EPIC_Run_Review.pptx
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This document provides an update and case review on traumatic brain injury (TBI) patients for EMS providers. It summarizes that over 70% of moderate to severe TBI patients initially present with a Glasgow Coma Scale score of 13-15, and over half have a normal GCS score of 15. It then reviews guidelines for treating all trauma patients according to EPIC protocols to prevent secondary injuries, including maintaining oxygen saturation above 90%, blood pressure above 90 mmHg, end-tidal carbon dioxide between 35-45 mmHg, and documenting vital signs and care provided. The case review describes a motorcycle accident patient who was alert on scene but had multiple internal injuries and required long-term care, highlighting how serious injuries may
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Tbi ppt
This document discusses traumatic brain injury (TBI), including definitions, classifications, symptoms, diagnostic criteria, rating scales, pathology, causes, risk factors, guidelines for management, prognostic factors, complications, rehabilitation programs, and prevention. It defines TBI as an injury to the brain caused by external forces and classifies TBIs as mild, moderate, severe or persistent vegetative state based on factors like loss of consciousness and Glasgow Coma Scale scores. Rating scales discussed include Glasgow Coma Scale, Glasgow Outcome Scale, and Rancho Los Amigos levels. Causes include falls, road traffic accidents, violence and other injuries. Risk factors include age, gender, socioeconomic status and child abuse. Guidelines are provided for management and rehabilitation
2015, Trauma, Brain
The document provides an overview of traumatic brain injury (TBI) for medical professionals. It discusses the demographics of TBI, including that over 2.5 million TBIs occur in the US each year from causes like falls, assaults, and motor vehicle accidents. It outlines the approach to evaluating a TBI patient, including performing a full neurological exam and Glasgow Coma Scale. Common injuries from TBI like contusions, hematomas, and shearing are also reviewed. The document then discusses various medical and surgical treatment options as well as factors that influence prognosis. The goal is to educate medical professionals on understanding and managing TBI.
Glasgow coma scale evaluation and clinical considerations
The Glasgow Coma Scale (GCS) is a neurological scale used to assess level of consciousness. It evaluates eye opening, verbal response, and motor response on a scale of 3-15. Though widely used, it has limitations like not assessing brainstem function or distinguishing mild injuries. Several other scales have been developed, like the FOUR score which also evaluates brainstem reflexes and eye movements, and the Glasgow Outcome Scale which measures long-term recovery. The GCS remains valuable for initial assessment, monitoring changes, and predicting outcomes in various conditions like traumatic brain injury and stroke.
HEAD INJURY Dr. Shitsama.pdf
1. Severe head injury is a leading cause of mortality and disability worldwide, especially in children under 5, teens and young adults, and those over 70. In Kenya it accounts for 10-14% of brain injuries.
2. The pathophysiology of brain injury involves both primary injury on impact and secondary injury developing over hours to days from processes like edema, increased intracranial pressure, and ischemia.
3. Treatment involves stabilizing the patient's airway, breathing, and circulation according to ATLS protocols, assessing neurological status including Glasgow Coma Scale, monitoring for increased intracranial pressure, and managing complications like seizures. S
Traumatic brain injury
Traumatic brain injury (TBI) can be classified in several ways including using the Glasgow Coma Scale or neuroimaging scales. The presentation outlines strategies to decrease secondary brain injury following TBI. It recommends treatments such as decompressive craniectomy, ventilation therapies, hyperosmolar therapy, cerebrospinal fluid drainage, infection prophylaxis, and intracranial pressure monitoring to reduce mortality and improve outcomes. Monitoring of cerebral physiology including intracranial pressure, cerebral perfusion pressure, and jugular venous oxygen saturation is advised to guide management of severe TBI.
Dr Chong Shu Ling - Paediatric head injury
The document discusses the management of a 7-year-old girl who presented to the emergency department after being hit by a taxi while crossing the road. On examination, she was crying and oriented but became agitated and drowsy. Her GCS score was assessed and she displayed abnormal flexion in response to pain. The document discusses various clinical decision rules for determining which pediatric patients with head injuries require CT imaging, including the CHALICE, PECARN, and CATCH rules. It considers the risks of radiation exposure from CT scans for children and how to balance these risks with clinical need.
Traumatic Brain Injury by Shashank nayer
Traumatic brain injury (TBI) occurs when an external force causes brain damage. Primary injury is caused by the impact, while secondary injury involves swelling and reduced blood flow. TBI can be mild, moderate, or severe based on symptoms. Treatment focuses on preventing secondary injury by controlling swelling, blood pressure, and seizures. Patients require rehabilitation to regain abilities lost from brain damage. Long term issues may include headaches, depression, and cognitive impairments.
Head injury
This document discusses classifications of traumatic brain injury (TBI). It describes several classification systems including:
- Glasgow Coma Scale (GCS) which grades severity as mild, moderate or severe.
- Mayo classification which defines moderate-severe TBI based on features like loss of consciousness over 30 minutes.
- Outcome-based classifications like Glasgow Outcome Scale which grades outcome on a scale from death to good recovery.
Pathophysiology of primary injury from mechanical forces and secondary injury from physiological changes are outlined. Initial stabilization priorities and neurological assessment techniques are also reviewed.
Recommended
Tbi ppt
This document discusses traumatic brain injury (TBI), including definitions, classifications, symptoms, diagnostic criteria, rating scales, pathology, causes, risk factors, guidelines for management, prognostic factors, complications, rehabilitation programs, and prevention. It defines TBI as an injury to the brain caused by external forces and classifies TBIs as mild, moderate, severe or persistent vegetative state based on factors like loss of consciousness and Glasgow Coma Scale scores. Rating scales discussed include Glasgow Coma Scale, Glasgow Outcome Scale, and Rancho Los Amigos levels. Causes include falls, road traffic accidents, violence and other injuries. Risk factors include age, gender, socioeconomic status and child abuse. Guidelines are provided for management and rehabilitation
2015, Trauma, Brain
The document provides an overview of traumatic brain injury (TBI) for medical professionals. It discusses the demographics of TBI, including that over 2.5 million TBIs occur in the US each year from causes like falls, assaults, and motor vehicle accidents. It outlines the approach to evaluating a TBI patient, including performing a full neurological exam and Glasgow Coma Scale. Common injuries from TBI like contusions, hematomas, and shearing are also reviewed. The document then discusses various medical and surgical treatment options as well as factors that influence prognosis. The goal is to educate medical professionals on understanding and managing TBI.
Glasgow coma scale evaluation and clinical considerations
The Glasgow Coma Scale (GCS) is a neurological scale used to assess level of consciousness. It evaluates eye opening, verbal response, and motor response on a scale of 3-15. Though widely used, it has limitations like not assessing brainstem function or distinguishing mild injuries. Several other scales have been developed, like the FOUR score which also evaluates brainstem reflexes and eye movements, and the Glasgow Outcome Scale which measures long-term recovery. The GCS remains valuable for initial assessment, monitoring changes, and predicting outcomes in various conditions like traumatic brain injury and stroke.
HEAD INJURY Dr. Shitsama.pdf
1. Severe head injury is a leading cause of mortality and disability worldwide, especially in children under 5, teens and young adults, and those over 70. In Kenya it accounts for 10-14% of brain injuries.
2. The pathophysiology of brain injury involves both primary injury on impact and secondary injury developing over hours to days from processes like edema, increased intracranial pressure, and ischemia.
3. Treatment involves stabilizing the patient's airway, breathing, and circulation according to ATLS protocols, assessing neurological status including Glasgow Coma Scale, monitoring for increased intracranial pressure, and managing complications like seizures. S
Traumatic brain injury
Traumatic brain injury (TBI) can be classified in several ways including using the Glasgow Coma Scale or neuroimaging scales. The presentation outlines strategies to decrease secondary brain injury following TBI. It recommends treatments such as decompressive craniectomy, ventilation therapies, hyperosmolar therapy, cerebrospinal fluid drainage, infection prophylaxis, and intracranial pressure monitoring to reduce mortality and improve outcomes. Monitoring of cerebral physiology including intracranial pressure, cerebral perfusion pressure, and jugular venous oxygen saturation is advised to guide management of severe TBI.
Dr Chong Shu Ling - Paediatric head injury
The document discusses the management of a 7-year-old girl who presented to the emergency department after being hit by a taxi while crossing the road. On examination, she was crying and oriented but became agitated and drowsy. Her GCS score was assessed and she displayed abnormal flexion in response to pain. The document discusses various clinical decision rules for determining which pediatric patients with head injuries require CT imaging, including the CHALICE, PECARN, and CATCH rules. It considers the risks of radiation exposure from CT scans for children and how to balance these risks with clinical need.
Traumatic Brain Injury by Shashank nayer
Traumatic brain injury (TBI) occurs when an external force causes brain damage. Primary injury is caused by the impact, while secondary injury involves swelling and reduced blood flow. TBI can be mild, moderate, or severe based on symptoms. Treatment focuses on preventing secondary injury by controlling swelling, blood pressure, and seizures. Patients require rehabilitation to regain abilities lost from brain damage. Long term issues may include headaches, depression, and cognitive impairments.
Head injury
This document discusses classifications of traumatic brain injury (TBI). It describes several classification systems including:
- Glasgow Coma Scale (GCS) which grades severity as mild, moderate or severe.
- Mayo classification which defines moderate-severe TBI based on features like loss of consciousness over 30 minutes.
- Outcome-based classifications like Glasgow Outcome Scale which grades outcome on a scale from death to good recovery.
Pathophysiology of primary injury from mechanical forces and secondary injury from physiological changes are outlined. Initial stabilization priorities and neurological assessment techniques are also reviewed.
Head and Neck Injuries in Sports: A Sports Medicine Physician's Perspective
Dr. David Carfagno is the principal at Scottsdale Sports Medicine Institute, and a frequent presenter on sports medicine topics around the country.
Concussions and neck injuries are a chronic issue among athletes, particularly in both collegiate and professional football. While their severity is getting more attention today, there are still unique factors that physicians and medical personnel should be aware of.
Pediatric Severe Traumatic Brain Injury-1.pptx
- The document describes the case of a 6-month-old girl who presented with agitation, somnolence, spastic movements, and a history of head trauma after a fall.
- Initial workup revealed a Glasgow Coma Scale of 8, dilated pupils, and abnormal movements indicative of severe traumatic brain injury and possible intracranial bleed.
- She was admitted to the PICU for monitoring and treatment including anti-seizure medications, steroids, hydration, and head elevation. Her condition gradually improved over the following days.
Pediatric head injury public
This document presents a case of pediatric head injury. It discusses a case of an 11-year-old boy who was unrestrained in a motor vehicle collision and was ejected. He presented with a Glasgow Coma Scale of 4 and required intubation. Imaging showed open skull fractures, brain swelling, and hemorrhages. The document then reviews the epidemiology, pathophysiology, clinical features, decision rules, and management of minor, moderate and severe pediatric head injuries. Special considerations for pediatric head injuries include the increased risk of abuse in young children and anatomical differences that make the skull more vulnerable to injury compared to adults.
Triage-in-Emergency-Department.pptx
This document provides an overview of triage in emergency departments. It defines triage as a process used to assess patients' severity of injury or illness upon arrival to prioritize treatment. The document outlines several challenges emergency departments face and the goals of triage to provide appropriate care in a timely manner. It then describes common triage systems and levels (critical, semi-critical, non-critical), the roles of triage officers, and the process involving assessment, priority assignment, and initial treatment or transport. The Malaysian Triage Category is presented as an example, detailing its levels and clinical descriptions to guide triage decisions.
Hart City Case Study – Scenario 9 © 2020 Walden Universi
Hart City Case Study – Scenario 9
© 2020 Walden University 1
Hart City Case Study – Scenario 9
Program Transcript
MALE SPEAKER: Look who it is. It's little Jimmy.
MALE SPEAKER: Hi, Dan. My name is James, not Jimmy.
MALE SPEAKER: You know, I'm not sure how you were promoted to the services
coordinator. You never have good ideas. And you're not the best organized.
To tell you the truth, anyone would have been better than you. I wouldn't trust you to
supervise paint drying. And they trust you to oversee a unit.
Oh, is little Jimmy getting mad? What are you going to do about it?
MALE SPEAKER: I am getting really tired of him. He never quits. The name calling and
insults are really frustrating. How should I handle this?
[MUSIC PLAYING]
Hart City Case Study – Scenario 9
Content Attribution
Name: AdobeStockLicense_238412363.jpeg
Credit Line: JackF/ Adobe Stock
Name: AdobeStockLicense_308761990.jpeg
Credit Line: Prostock-studio/ Adobe Stock
Document: Provider Notes – NURS 6512
Name:
Focused Exam: Chest Pain
Type your narrative-style documentation for each section of the assignment into the corresponding dialogue boxes below. When you are ready to submit your documentation, ‘Save As’ with this title format: “[LastName_FirstName] Shadow Health Documentation Template - Focused Exam_Chest_Pain - NURS 6512”
Subjective
Objective
Assessment
- 1 -
Copyright © 2019 || Shadowhealth.com
Name:
Focused Exam: Chest Pain
Subjective
Type your narrative-style documentation for each section of the assignment into the corresponding dialogue boxes
below. When you are ready to submit your documentation, ‘Save As’ with this title format: “[LastName_FirstName]
Shadow Health Documentation Template - Focused Exam_Chest_Pain - NURS 6512”
S.
CC: “Chest pain”
HPI: The patient is a 58-year-old white American male who reports pain in the mid chest every no-and-then
for the past month. The patient states the pain “feels like tightness than sharp pain” Patient reports pain is in
the middle of the chest over the heart and has occurred three times in the past month and goes away after a
couple of minutes. Patient rates pain six out of ten in terms of intensity but is currently a zero intensity. The
pain is aggravated by physical activity and relieved by rest. The denied taking any medication to relieve the
pain.
PMH: Positive for high blood pressure and high cholesterol, checks BP during check-up visits to the doctor
every 6months, last labs were drawn 3 months ago. Believes he takes Lisinopril 20mg daily and Atorvastatin
20mg daily for high BP and high cholesterol, respectively. Takes 1200mg fish oil daily, Ibuprofen or Tylenol
for pain occasionally, allergy to Codeine causes nausea and vomiting. Denies previous hospitalizations or
surgeries.
FH: Dad died at 75 from colon cancer but was overweight and had high blood pressure and high cholesterol
prior to death. Mom is 80 and has type 2 diabe ...
サーチン先生発表資料 瞳孔計
1) Pupillometer use at Columbia University Neuro ICU provides objective pupillary assessment to guide patient management, triage, and prognosis.
2) Case studies demonstrate how pupillometer detected subtle pupillary changes preceding clinical deterioration in TBI and SAH patients, allowing timely interventions.
3) Abnormal pupillometer readings correctly identified increased intracranial pressure and need for surgery in several cases.
Heroic procedures you should know
1) A 31-year-old man presented with a stab wound to the chest and became unresponsive. Emergency thoracotomy is indicated to treat pericardial tamponade, control hemorrhage, perform open cardiac massage, and temporarily occlude the thoracic aorta.
2) A 29-year-old pregnant woman at 34 weeks gestation collapsed in PEA. Perimortem cesarean section should be considered to deliver the fetus within 5 minutes of maternal cardiac arrest.
3) A 37-year-old man with a GCS of 6 following an MVC had proptosis and firmness of the left eye. He was diagnosed with orbital compartment syndrome and treated with lateral
Resistin
- The document discusses a study examining serum resistin levels as a predictor of outcome in traumatic head injury patients in the intensive care unit.
- The study found that higher serum resistin levels on admission were significantly associated with poorer outcomes and mortality within 14 days. A resistin level above 0.618 ng/ml perfectly predicted mortality with 100% sensitivity but lower specificity.
- Additional factors like lower Glasgow Coma Scale scores, nonreactive pupils, higher blood sugar levels, and more severe injuries on CT scans were also associated with worse outcomes. The study concludes that resistin levels could help identify patients at highest risk of mortality after head trauma.
Tbi military 1
The document discusses vision problems that commonly occur after traumatic brain injury (TBI). It summarizes research finding high rates of convergence insufficiency, accommodative disorders, and other issues in both civilian and military populations with TBI. The document proposes a model of care where optometrists diagnose and treat vision problems, including prescribing vision rehabilitation, while occupational therapists administer the rehabilitation under optometrist supervision. This combines optometric and rehabilitation expertise to help patients recover visual functions impaired by TBI.
Approach to patients with minor head injury-Dr Sameep Koshti (Consultant Neur...
Minor head injury : Classification, Presentation.investigation and management
CT criteria,Discharge criteria
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The bottom line:
The visual cortex has the capacity for experience dependent change (neuroplasticity) throughout life. Unfortunately, when it comes to the adult with binocular vision problems, this is not always recognized as being true even though there is strong clinical evidence to suggest a high level of adult neuroplasticity. Current research shows that adults tend to have numerous anomalies associated with the binocular vision system especially within certain populations. This case series demonstrates how those even approaching 70 years of age can benefit from optometric vision therapy.
GCS-SCTE.ppt
Glasgow Coma Scale (GCS) assessment is an important aspect in neurological assessment and its management. It helps in the objective assessment of the patients and facilitates accurate interpersonal communication.
Delaney on Cerebral protection
Research guru and PI for the ARISE study, college examiner and semi-professional forrest-based carpenter, Anthony always gives a fascinating talk. This time he gives an intelligent and considered breakdown on the nebulous topic of cerebral protection.
Glasgow Coma Scale.pdf
The Glasgow Coma Scale (GCS) objectively measures a patient's level of consciousness and awareness following acute brain injury or illness. It assesses eye opening, verbal response, and motor response on a scale of 3-15, with lower scores indicating more severe impairment. The GCS allows for standardized communication of a patient's condition and guides management decisions. It has been shown to correlate with patient outcomes, with mortality increasing as GCS scores decrease. The GCS is a core assessment for many clinical guidelines involving trauma, critical illness, and neurological conditions.
Does ICP monitoring in TBI really help? by Dr Paul Goldrick
This document summarizes research on intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury. It discusses several key points:
1. While ICP monitoring is commonly recommended, the evidence from randomized controlled trials does not clearly support its use. One trial found no benefit to management guided by ICP monitoring over clinical exams and CT scans.
2. Guidelines set ICP thresholds for intervention but the optimal thresholds are unclear. Some studies found thresholds of 22 mmHg for mortality and functional outcomes.
3. Monitoring cerebral perfusion pressure (CPP) in addition to ICP may be important as outcomes improved with better adherence to CPP guidelines over time.
4. Effective treatments for elevated
Hypocortisolism in traumatic brain injury presentation
This document summarizes a study investigating risk factors for corticosteroid insufficiency during the sub-acute phase of acute traumatic brain injury. The study found that traumatic brain injury induced corticosteroid insufficiency was associated with injury severity, and was an independent risk factor for death. Severe hemorrhagic cerebral contusions, diffuse axonal injury, hypotension, and injury severity were identified as independent risk factors. Corticosteroid insufficiency was also associated with increased rates of pneumonia, gastrointestinal bleeding, and 28-day mortality.
Traumatic brain injury
This document provides an overview of traumatic brain injury (TBI) including grading and classification, types of TBI, prehospital and emergency department management, imaging, monitoring, and advice for patients and relatives. It discusses mild, moderate and severe TBI based on Glasgow Coma Scale. Primary and secondary brain injuries are defined. Prehospital care follows DRABC protocol. ED management focuses on stabilization, prevention of secondary injury, and determining need for CT scan or neurosurgery. Home care involves careful observation for warning signs.
Initial assesment atls
The document outlines the steps of the Advanced Trauma Life Support protocol. It includes: 1) preparing equipment and summoning a trauma team, 2) performing triage on multiple casualties, 3) conducting a primary survey to address life threats like airway, breathing, circulation, disability and exposure, 4) providing resuscitation as needed, 5) using adjuncts like monitoring, IVs and diagnostics, 6) performing a full secondary survey and history, 7) using additional adjuncts, 8) continued re-evaluation of the patient, and 9) arranging for their definite care. The protocol aims to quickly identify and treat life threats in a trauma patient.
Old Patients Present with High GCS in traumatic brain injury
This study analyzed data from over 25,000 patients with traumatic brain injuries (TBI) in the Trauma Audit Research Network database between 1988-2013. It found that older patients (65+) presented with more severe forms of TBI but higher Glasgow Coma Scale (GCS) scores than younger patients (<65), meaning current triage guidelines may miss significant injuries in older groups. Mortality was almost three times higher in older patients despite their higher GCS. The study concludes that trauma systems should adapt guidelines to better recognize serious TBIs in the elderly based on injury severity rather than just GCS.
Management of Head Injuries with normal CT
1) A 7-year-old male child presented with a severe head injury after falling 4 stories, with an initial normal CT scan but gradually rising intracranial pressure.
2) The patient underwent an emergency decompressive craniectomy due to refractory elevated ICP, which improved his condition and he was successfully extubated on the third postoperative day.
3) An audit of over 2000 head injury patients at this trauma center over 18 months found that 53% had severe injuries, with an overall mortality of 22%, rising to 36% for severe injuries.
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Brief description worm infestation/Helminthiasis for Basic B.Sc Nursing students
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Visit Us: https://drdeepikashomeopathy.com/service/irregular-periods-treatment/
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Similar to EPIC_Run_Review.pptx
Head and Neck Injuries in Sports: A Sports Medicine Physician's Perspective
Dr. David Carfagno is the principal at Scottsdale Sports Medicine Institute, and a frequent presenter on sports medicine topics around the country.
Concussions and neck injuries are a chronic issue among athletes, particularly in both collegiate and professional football. While their severity is getting more attention today, there are still unique factors that physicians and medical personnel should be aware of.
Pediatric Severe Traumatic Brain Injury-1.pptx
- The document describes the case of a 6-month-old girl who presented with agitation, somnolence, spastic movements, and a history of head trauma after a fall.
- Initial workup revealed a Glasgow Coma Scale of 8, dilated pupils, and abnormal movements indicative of severe traumatic brain injury and possible intracranial bleed.
- She was admitted to the PICU for monitoring and treatment including anti-seizure medications, steroids, hydration, and head elevation. Her condition gradually improved over the following days.
Pediatric head injury public
This document presents a case of pediatric head injury. It discusses a case of an 11-year-old boy who was unrestrained in a motor vehicle collision and was ejected. He presented with a Glasgow Coma Scale of 4 and required intubation. Imaging showed open skull fractures, brain swelling, and hemorrhages. The document then reviews the epidemiology, pathophysiology, clinical features, decision rules, and management of minor, moderate and severe pediatric head injuries. Special considerations for pediatric head injuries include the increased risk of abuse in young children and anatomical differences that make the skull more vulnerable to injury compared to adults.
Triage-in-Emergency-Department.pptx
This document provides an overview of triage in emergency departments. It defines triage as a process used to assess patients' severity of injury or illness upon arrival to prioritize treatment. The document outlines several challenges emergency departments face and the goals of triage to provide appropriate care in a timely manner. It then describes common triage systems and levels (critical, semi-critical, non-critical), the roles of triage officers, and the process involving assessment, priority assignment, and initial treatment or transport. The Malaysian Triage Category is presented as an example, detailing its levels and clinical descriptions to guide triage decisions.
Hart City Case Study – Scenario 9 © 2020 Walden Universi
Hart City Case Study – Scenario 9
© 2020 Walden University 1
Hart City Case Study – Scenario 9
Program Transcript
MALE SPEAKER: Look who it is. It's little Jimmy.
MALE SPEAKER: Hi, Dan. My name is James, not Jimmy.
MALE SPEAKER: You know, I'm not sure how you were promoted to the services
coordinator. You never have good ideas. And you're not the best organized.
To tell you the truth, anyone would have been better than you. I wouldn't trust you to
supervise paint drying. And they trust you to oversee a unit.
Oh, is little Jimmy getting mad? What are you going to do about it?
MALE SPEAKER: I am getting really tired of him. He never quits. The name calling and
insults are really frustrating. How should I handle this?
[MUSIC PLAYING]
Hart City Case Study – Scenario 9
Content Attribution
Name: AdobeStockLicense_238412363.jpeg
Credit Line: JackF/ Adobe Stock
Name: AdobeStockLicense_308761990.jpeg
Credit Line: Prostock-studio/ Adobe Stock
Document: Provider Notes – NURS 6512
Name:
Focused Exam: Chest Pain
Type your narrative-style documentation for each section of the assignment into the corresponding dialogue boxes below. When you are ready to submit your documentation, ‘Save As’ with this title format: “[LastName_FirstName] Shadow Health Documentation Template - Focused Exam_Chest_Pain - NURS 6512”
Subjective
Objective
Assessment
- 1 -
Copyright © 2019 || Shadowhealth.com
Name:
Focused Exam: Chest Pain
Subjective
Type your narrative-style documentation for each section of the assignment into the corresponding dialogue boxes
below. When you are ready to submit your documentation, ‘Save As’ with this title format: “[LastName_FirstName]
Shadow Health Documentation Template - Focused Exam_Chest_Pain - NURS 6512”
S.
CC: “Chest pain”
HPI: The patient is a 58-year-old white American male who reports pain in the mid chest every no-and-then
for the past month. The patient states the pain “feels like tightness than sharp pain” Patient reports pain is in
the middle of the chest over the heart and has occurred three times in the past month and goes away after a
couple of minutes. Patient rates pain six out of ten in terms of intensity but is currently a zero intensity. The
pain is aggravated by physical activity and relieved by rest. The denied taking any medication to relieve the
pain.
PMH: Positive for high blood pressure and high cholesterol, checks BP during check-up visits to the doctor
every 6months, last labs were drawn 3 months ago. Believes he takes Lisinopril 20mg daily and Atorvastatin
20mg daily for high BP and high cholesterol, respectively. Takes 1200mg fish oil daily, Ibuprofen or Tylenol
for pain occasionally, allergy to Codeine causes nausea and vomiting. Denies previous hospitalizations or
surgeries.
FH: Dad died at 75 from colon cancer but was overweight and had high blood pressure and high cholesterol
prior to death. Mom is 80 and has type 2 diabe ...
サーチン先生発表資料 瞳孔計
1) Pupillometer use at Columbia University Neuro ICU provides objective pupillary assessment to guide patient management, triage, and prognosis.
2) Case studies demonstrate how pupillometer detected subtle pupillary changes preceding clinical deterioration in TBI and SAH patients, allowing timely interventions.
3) Abnormal pupillometer readings correctly identified increased intracranial pressure and need for surgery in several cases.
Heroic procedures you should know
1) A 31-year-old man presented with a stab wound to the chest and became unresponsive. Emergency thoracotomy is indicated to treat pericardial tamponade, control hemorrhage, perform open cardiac massage, and temporarily occlude the thoracic aorta.
2) A 29-year-old pregnant woman at 34 weeks gestation collapsed in PEA. Perimortem cesarean section should be considered to deliver the fetus within 5 minutes of maternal cardiac arrest.
3) A 37-year-old man with a GCS of 6 following an MVC had proptosis and firmness of the left eye. He was diagnosed with orbital compartment syndrome and treated with lateral
Resistin
- The document discusses a study examining serum resistin levels as a predictor of outcome in traumatic head injury patients in the intensive care unit.
- The study found that higher serum resistin levels on admission were significantly associated with poorer outcomes and mortality within 14 days. A resistin level above 0.618 ng/ml perfectly predicted mortality with 100% sensitivity but lower specificity.
- Additional factors like lower Glasgow Coma Scale scores, nonreactive pupils, higher blood sugar levels, and more severe injuries on CT scans were also associated with worse outcomes. The study concludes that resistin levels could help identify patients at highest risk of mortality after head trauma.
Tbi military 1
The document discusses vision problems that commonly occur after traumatic brain injury (TBI). It summarizes research finding high rates of convergence insufficiency, accommodative disorders, and other issues in both civilian and military populations with TBI. The document proposes a model of care where optometrists diagnose and treat vision problems, including prescribing vision rehabilitation, while occupational therapists administer the rehabilitation under optometrist supervision. This combines optometric and rehabilitation expertise to help patients recover visual functions impaired by TBI.
Approach to patients with minor head injury-Dr Sameep Koshti (Consultant Neur...
Minor head injury : Classification, Presentation.investigation and management
CT criteria,Discharge criteria
Neuroplasticity and Vision Therapy for Adults; A Case Series
This poster was presented at the American Optometric Association's Annual meeting in Boston, MA 06/2016
The bottom line:
The visual cortex has the capacity for experience dependent change (neuroplasticity) throughout life. Unfortunately, when it comes to the adult with binocular vision problems, this is not always recognized as being true even though there is strong clinical evidence to suggest a high level of adult neuroplasticity. Current research shows that adults tend to have numerous anomalies associated with the binocular vision system especially within certain populations. This case series demonstrates how those even approaching 70 years of age can benefit from optometric vision therapy.
GCS-SCTE.ppt
Glasgow Coma Scale (GCS) assessment is an important aspect in neurological assessment and its management. It helps in the objective assessment of the patients and facilitates accurate interpersonal communication.
Delaney on Cerebral protection
Research guru and PI for the ARISE study, college examiner and semi-professional forrest-based carpenter, Anthony always gives a fascinating talk. This time he gives an intelligent and considered breakdown on the nebulous topic of cerebral protection.
Glasgow Coma Scale.pdf
The Glasgow Coma Scale (GCS) objectively measures a patient's level of consciousness and awareness following acute brain injury or illness. It assesses eye opening, verbal response, and motor response on a scale of 3-15, with lower scores indicating more severe impairment. The GCS allows for standardized communication of a patient's condition and guides management decisions. It has been shown to correlate with patient outcomes, with mortality increasing as GCS scores decrease. The GCS is a core assessment for many clinical guidelines involving trauma, critical illness, and neurological conditions.
Does ICP monitoring in TBI really help? by Dr Paul Goldrick
This document summarizes research on intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury. It discusses several key points:
1. While ICP monitoring is commonly recommended, the evidence from randomized controlled trials does not clearly support its use. One trial found no benefit to management guided by ICP monitoring over clinical exams and CT scans.
2. Guidelines set ICP thresholds for intervention but the optimal thresholds are unclear. Some studies found thresholds of 22 mmHg for mortality and functional outcomes.
3. Monitoring cerebral perfusion pressure (CPP) in addition to ICP may be important as outcomes improved with better adherence to CPP guidelines over time.
4. Effective treatments for elevated
Hypocortisolism in traumatic brain injury presentation
This document summarizes a study investigating risk factors for corticosteroid insufficiency during the sub-acute phase of acute traumatic brain injury. The study found that traumatic brain injury induced corticosteroid insufficiency was associated with injury severity, and was an independent risk factor for death. Severe hemorrhagic cerebral contusions, diffuse axonal injury, hypotension, and injury severity were identified as independent risk factors. Corticosteroid insufficiency was also associated with increased rates of pneumonia, gastrointestinal bleeding, and 28-day mortality.
Traumatic brain injury
This document provides an overview of traumatic brain injury (TBI) including grading and classification, types of TBI, prehospital and emergency department management, imaging, monitoring, and advice for patients and relatives. It discusses mild, moderate and severe TBI based on Glasgow Coma Scale. Primary and secondary brain injuries are defined. Prehospital care follows DRABC protocol. ED management focuses on stabilization, prevention of secondary injury, and determining need for CT scan or neurosurgery. Home care involves careful observation for warning signs.
Initial assesment atls
The document outlines the steps of the Advanced Trauma Life Support protocol. It includes: 1) preparing equipment and summoning a trauma team, 2) performing triage on multiple casualties, 3) conducting a primary survey to address life threats like airway, breathing, circulation, disability and exposure, 4) providing resuscitation as needed, 5) using adjuncts like monitoring, IVs and diagnostics, 6) performing a full secondary survey and history, 7) using additional adjuncts, 8) continued re-evaluation of the patient, and 9) arranging for their definite care. The protocol aims to quickly identify and treat life threats in a trauma patient.
Old Patients Present with High GCS in traumatic brain injury
This study analyzed data from over 25,000 patients with traumatic brain injuries (TBI) in the Trauma Audit Research Network database between 1988-2013. It found that older patients (65+) presented with more severe forms of TBI but higher Glasgow Coma Scale (GCS) scores than younger patients (<65), meaning current triage guidelines may miss significant injuries in older groups. Mortality was almost three times higher in older patients despite their higher GCS. The study concludes that trauma systems should adapt guidelines to better recognize serious TBIs in the elderly based on injury severity rather than just GCS.
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1) A 7-year-old male child presented with a severe head injury after falling 4 stories, with an initial normal CT scan but gradually rising intracranial pressure.
2) The patient underwent an emergency decompressive craniectomy due to refractory elevated ICP, which improved his condition and he was successfully extubated on the third postoperative day.
3) An audit of over 2000 head injury patients at this trauma center over 18 months found that 53% had severe injuries, with an overall mortality of 22%, rising to 36% for severe injuries.
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EPIC_Run_Review.pptx
- 1. EPIC Run Review / Update Sneaky TBI Patients Case 663221 V1.0 3/2014
- 2. Actual TBI pts from Arizona agencies Goal: Quick Refresher/Run Review TBI can be hard to spot in field Review good TBI management Outcomes-What happened?
- 3. No. Initial Trauma Center GCS can’t either. 73% of moderate to severe TBI patients have initial TC GCS scores of 13-15. EMS GCS is no better at predicting TBI Over HALF (52%) of moderate to severe TBI patients have normal GCS scores (4/5/6=15) initially. GOAL: Treating EVERY trauma pt. using EPIC guidelines helps prevent secondary injury in all of them. Source: ASTR and EPIC database, similar findings reported in Emerg Med J 2013;30:876 doi:10.1136/emermed-2013-203113.24
- 4. Trauma patients from any cause AND: ◦ GCS of 14 or less…OR… ◦ Multisystem trauma requiring intubation …OR… ◦ Post-traumatic seizures (whether continuing or not) ◦ Keep a high index of suspicion
- 5. Hypoxia- Early High flow O2 Keep SPO2 >90% Hypotension- Keep SBP >90 Use caution with any sedation Hyperventilation- Monitor ETCO2 Keep at 40 (35-45) Flow Controlled BVM Smartbag Ventilation Rate Timer One breath/6 sec. Ventilator (7cc/kg, 10bpm NEVER HYPERVENTILATE Your good care matters!!!!
- 6. Document VS q 5 min (including GCS, SPO2, ETCO2) Total Fluids given Fingerstick Blood Glucose (Treat if low) Care given, even if not consistent with EPIC guidelines. Do the best you can delivering quality care.
- 7. Case Criteria: Prehospital GCS never below 13 Final Diagnosis of Moderate to Severe TBI High cost (generally indicates higher injury severity). Points to Remember: TBI is very difficult to identify in the field. All trauma are EPIC patients Critically injured TBI patients often appear essentially normal early in care.
- 12. EPIC ID 663221 Motorcycle Accident Major Injuries: Subdural hematoma, lung contusion, pneumo or hemothorax, subarachnoid hematoma, cerebral hemorrhage, liver and spleen lacerations, kidney contusion, GI tract injury. Discharge Status Rehab or Long Term Care Comments: Great job!!! Very complex injuries not evident on scene, but assessed really well. Very severe injuries for a patient alert and oriented with no reported loss of consciousness. Great on scene time of 7 minutes. Case was before EPIC training. These patients were chosen because they are hard to identify, but have significant injuries and high hospital expenses. Clinical correlation (another set of eyes) is strongly recommended. If we have missed any care given, we apologize. We only look at data, not circumstances. We are not tracking individual performance. This is simply intended as a way to reinforce the best EPIC care possible using real cases you have been on and provide outcomes on cases.
- 13. EPIC care matters. Thanks for all you are doing! Great work!
Editor's Notes
- 2nd bullet explanation: Multisystem trauma requiring intubation whether the need for intubation was from TBI or other potential injuries