHSS exam.
An altered level of consciousness is a continuum ranging from normal alertness to coma. Assessment of a patient's LOC involves evaluating eye opening, verbal response, and motor response using tools like the Glasgow Coma Scale. Potential causes of an altered LOC include neurological, toxicological, or metabolic etiologies. Complications can involve respiratory failure, pneumonia, pressure ulcers, or aspiration. Treatment focuses on airway maintenance, circulatory and neurological support, and preventing complications.
The document provides an overview of how to perform a neurological examination, including:
1) Assessing the level of consciousness using scales like the Glasgow Coma Scale.
2) Examining the cranial nerves and assessing functions like vision, hearing, smell, facial movement and strength.
3) Evaluating motor strength, tone, reflexes, and involuntary movements.
4) Testing sensory functions including pain, temperature, vibration and position sensation.
The examination aims to screen for neurological disorders by assessing different parts of the nervous system from the cortex to peripheral nerves.
Neurological Assessment for nursing students pptblessyjannu21
Prepared by Prof. BLESSY THOMAS, MSc NURSING (NEUROSCIENCE NURSING) Neurological assessment helps us to identify any abnormalities in the nervous system. it includes several assessment techniques. NEUROLOGICAL ASSESSMENT IS A SYSTEM PROCESS THAT INCLUDES A VARIETY OF CLINICAL TESTS, OBSERVATION ANS ASSESSMWNT DESIGNED TO EVALUATE THE COMPLEX SYSTEM. NEUROLOGICAL ASSESSMENT HELPS TO IDENTIFY MAY COMPLES DISEASES EARLY AND ALSO HELPS TO PROVIDE THE TREATMENT WITHOUT DELAY.
The document provides guidance on performing a neurological assessment to identify abnormalities. The assessment involves gathering information on symptoms, medical history, and conducting a mental status exam, cranial nerve assessment, reflex testing, motor and sensory exams, and evaluating coordination and gait. The goal is to screen for neurological disorders and determine the location and components affected. The assessment uses basic equipment and involves systematically testing various reflexes, sensations, strengths, and movements.
This document provides a one-page summary of exam procedures for evaluating a patient experiencing dizziness. It outlines key history questions, tests of eye movements and balance, and positioning maneuvers to assess the vestibular system. Tests include spontaneous and gaze nystagmus, smooth pursuit, saccades, head thrust, gait observation, CTSIB, Dix-Hallpike maneuver, and roll test. Normal and abnormal responses are defined to help localize potential peripheral or central vestibular lesions. The summary is intended to guide examiners through a targeted vestibular assessment for dizziness.
A neurological examination assesses the functioning of the nervous system through physical examination and review of medical history. It involves evaluating levels of consciousness, cranial nerve function, motor skills, sensation, coordination, and reflexes. Abnormal findings may indicate neurological disorders requiring further investigation.
Similar to APPROACH TO UNCONSCIOUS PATIENT.pptx (20)
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Can Traditional Chinese Medicine Treat Blocked Fallopian Tubes.pptxFFragrant
There are many traditional Chinese medicine therapies to treat blocked fallopian tubes. And herbal medicine Fuyan Pill is one of the more effective choices.
“Environmental sanitation means the art and science of applying sanitary, biological and physical science principles and knowledge to improve and control the environment therein for the protection of the health and welfare of the public”.The overall importance of sanitation are to provide a healthy living environment for everyone, to protect the natural resources (such as surface water, groundwater, soil ), and to provide safety, security and dignity for people when they defecate or urinate .Sanitation refers to public health conditions such as drinking clean water, sewage treatment, etc. All the effective tools and actions that help in keeping the environment clean come under sanitation. Sanitation refers to public health conditions such as drinking clean water, sewage treatment. All the effective tools and actions that help in keeping the environment clean and promotes public health is the necessary in todays life.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Congestive Heart failure is caused by low cardiac output and high sympathetic discharge. Diuretics reduce preload, ACE inhibitors lower afterload, beta blockers reduce sympathetic activity, and digitalis has inotropic effects. Newer medications target vasodilation and myosin activation to improve heart efficiency while lowering energy requirements. Combination therapy, following an assessment of cardiac function and volume status, is the most effective strategy to heart failure care.
Nutritional deficiency Disorder are problems in india.
It is very important to learn about Indian child's nutritional parameters as well the Disease related to alteration in their Nutrition.
- Video recording of this lecture in English language: https://youtu.be/RvdYsTzgQq8
- Video recording of this lecture in Arabic language: https://youtu.be/ECILGWtgZko
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
BBB and BCF
control the entry of compounds into the brain and
regulate brain homeostasis.
restricts access to brain cells of blood–borne compounds and
facilitates nutrients essential for normal metabolism to reach brain cells
Pictorial and detailed description of patellar instability with sign and symptoms and how to diagnose , what investigations you should go with and how to approach with treatment options . I have presented this slide in my 2nd year junior residency in orthopedics at LLRM medical college Meerut and got good reviews for it
After getting it read you will definitely understand the topic.
CLASSIFICATION OF H1 ANTIHISTAMINICS-
FIRST GENERATION ANTIHISTAMINICS-
1)HIGHLY SEDATIVE-DIPHENHYDRAMINE,DIMENHYDRINATE,PROMETHAZINE,HYDROXYZINE 2)MODERATELY SEDATIVE- PHENARIMINE,CYPROHEPTADINE, MECLIZINE,CINNARIZINE
3)MILD SEDATIVE-CHLORPHENIRAMINE,DEXCHLORPHENIRAMINE
TRIPROLIDINE,CLEMASTINE
SECOND GENERATION ANTIHISTAMINICS-FEXOFENADINE,
LORATADINE,DESLORATADINE,CETIRIZINE,LEVOCETIRIZINE,
AZELASTINE,MIZOLASTINE,EBASTINE,RUPATADINE. Mechanism of action of 2nd generation antihistaminics-
These drugs competitively antagonize actions of
histamine at the H1 receptors.
Pharmacological actions-
Antagonism of histamine-The H1 antagonists effectively block histamine induced bronchoconstriction, contraction of intestinal and other smooth muscle and triple response especially wheal, flare and itch. Constriction of larger blood vessel by histamine is also antagonized.
2) Antiallergic actions-Many manifestations of immediate hypersensitivity (type I reactions)are suppressed. Urticaria, itching and angioedema are well controlled.3) CNS action-The older antihistamines produce variable degree of CNS depression.But in case of 2nd gen antihistaminics there is less CNS depressant property as these cross BBB to significantly lesser extent.
4) Anticholinergic action- many H1 blockers
in addition antagonize muscarinic actions of ACh. BUT IN 2ND gen histaminics there is Higher H1 selectivitiy : no anticholinergic side effects
Allopurinol, a uric acid synthesis inhibitor acts by inhibiting Xanthine oxidase competitively as well as non- competitively, Whereas Oxypurinol is a non-competitive inhibitor of xanthine oxidase.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Selective alpha1 blockers are Prazosin, Terazosin, Doxazosin, Tamsulosin and Silodosin majorly used to treat BPH, also hypertension, PTSD, Raynaud's phenomenon, CHF
2. CONSCIOUSNESS, WHAT IS IT??
Consciousness is the state of full awareness of the self and one’s relationship to the
environment.
Clinically, the level of consciousness of a patient is defined at the bedside
by the responses of the patient to the examiner.
It is clear from this definition that it is possible for a patient to be conscious yet not
responsive to the examiner.
For example,
• if the patient lacks sensory inputs,
• is paralyzed (Locked In Syndrome),
• or for psychologic reasons
decides not to respond
3. WHAT IS SLEEP ,THEN?
Sleep is a form of reduced consciousness in which the responsiveness of
brain systems responsible for cognitive function is globally reduced,
So that the brain does not respond readily to environmental stimuli.
Pathologic alteration of the relationships between the brain systems that
are responsible for wakefulness and sleep can impair consciousness.
A key difference between sleep and coma is that sleep is intrinsically
reversible:
sufficient stimulation will return the individual to a normal waking state
4. SO……WHO IS UNCONSCIOUS ???
Patients who have a sleep like appearance and remain
behaviorally unresponsive to all external stimuli are unconscious
by any definition.
• Impaired consciousness is among the most difficult and
dramatic of clinical problems.
The brain tolerates only limited physical or metabolic injury, so that
impaired consciousness is often a sign of impending irreparable
damage to the brain.
5. TERMS USED TO DESCRIBE
DISORDERS OF CONSCIOUSNESS
Acute Chronic
Clouding
Delirium
Obtundation
Stupor
Coma
Locked in Syndrome
Dementia
Hypersomnia
Abulic
Akinetic mutism
Minimal consciousness
Vegetative State
Brain Death
6. PROBLEMS WITH DIFFERENT TERMS….IT’S
CONFUSING!!
• A wide variety of systemic and intracranial problems produce
depression of conscious level.
• Accurate assessment and recording are essential to determine
deterioration or improvement in a patient’s condition
• In 1974 Teasdale and Jennett, in Glasgow, developed a system for
conscious level assessment.
• They discarded vague terms such as stupor, semi coma and deep
coma
9. EYE OPENING -4 CATEGORIES-DESCRIPTION
Patient’s visual or eye response
Score your patient a 4 if he/she can open their eyes spontaneously
Score your patient a 3 if they open their eyes to verbal speech -“Mr. X”or
light touch
Score your patient a 2 if your patient requires painful stimuli to open
their eyes
Score your patient a 1 if their eyes do not open. Patient is unresponsive.
10. VERBAL RESPONSE- 5 categories
Patient’s verbal response (if intubated or tracheotomy score NT=not
testable / T=Tube)
Score your patient a 5 if patient is oriented x 3 (He or she knows who
they are, where they are, and what the date is)
Score your patient a 4 if you not they are having some confusion or
forgetfulness (unable to answer all orientation questions)
Score your patient a 3 if they are not understood and using inappropriate
words (i.e. swearing, unrelated words, aggressive)
Score your patient a 2 if they are not able to form words and just can
make sounds
Score your patient a 1 if they are unresponsive and make no noise
12. Localizing to pain
Apply a painful stimulus to the
supraorbital nerve,
e.g. rub thumb nail in the
supraorbital groove,
increasing pressure until a
response is
obtained
5
13. If the patient does not localize to
supraorbital pressure, apply
pressure with a pen or hard
object to the nail bed. Record
elbow flexion as
‘flexing to pain’.
4
14. Abnormal flexion to a painful stimulus typically involves
• Adduction of the arm,
• internal rotation of the shoulder,
• flexion of the elbow,
• pronation of the forearm and wrist flexion (known as decorticate
posturing).
3
15. • Abnormal extension to a painful stimulus is also known as decerebrate
posturing.
• In decerebrate posturing, the head is extended, with the arms and legs
also extended and internally rotated.
• The patient appears rigid with their teeth clenched.
• The signs can be on just one side of the body or on both sides (the signs
may only be present in the upper limbs)
2
17. Examination of Unconscious patient-History
• Questioning relatives, friends or the ambulance team is an essential part
of the assessment of the unconscious patient
• Has the patient sustained a head injury – leading to admission, or in the
preceding weeks?
• Did the patient collapse suddenly?-Indicating that an acute problem is
more likely
• Did limb twitching occur?-Explain
• Have symptoms occurred in the preceding weeks?
• Has the patient suffered a previous illness?-DM/HTN/IHD
• Does the patient take medication?-Such as Antiplatelets/Anticoagulants
18. GENERAL EXAMINATION
Lack of patient co-operation does not limit general examination and this
may reveal important diagnostic signs.
In addition to those features, also look for
• signs of head injury,
• needle marks on the arm and
• evidence of tongue biting.
• Also note the smell of alcohol- beware of attributing the patient’s clinical
state solely to alcohol excess
19. NEUROLOGICAL EXAMINATION
• Conscious level: This assessment is of major importance. It
not only serves as an immediate prognostic guide, but also
provides a baseline with which future examinations may be
compared.
• Assess conscious level as described previously in terms
of eye opening,
verbal response and
motor response
20. • It is important to avoid the tendency to simply quote the patient’s
total score. This can be misleading.
• Describing the conscious level in terms of the actual responses
i.e.
• ‘no eye opening, no verbal response and extending’, avoids
any confusion over numbers
22. IMPORTANCE OF PUPIL EXAMINATION
• The pupil size should be recorded in millimeters and the reactivity
documented as present, sluggish or absent
• UNCAL HERNIATION can compress the third nerve, compromising the
parasympathetic supply to the pupil.
• Unopposed sympathetic activity produces a sluggish enlarged pupil,
progressing to fixed and dilated under continued compression
24. VESTIBULO-OCULAR REFLEX
Method: Water at 30°C irrigated into the external auditory meatus. Nystagmus
usually develops after a 20 second delay and lasts for more than a minute
The test is repeated after 5 minutes with water at 44°C.
Cold water effectively reduces the vestibular output from one side, creating an
imbalance and producing eye drift towards the irrigated ear.
Rapid corrective movements result in ‘nystagmus’ to the opposite ear. Hot water
(44°) reverses the convection current, increases the vestibular output and changes
the direction of nystagmus.
25. • Nystagmus is a condition in which the eyes make repetitive,
uncontrolled movements.
• These movements often result in reduced vision and depth
perception and can affect balance and coordination. These
involuntary eye movements can occur from side to side, up and
down, or in a circular pattern.
26.
27. VISUAL FIELDS
In the unco-operative
patient, the examiner may
detect a field defect when
‘menacing’ from one side
fails to produce a ‘blink’
29. LIMB WEAKNESS
Detect by comparing the response in
the limbs to painful stimuli. If pain
produces an asymmetric response,
then limb weakness is present.
(If the patient ‘localises’ with one
arm, hold this down and retest to
ensure that a similar response
cannot be elicited
from the other limb.)
30. LOWER LIMBS
• Pain stimulus applied to the toe nails or Achilles tendon similarly tests power in
the lower limbs.
• Variation in tone,
• reflexes or
• plantar responses between each side also indicates a focal deficit.
• In practice, if the examiner fails to detect a difference in response to painful
stimuli, these additional features seldom provide convincing evidence
31. • Patients who do not meet all the discharge criteria will need admission for a further
period of observation and/or brain imaging.
GUIDELINES FOR COMPUTED TOMOGRAPHY (CT) IN HEAD INJURY.
Indications for CT imaging in head injury within 1 hour
● GCS <13 at any point
● GCS <15 at 2 hours
● Focal neurological deficit
● Suspected open, depressed or basal skull fracture
● More than one episode of vomiting
● Post-traumatic seizure
Indications for CT imaging within 8 hours
● Age >65
● Coagulopathy (e.g. aspirin, warfarin or rivaroxaban use)
● Dangerous mechanism of injury (e.g. fall from a height, RTA)
● Retrograde amnesia >30 minutes