Epilepsy surgery
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Epilepsy is a condition caused by recurrent seizures which can be triggered by idiopathic factors, tumors, head injuries, toxic chemicals, alcohol withdrawal, birth injuries or strokes. Epilepsy surgery options include temporal lobectomy, hemispherectomy, and corpus callostomy to treat epilepsy when medications are not effective. Dr. Paresh Doshi is a neurological surgeon in Mumbai, India who performs various epilepsy surgeries and can be contacted for further information or consultation.
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care in Pediatric head injuries –Nursing Neuro surgery ICU
ABSTRACT
care in Pediatric head injuries –Nursing Neuro surgery ICU
Anu Antony , Deepak Agrawal
Department of Neurosurgery, JPNA Trauma Centre, AIIMS ,New Delhi
Background: Nursing assessment of pediatric head injuries is difficult as GCS scoring system is not applicable to this age group. Also managing head injured children in the same ICU with adults is challenging
Objectives: To assess outcome of admitted pediatric head injury patients (<12yrs) as a surrogate marker for nursing care in the ICU.
Materials &methods: In this prospective study over 9months (Jan2011-Sept2011), the demographic profile ,surgical intervention ,mode of injury and outcome was evaluated for all children with head injury admitted in neurosurgery ICU at JPNA Trauma Center AIIMS.
Result: 104 children with head injury were admitted in the ICU during study period. There were 70males & 34 females. The mean age was 6.5yrs (range day1-12yrs) 51 children had severe head injury, 19 had moderate&34had minor head injury. 51(49%) children underwent surgical intervention. The overall mortality rate was 19.23%(n-20).Mortality rate was 33.3% (n-17) in severe head injuries,5.9% (n-2) in minor head injuries and 5.2%(n-1) in moderate head injury group.84 children were discharged .Of these 84.5%(n-71)had improvement in GCS,10.7%(n-9) had same GCS&4(4.7%) children deteriorated. The average hospital stay was 10 days (range2-94 days).2 patients were still hospitalized at the time of this study.
Conclusion: The mortality rates compare very favorably with international data. This study shows head inured children can be managed appropriately in neurosurgery ICU with nurses trained in neuro- nursing
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Being able to prognosticate in the aftermath of a traumatic brain injury (TBI) is important as it assists with counselling patients and families. Moreover, it helps rationally allocate healthcare resources.
However, due to the heterogenous nature of TBI and variable pre brain injury patient factors and post brain injury course, this has proven to be a difficult task.
Large cohort studies have enabled improved accuracy in the prediction of 6 month mortality and unfavourable outcome.
Furthermore, many of the factors that contribute to long-term outcome have also emerged. However, it is not yet possible to use them in prediction algorithms or mathematical models.
There is emerging evidence that pre injury psychosocial and demographic factors may be of more relevance than injury severity. Moreover, that 'outcome' becomes increasingly subjective and complex as the post injury duration increases.
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- The study included 11 cases of cerebellopontine angle tumors in children between the ages of 2-16 years.
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Recommended
care in Pediatric head injuries –Nursing Neuro surgery ICU
ABSTRACT
care in Pediatric head injuries –Nursing Neuro surgery ICU
Anu Antony , Deepak Agrawal
Department of Neurosurgery, JPNA Trauma Centre, AIIMS ,New Delhi
Background: Nursing assessment of pediatric head injuries is difficult as GCS scoring system is not applicable to this age group. Also managing head injured children in the same ICU with adults is challenging
Objectives: To assess outcome of admitted pediatric head injury patients (<12yrs) as a surrogate marker for nursing care in the ICU.
Materials &methods: In this prospective study over 9months (Jan2011-Sept2011), the demographic profile ,surgical intervention ,mode of injury and outcome was evaluated for all children with head injury admitted in neurosurgery ICU at JPNA Trauma Center AIIMS.
Result: 104 children with head injury were admitted in the ICU during study period. There were 70males & 34 females. The mean age was 6.5yrs (range day1-12yrs) 51 children had severe head injury, 19 had moderate&34had minor head injury. 51(49%) children underwent surgical intervention. The overall mortality rate was 19.23%(n-20).Mortality rate was 33.3% (n-17) in severe head injuries,5.9% (n-2) in minor head injuries and 5.2%(n-1) in moderate head injury group.84 children were discharged .Of these 84.5%(n-71)had improvement in GCS,10.7%(n-9) had same GCS&4(4.7%) children deteriorated. The average hospital stay was 10 days (range2-94 days).2 patients were still hospitalized at the time of this study.
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Large cohort studies have enabled improved accuracy in the prediction of 6 month mortality and unfavourable outcome.
Furthermore, many of the factors that contribute to long-term outcome have also emerged. However, it is not yet possible to use them in prediction algorithms or mathematical models.
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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.
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- The study included 11 cases of cerebellopontine angle tumors in children between the ages of 2-16 years.
- Histopathological analysis found 6 cases of ependymoma, 3 cases of atypical teratoid/rhabdoid tumor, and 2 cases of medulloblastoma.
- Gross total resection was achieved in only 2 cases due
Intraoperative Monitoring for Brain and Spinal Cord Tumors
Intraoperative monitoring (IOM) during brain and spinal surgeries aims to prevent new or worsened neurological deficits. While IOM is not based on class I evidence, controlled studies would be unethical given its effectiveness in predicting injuries. Studies show IOM reduces postoperative deficits compared to no monitoring. For glioma resections, IOM-guided resection allows safer maximal removal in eloquent areas, improving survival and quality of life. Awake craniotomy with IOM results in fewer deficits than general anesthesia. While false negatives and cost are challenges, IOM avoidance risks greater deficits and rehabilitation costs. IOM should be used for brain and spinal tumor resections when near critical structures.
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●Electrical activity has two phases:
Depolarization- contraction of muscle
Repolarization- relaxation of muscle
ECG Leads:
●6 Chest leads
●6 Limb leads
1. Bipolar Limb Leads:
Lead 1- Between right arm(-ve) and left arm(+ve)
Lead 2- Between right arm(-ve) and left leg(+ve)
Lead 3- Between left arm(-ve)
and left leg(+ve)
2. Augmented unipolar Limb Leads:
AvR- Right arm
AvL- Left arm
AvF- Left leg
3.Chest Leads:
V1 : Over 4th intercostal
space near right sternal margin
V2: Over 4th intercostal space near left sternal margin
V3:In between V2 and V4
V4:Over left 5th intercostal space on the mid
clavicular line
V5:Over left 5th intercostal space on the anterior
axillary line
V6:Over left 5th intercostal space on the mid
axillary line.
Normal ECG:
Waves of ECG:
P Wave
•P Wave is a positive wave and the first wave in ECG.
•It is also called as atrial complex.
Cause: Atrial depolarisation
Duration: 0.1 sec
QRS Complex:
•QRS’ complex is also called the initial ventricular complex.
•‘Q’ wave is a small negative wave. It is continued as the tall ‘R’ wave, which is a positive wave.
‘R’ wave is followed by a small negative wave, the ‘S’ wave.
Cause:Ventricular depolarization and atrial repolarization
Duration: 0.08- 0.10 sec
T Wave:
•‘T’ wave is the final ventricular complex and is a positive wave.
Cause:Ventricular repolarization Duration: 0.2 sec
Intervals and Segments of ECG:
P-R Interval:
•‘P-R’ interval is the interval
between the onset of ‘P’wave and onset of ‘Q’ wave.
•‘P-R’ interval cause atrial depolarization and conduction of impulses through AV node.
Duration:0.18 (0.12 to 0.2) sec
Q-T Interval:
•‘Q-T’ interval is the interval between the onset of ‘Q’
wave and the end of ‘T’ wave.
•‘Q-T’ interval indicates the ventricular depolarization
and ventricular repolarization,
i.e. it signifies the
electrical activity in ventricles.
Duration:0.4-0.42sec
S-T Segment:
•‘S-T’ segment is the time interval between the end of ‘S’ wave and the onset of ‘T’ wave.
Duration: 0.08 sec
R-R Interval:
•‘R-R’ interval is the time interval between two consecutive ‘R’ waves.
•It signifies the duration of one cardiac cycle.
Duration: 0.8 sec
Dimension of ECG:
How to find heart rhytm of the heart?
Regular rhytm:
Irregular rhytm:
More than or less than 4
How to find heart rate using ECG?
If heart Rhytm is Regular :
Heart rate =
300/No.of large b/w 2 QRS complex
= 300/4
=75 beats/mins
How to find heart rate using ECG?
If heart Rhytm is irregular:
Heart rate = 10×No.of QRS complex in 6 sec 5large box = 1sec
5×6=30
10×7 = 70 Beats/min
Abnormalities of ECG:
Cardiac Arrythmias:
1.Tachycardia
Heart Rate more than 100 beats/min
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How to effectively start market research in the health tech industry by defining objectives, crafting problem statements, selecting methods, identifying data collection sources, and setting clear timelines. This guide covers all the preliminary steps needed to lay a strong foundation for your research.
This lays foundation of scoping research project what are the
Before embarking on a research project, especially one aimed at scoping and defining parameters like the one described for health tech IT, several crucial considerations should be addressed. Here’s a comprehensive guide covering key aspects to ensure a well-structured and successful research initiative:
1. Define Research Objectives and Scope
Clear Objectives: Define specific goals such as understanding market needs, identifying new opportunities, assessing risks, or refining pricing strategies.
Scope Definition: Clearly outline the boundaries of the research in terms of geographical focus, target demographics (e.g., age, socio-economic status), and industry sectors (e.g., healthcare IT).
3. Review Existing Literature and Resources
Literature Review: Conduct a thorough review of existing research, market reports, and relevant literature to build foundational knowledge.
Gap Analysis: Identify gaps in existing knowledge or areas where further exploration is needed.
4. Select Research Methodology and Tools
Methodological Approach: Choose appropriate research methods such as surveys, interviews, focus groups, or data analytics.
Tools and Resources: Select tools like Google Forms for surveys, analytics platforms (e.g., SimilarWeb, Statista), and expert consultations.
5. Ethical Considerations and Compliance
Ethical Approval: Ensure compliance with ethical guidelines for research involving human subjects.
Data Privacy: Implement measures to protect participant confidentiality and adhere to data protection regulations (e.g., GDPR, HIPAA).
6. Budget and Resource Allocation
Resource Planning: Allocate resources including time, budget, and personnel required for each phase of the research.
Contingency Planning: Anticipate and plan for unforeseen challenges or adjustments to the research plan.
7. Develop Research Instruments
Survey Design: Create well-structured surveys using tools like Google Forms to gather quantitative data.
Interview and Focus Group Guides: Prepare detailed scripts and discussion points for qualitative data collection.
8. Sampling Strategy
Sampling Design: Define the sampling frame, size, and method (e.g., random sampling, stratified sampling) to ensure representation of target demographics.
Participant Recruitment: Plan recruitment strategies to reach and engage the intended participant groups effectively.
9. Data Collection and Analysis Plan
Data Collection: Implement methods for data gathering, ensuring consistency and validity.
Analysis Techniques: Decide on analytical approaches (e.g., statistical
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- 2. What is Epilepsy and causes • Epilepsy is a condition in which a person has recurrent seizures. • Causes are: • Idiopathic (cause not known). • Tumor , Head injuries. • Toxic chemicals, chemical imbalance. • Alcohol withdrawal. • Birth injuries, Stroke .
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- 5. THANK YOU