Goodbye GCS! - Mark Wilson
•Download as PPTX, PDF•
5 likes•4,843 views
Goodbye GCS! Summary by: Mark Wilson Consciousness comprises “wakefulness” (that’s the brain stem, opening your eyes component) and “content” (that’s the supratentorial, thinking, “someone’s home” component). You can have wakefulness without content (e.g. persistent vegetative state) but not content without wakefulness. Describing a “level” of consciousness, converting this multifaceted human brain ability into a linear scale was possibly the biggest neuroscience break through of the 20th Century. The 1974 Lancet paper in which Brian Jennet and Sir Graham Teasdale proposed the Glasgow Coma Scale (GCS) is certainly the most cited neuroscience paper. We had even put a man on the moon before this had been created. It’s relative simplicity and repeatability meant GCS was rapidly taken up across the world. Now 40 years on, is it out of date? There are problems with the GCS – it doesn’t include pupil response, it doesn’t look at ventilation or other autonomic functions hence other systems such as the 4 score system have been proposed. But these take longer, and are poorly known so cannot be used like GCS to rapidly convey in a meaningful way the level of consciousness of a patient between clinicians. In this talk Mark Wilson goes through the history of the GCS and other conscious measures… is it time to say Goodbye to GCS?
Report
Share
Report
Share
Recommended
Management of pediatric head injury
This document discusses the management of pediatric head injuries. Key points include:
- Pediatric head trauma can have lifelong implications and risks are higher for boys starting at age 5. Moderate to severe injuries increase risks of behavioral/cognitive issues.
- Differences from adults include epidemiology, types of injuries like birth injuries or abuse, and responses like malignant cerebral edema more common in young children.
- Management involves stabilizing the patient, assessing GCS and pupils, controlling ICP/CPP, monitoring for herniation, providing nutrition/seizure prophylaxis, and considering decompressive craniectomy for refractory elevated ICP.
Central Hyperthermia
Central hyperthermia can occur after stroke or brain injury due to damage to the hypothalamus or brainstem centers that regulate temperature. It causes rapid onset fever without evidence of infection. Diagnosis involves ruling out infection and treatment uses a multimodal approach including medications like bromocriptine or baclofen to reduce fever by acting on dopamine or GABA receptors in the brain.
Traumatic Brain Injury: Approach
70% of RTA patients have head injury(HI).
One of the most important public health problems of today.
70% of deaths in RTA are due to HI.
At Risk population
Males 15-24
Infants
Young Children
Elderly
TRAUMATIC BRAIN INJURY
The document discusses strategies and rationale for decreasing secondary brain injury following traumatic brain injury (TBI). It describes that TBI consists of primary and secondary brain injury, with primary injury occurring immediately from mechanical forces and secondary injury developing over time from cellular and biochemical cascades. The document outlines various mechanisms of secondary injury including excitotoxicity, inflammation, edema, and ischemia. It then provides recommendations for treating and monitoring TBI to decrease secondary injury, such as decompressive craniectomy, ICP/CPP monitoring, ventilation strategies, hypothermia, hyperosmolar therapy, and seizure prophylaxis.
Approach to traumatic brain injury
This document provides an overview of traumatic brain injury (TBI), including:
1) It defines TBI and outlines primary and secondary brain injury mechanisms. Common causes include motor vehicle accidents, falls, and assaults.
2) It discusses evaluation and treatment, including importance of preventing hypotension and hypoxia. Neuroimaging with CT is important for diagnosis and prognosis.
3) Management of elevated intracranial pressure is also covered, including osmotherapy, sedation, cerebral perfusion pressure maintenance, temperature control, and avoiding hypocapnia or steroids.
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.
Traumatic Brain Injury
Traumatic brain injury (TBI) occurs when an external force causes damage to the brain. TBI can be classified based on severity and mechanism of injury. Common causes include motor vehicle accidents, falls, assaults, and sports-related injuries. Symptoms vary depending on the location and severity of the injury but may include cognitive and language deficits, memory loss, seizures, and behavioral changes. Prevention focuses on reducing risk factors like not wearing a helmet during activities or a seatbelt during vehicle travel. Occupational therapists can help people with TBI regain independence through tasks and environmental modifications.
Traumatic brain injury
This document provides information on traumatic brain injury (TBI) and its critical care management. It begins with definitions of TBI and classifications based on Glasgow Coma Scale. It then discusses the epidemiology of TBI and types of brain injuries that can occur. The remainder of the document covers assessment, monitoring of vital signs and intracranial pressure, treatment goals and interventions to prevent secondary brain injury, common complications, nursing care and rehabilitation.
Recommended
Management of pediatric head injury
This document discusses the management of pediatric head injuries. Key points include:
- Pediatric head trauma can have lifelong implications and risks are higher for boys starting at age 5. Moderate to severe injuries increase risks of behavioral/cognitive issues.
- Differences from adults include epidemiology, types of injuries like birth injuries or abuse, and responses like malignant cerebral edema more common in young children.
- Management involves stabilizing the patient, assessing GCS and pupils, controlling ICP/CPP, monitoring for herniation, providing nutrition/seizure prophylaxis, and considering decompressive craniectomy for refractory elevated ICP.
Central Hyperthermia
Central hyperthermia can occur after stroke or brain injury due to damage to the hypothalamus or brainstem centers that regulate temperature. It causes rapid onset fever without evidence of infection. Diagnosis involves ruling out infection and treatment uses a multimodal approach including medications like bromocriptine or baclofen to reduce fever by acting on dopamine or GABA receptors in the brain.
Traumatic Brain Injury: Approach
70% of RTA patients have head injury(HI).
One of the most important public health problems of today.
70% of deaths in RTA are due to HI.
At Risk population
Males 15-24
Infants
Young Children
Elderly
TRAUMATIC BRAIN INJURY
The document discusses strategies and rationale for decreasing secondary brain injury following traumatic brain injury (TBI). It describes that TBI consists of primary and secondary brain injury, with primary injury occurring immediately from mechanical forces and secondary injury developing over time from cellular and biochemical cascades. The document outlines various mechanisms of secondary injury including excitotoxicity, inflammation, edema, and ischemia. It then provides recommendations for treating and monitoring TBI to decrease secondary injury, such as decompressive craniectomy, ICP/CPP monitoring, ventilation strategies, hypothermia, hyperosmolar therapy, and seizure prophylaxis.
Approach to traumatic brain injury
This document provides an overview of traumatic brain injury (TBI), including:
1) It defines TBI and outlines primary and secondary brain injury mechanisms. Common causes include motor vehicle accidents, falls, and assaults.
2) It discusses evaluation and treatment, including importance of preventing hypotension and hypoxia. Neuroimaging with CT is important for diagnosis and prognosis.
3) Management of elevated intracranial pressure is also covered, including osmotherapy, sedation, cerebral perfusion pressure maintenance, temperature control, and avoiding hypocapnia or steroids.
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.
Traumatic Brain Injury
Traumatic brain injury (TBI) occurs when an external force causes damage to the brain. TBI can be classified based on severity and mechanism of injury. Common causes include motor vehicle accidents, falls, assaults, and sports-related injuries. Symptoms vary depending on the location and severity of the injury but may include cognitive and language deficits, memory loss, seizures, and behavioral changes. Prevention focuses on reducing risk factors like not wearing a helmet during activities or a seatbelt during vehicle travel. Occupational therapists can help people with TBI regain independence through tasks and environmental modifications.
Traumatic brain injury
This document provides information on traumatic brain injury (TBI) and its critical care management. It begins with definitions of TBI and classifications based on Glasgow Coma Scale. It then discusses the epidemiology of TBI and types of brain injuries that can occur. The remainder of the document covers assessment, monitoring of vital signs and intracranial pressure, treatment goals and interventions to prevent secondary brain injury, common complications, nursing care and rehabilitation.
Cereberal palsy dr hussein abass 2019 ppt
Cerebral palsy is caused by non-progressive disturbances in the developing fetal or infant brain that affect movement and posture. The document discusses the normal process of brain development and the critical periods of growth. The majority (80%) of causes are prenatal, such as maternal infections, drugs/alcohol exposure, genetic malformations, or complications during birth like prematurity, oxygen deprivation, or infections. While cerebral palsy was once considered static, some features like movement disorders and orthopedic complications can change over time.
Intraoperative Evoked Potential Monitoring
This presentation looks at intraoperative monitoring of auditory evoked potential, somato sensory evoked potential and motor evoked potential, procedure, pitfalls and utility.
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
Head injury( Diagnosis/symptoms/investigation/Treatment)
This document provides an overview of head injuries, including:
- Classifications based on mechanism (primary vs secondary), severity (Glasgow Coma Scale), and patho-anatomical findings (focal vs diffuse injuries).
- Evaluation involves history, physical exam including Glasgow Coma Scale, and imaging like CT scan per NICE guidelines.
- Management includes emergency stabilization, monitoring for raised intracranial pressure, and either conservative treatment like head elevation/blood pressure control or surgery depending on injury type and severity.
- Outcomes involve rehabilitation and discharge criteria for minor/mild injuries focus on neurological status and education.
Neurosurgical Emergencies Final
This document provides an overview of neurologic and neurosurgical emergencies that may present in the intensive care unit (ICU). It discusses altered consciousness, increased intracranial pressure, neurogenic respiratory failure, status epilepticus, acute stroke, intracerebral hemorrhage, subarachnoid hemorrhage, head trauma, and spinal cord injury. For each topic, it describes evaluations, potential causes, and management strategies.
Pediatric Head Trauma
1) Pediatric head trauma is a leading cause of death and disability in children, with over 650,000 evaluated per year. The causes vary by age, from abuse and falls in infants/toddlers to motor vehicle crashes and assaults in adolescents.
2) Management involves stabilizing the ABCs, preventing secondary brain injury, and obtaining a CT scan if indicated based on decision rules. For severe injuries, intensive care is needed for ICP monitoring, seizure prophylaxis, and treating complications like hypo/hyperglycemia.
3) While outcomes have improved with specialized pediatric trauma care, severe traumatic brain injury continues to carry high mortality rates around 40% and most survivors have long-term impairments.
Brain abscess
Repeat CT scans or MRIs are recommended every 1-2 weeks during antimicrobial therapy to monitor response. Scans should continue every 4-6 weeks for 3-6 months after completion of therapy to ensure resolution and check for recurrence. Earlier follow up scans may be needed if clinical deterioration occurs which could indicate treatment failure or recurrence.
Definitions, and approach to Coma
This document provides information on consciousness and coma:
- Consciousness has two components - arousal from the reticular activating system and awareness from the cerebral cortex. Stimulation of the RAS produces arousal while its destruction causes coma.
- The Glasgow Coma Scale and newer scales like FOUR are used to evaluate patients in comatose or reduced states of consciousness. The FOUR scale assesses eye, motor, brainstem, and respiratory responses.
- Causes of coma can be structural/focal brain injuries or non-structural/diffuse issues like hypoxia, infections, or toxic exposures. An approach is outlined to initially stabilize an unconscious patient and guide further examination and investigations.
Herpes simpex encephalitis
This document discusses encephalitis, which is inflammation of the brain caused by viral infection. It notes that herpes simplex virus is a common cause. There are two main types: primary encephalitis results from direct viral infection of the brain, while secondary encephalitis results from an immune system response to infection elsewhere in the body. Symptoms can range from mild headaches and sensitivity to light to confusion, slower movements, hallucinations, and coma. Diagnosis involves tests such as PCR, virus culture, and ELISA to detect viral antigens in the brain or antibodies in the blood. Treatment options for herpes simplex encephalitis include antiviral drugs like aciclovir.
Head injury
1) Management of acute traumatic head injury involves evaluating the patient using the Glasgow Coma Scale and performing a CT scan to determine the type and severity of injury.
2) Treatment depends on factors such as intracranial pressure and includes measures to control ventilation, blood pressure, oxygen levels, and reduce swelling in the brain.
3) Prognosis is influenced by age, severity of injury based on Glasgow Coma Scale, and presence of hypotension or hypoxia - all of which can be potentially controlled or mitigated through rapid evaluation and treatment.
Approach to the comatose patient
The document discusses coma, including its definition, causes, clinical assessment, investigations, differential diagnosis and management. Coma is characterized by a total lack of arousal and awareness lasting at least 1 hour. It can be caused by structural brain injuries or metabolic derangements and represents a severe impairment of cerebral function. A systematic clinical approach is needed to identify treatable causes of coma such as head injuries, infections, drugs or toxic exposures.
Moyamoya Angiopathy
This document discusses moyamoya disease, a progressive cerebral angiopathy characterized by stenosis of the internal carotid artery and development of collateral vessels appearing as a "puff of smoke". It is more common in East Asia and presents with ischemic or hemorrhagic strokes. Diagnosis is made through angiography showing the characteristic findings. Treatment involves surgical revascularization for symptomatic patients to prevent further strokes.
Nmosd & mog
Dr. Shubham Garg discusses neuromyelitis optica (NMO), an autoimmune condition where antibodies attack aquaporin-4 in the central nervous system. NMO predominantly affects women and has a median age of onset of 32-41 years. Key clinical features include transverse myelitis, typically longitudinally extensive, and severe optic neuritis. Treatment involves high-dose steroids for acute attacks and immunosuppressants like azathioprine to reduce relapse rates. Prognosis is generally worse than multiple sclerosis due to risk of cumulative disability, though relapse rates can be lowered with appropriate treatment.
Traumatic brain injury
Traumatic brain injury (TBI) is caused by external forces that impact or rapidly accelerate/decelerate the head. This can lead to primary injuries like contusions or hematomas from impact, or diffuse axonal injury from acceleration/deceleration forces. Secondary injuries may occur hours or days later and involve processes like cerebral edema, increased intracranial pressure, and reduced cerebral blood flow. The goals of management are to prevent secondary injuries by maintaining cerebral perfusion pressure and minimizing intracranial pressure increases through monitoring, treatment of complications, and other interventions.
Head injury management
head injury is serious dangerous and life threatening problem if NOT treated in time it takes the life of patient
Epilepsy surgery
This document discusses epilepsy surgery evaluation and outcomes. It notes that about one-third of epilepsy patients have seizures that cannot be controlled with medication. For these patients, surgical therapy can be an important treatment option. The goals of presurgical evaluation are to localize the epileptogenic zone and assess risk to brain functions from surgery. Evaluations may include brain imaging, video-EEG monitoring, neuropsychological testing, and in some cases invasive monitoring. Common indications for surgery include mesial temporal lobe epilepsy and lesions. Seizure freedom rates after surgery range from 50-90% depending on the specific diagnosis and evaluation findings. Outcome measures also consider cognitive and quality of life impacts.
Gbs Eps Am
Electrophysiology studies are essential for diagnosing Guillain-Barré syndrome (GBS) and determining the subtype. Parameters measured include distal latency, nerve conduction velocity, compound muscle action potential amplitude and duration, F-waves, and sensory conduction. Early GBS often shows absent H-reflexes and F-waves, low or absent sensory responses, and prolonged distal latencies. Electrodiagnosis can confirm GBS in 55% of early cases and helps classify it as demyelinating or axonal based on specific nerve conduction criteria. Serial studies track disease evolution and inform prognosis.
Traumatic Brain Injury (TBI)
Traumatic brain injury (TBI) can cause focal or diffuse damage to the brain from blunt or penetrating trauma. Immediately after a TBI there may be tissue damage, bleeding, and swelling in the brain. Evaluation involves assessing the airway, breathing, circulation, history of injury, and using the Glasgow Coma Scale to evaluate consciousness. Recovery from TBI is a multi-stage process that can continue for years and varies between individuals. Chest trauma can involve injuries such as pneumothorax, hemothorax, flail chest, and cardiac tamponade resulting from blunt or penetrating trauma to the chest. Crush syndrome results from prolonged compression of muscle and can lead to rhabdomyolysis, metabolic der
Diagnosis of MS and related disorders in children - Cheryl Hemingway
This document discusses the diagnosis of multiple sclerosis (MS) and related disorders in children. It begins by reviewing the spectrum of acquired demyelinating syndromes (ADS) and criteria for diagnosing pediatric MS. Through several case examples, it illustrates key features of ADS and differential diagnoses. It also discusses current challenges in diagnosis and new phenotypes associated with antibodies. The document emphasizes the importance of timely and accurate diagnosis to guide appropriate treatment in the potential window of therapeutic opportunity.
Glasgow coma scale
The Glasgow Coma Scale (GCS) is a neurological assessment tool used to determine the severity of brain injury or dysfunction. It assesses three factors: eye opening, verbal response, and motor response, with scores ranging from 3 to 15. Lower scores indicate more severe brain injury. The GCS aids in classifying brain injuries as mild, moderate, or severe and helps identify potential causes of decreased consciousness like hypoxemia or hypotension. Signs of increased intracranial pressure include deteriorating consciousness, headache, pupil abnormalities, and motor or sensory deficits. The GCS is a widely-used assessment for monitoring acute medical and trauma patients.
Glasgow Coma Scale Presentation
The Glasgow Coma Scale (GCS) was developed as a simple, practical tool for assessing neurological injury and monitoring patients. It evaluates eye opening, verbal response, and motor response on a scale of 3-15. A lower score indicates a lower level of consciousness and worse prognosis. While initially created for adults, modified versions have been made for children who cannot communicate verbally. Though developed decades ago, the GCS remains the standard for initial assessment of brain injury severity and predicting outcomes.
More Related Content
What's hot
Cereberal palsy dr hussein abass 2019 ppt
Cerebral palsy is caused by non-progressive disturbances in the developing fetal or infant brain that affect movement and posture. The document discusses the normal process of brain development and the critical periods of growth. The majority (80%) of causes are prenatal, such as maternal infections, drugs/alcohol exposure, genetic malformations, or complications during birth like prematurity, oxygen deprivation, or infections. While cerebral palsy was once considered static, some features like movement disorders and orthopedic complications can change over time.
Intraoperative Evoked Potential Monitoring
This presentation looks at intraoperative monitoring of auditory evoked potential, somato sensory evoked potential and motor evoked potential, procedure, pitfalls and utility.
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
Head injury( Diagnosis/symptoms/investigation/Treatment)
This document provides an overview of head injuries, including:
- Classifications based on mechanism (primary vs secondary), severity (Glasgow Coma Scale), and patho-anatomical findings (focal vs diffuse injuries).
- Evaluation involves history, physical exam including Glasgow Coma Scale, and imaging like CT scan per NICE guidelines.
- Management includes emergency stabilization, monitoring for raised intracranial pressure, and either conservative treatment like head elevation/blood pressure control or surgery depending on injury type and severity.
- Outcomes involve rehabilitation and discharge criteria for minor/mild injuries focus on neurological status and education.
Neurosurgical Emergencies Final
This document provides an overview of neurologic and neurosurgical emergencies that may present in the intensive care unit (ICU). It discusses altered consciousness, increased intracranial pressure, neurogenic respiratory failure, status epilepticus, acute stroke, intracerebral hemorrhage, subarachnoid hemorrhage, head trauma, and spinal cord injury. For each topic, it describes evaluations, potential causes, and management strategies.
Pediatric Head Trauma
1) Pediatric head trauma is a leading cause of death and disability in children, with over 650,000 evaluated per year. The causes vary by age, from abuse and falls in infants/toddlers to motor vehicle crashes and assaults in adolescents.
2) Management involves stabilizing the ABCs, preventing secondary brain injury, and obtaining a CT scan if indicated based on decision rules. For severe injuries, intensive care is needed for ICP monitoring, seizure prophylaxis, and treating complications like hypo/hyperglycemia.
3) While outcomes have improved with specialized pediatric trauma care, severe traumatic brain injury continues to carry high mortality rates around 40% and most survivors have long-term impairments.
Brain abscess
Repeat CT scans or MRIs are recommended every 1-2 weeks during antimicrobial therapy to monitor response. Scans should continue every 4-6 weeks for 3-6 months after completion of therapy to ensure resolution and check for recurrence. Earlier follow up scans may be needed if clinical deterioration occurs which could indicate treatment failure or recurrence.
Definitions, and approach to Coma
This document provides information on consciousness and coma:
- Consciousness has two components - arousal from the reticular activating system and awareness from the cerebral cortex. Stimulation of the RAS produces arousal while its destruction causes coma.
- The Glasgow Coma Scale and newer scales like FOUR are used to evaluate patients in comatose or reduced states of consciousness. The FOUR scale assesses eye, motor, brainstem, and respiratory responses.
- Causes of coma can be structural/focal brain injuries or non-structural/diffuse issues like hypoxia, infections, or toxic exposures. An approach is outlined to initially stabilize an unconscious patient and guide further examination and investigations.
Herpes simpex encephalitis
This document discusses encephalitis, which is inflammation of the brain caused by viral infection. It notes that herpes simplex virus is a common cause. There are two main types: primary encephalitis results from direct viral infection of the brain, while secondary encephalitis results from an immune system response to infection elsewhere in the body. Symptoms can range from mild headaches and sensitivity to light to confusion, slower movements, hallucinations, and coma. Diagnosis involves tests such as PCR, virus culture, and ELISA to detect viral antigens in the brain or antibodies in the blood. Treatment options for herpes simplex encephalitis include antiviral drugs like aciclovir.
Head injury
1) Management of acute traumatic head injury involves evaluating the patient using the Glasgow Coma Scale and performing a CT scan to determine the type and severity of injury.
2) Treatment depends on factors such as intracranial pressure and includes measures to control ventilation, blood pressure, oxygen levels, and reduce swelling in the brain.
3) Prognosis is influenced by age, severity of injury based on Glasgow Coma Scale, and presence of hypotension or hypoxia - all of which can be potentially controlled or mitigated through rapid evaluation and treatment.
Approach to the comatose patient
The document discusses coma, including its definition, causes, clinical assessment, investigations, differential diagnosis and management. Coma is characterized by a total lack of arousal and awareness lasting at least 1 hour. It can be caused by structural brain injuries or metabolic derangements and represents a severe impairment of cerebral function. A systematic clinical approach is needed to identify treatable causes of coma such as head injuries, infections, drugs or toxic exposures.
Moyamoya Angiopathy
This document discusses moyamoya disease, a progressive cerebral angiopathy characterized by stenosis of the internal carotid artery and development of collateral vessels appearing as a "puff of smoke". It is more common in East Asia and presents with ischemic or hemorrhagic strokes. Diagnosis is made through angiography showing the characteristic findings. Treatment involves surgical revascularization for symptomatic patients to prevent further strokes.
Nmosd & mog
Dr. Shubham Garg discusses neuromyelitis optica (NMO), an autoimmune condition where antibodies attack aquaporin-4 in the central nervous system. NMO predominantly affects women and has a median age of onset of 32-41 years. Key clinical features include transverse myelitis, typically longitudinally extensive, and severe optic neuritis. Treatment involves high-dose steroids for acute attacks and immunosuppressants like azathioprine to reduce relapse rates. Prognosis is generally worse than multiple sclerosis due to risk of cumulative disability, though relapse rates can be lowered with appropriate treatment.
Traumatic brain injury
Traumatic brain injury (TBI) is caused by external forces that impact or rapidly accelerate/decelerate the head. This can lead to primary injuries like contusions or hematomas from impact, or diffuse axonal injury from acceleration/deceleration forces. Secondary injuries may occur hours or days later and involve processes like cerebral edema, increased intracranial pressure, and reduced cerebral blood flow. The goals of management are to prevent secondary injuries by maintaining cerebral perfusion pressure and minimizing intracranial pressure increases through monitoring, treatment of complications, and other interventions.
Head injury management
head injury is serious dangerous and life threatening problem if NOT treated in time it takes the life of patient
Epilepsy surgery
This document discusses epilepsy surgery evaluation and outcomes. It notes that about one-third of epilepsy patients have seizures that cannot be controlled with medication. For these patients, surgical therapy can be an important treatment option. The goals of presurgical evaluation are to localize the epileptogenic zone and assess risk to brain functions from surgery. Evaluations may include brain imaging, video-EEG monitoring, neuropsychological testing, and in some cases invasive monitoring. Common indications for surgery include mesial temporal lobe epilepsy and lesions. Seizure freedom rates after surgery range from 50-90% depending on the specific diagnosis and evaluation findings. Outcome measures also consider cognitive and quality of life impacts.
Gbs Eps Am
Electrophysiology studies are essential for diagnosing Guillain-Barré syndrome (GBS) and determining the subtype. Parameters measured include distal latency, nerve conduction velocity, compound muscle action potential amplitude and duration, F-waves, and sensory conduction. Early GBS often shows absent H-reflexes and F-waves, low or absent sensory responses, and prolonged distal latencies. Electrodiagnosis can confirm GBS in 55% of early cases and helps classify it as demyelinating or axonal based on specific nerve conduction criteria. Serial studies track disease evolution and inform prognosis.
Traumatic Brain Injury (TBI)
Traumatic brain injury (TBI) can cause focal or diffuse damage to the brain from blunt or penetrating trauma. Immediately after a TBI there may be tissue damage, bleeding, and swelling in the brain. Evaluation involves assessing the airway, breathing, circulation, history of injury, and using the Glasgow Coma Scale to evaluate consciousness. Recovery from TBI is a multi-stage process that can continue for years and varies between individuals. Chest trauma can involve injuries such as pneumothorax, hemothorax, flail chest, and cardiac tamponade resulting from blunt or penetrating trauma to the chest. Crush syndrome results from prolonged compression of muscle and can lead to rhabdomyolysis, metabolic der
Diagnosis of MS and related disorders in children - Cheryl Hemingway
This document discusses the diagnosis of multiple sclerosis (MS) and related disorders in children. It begins by reviewing the spectrum of acquired demyelinating syndromes (ADS) and criteria for diagnosing pediatric MS. Through several case examples, it illustrates key features of ADS and differential diagnoses. It also discusses current challenges in diagnosis and new phenotypes associated with antibodies. The document emphasizes the importance of timely and accurate diagnosis to guide appropriate treatment in the potential window of therapeutic opportunity.
What's hot (20)
Head injury( Diagnosis/symptoms/investigation/Treatment)
Head injury( Diagnosis/symptoms/investigation/Treatment)
Diagnosis of MS and related disorders in children - Cheryl Hemingway
Diagnosis of MS and related disorders in children - Cheryl Hemingway
Viewers also liked
Glasgow coma scale
The Glasgow Coma Scale (GCS) is a neurological assessment tool used to determine the severity of brain injury or dysfunction. It assesses three factors: eye opening, verbal response, and motor response, with scores ranging from 3 to 15. Lower scores indicate more severe brain injury. The GCS aids in classifying brain injuries as mild, moderate, or severe and helps identify potential causes of decreased consciousness like hypoxemia or hypotension. Signs of increased intracranial pressure include deteriorating consciousness, headache, pupil abnormalities, and motor or sensory deficits. The GCS is a widely-used assessment for monitoring acute medical and trauma patients.
Glasgow Coma Scale Presentation
The Glasgow Coma Scale (GCS) was developed as a simple, practical tool for assessing neurological injury and monitoring patients. It evaluates eye opening, verbal response, and motor response on a scale of 3-15. A lower score indicates a lower level of consciousness and worse prognosis. While initially created for adults, modified versions have been made for children who cannot communicate verbally. Though developed decades ago, the GCS remains the standard for initial assessment of brain injury severity and predicting outcomes.
Ppt ilkom new
Dokumen tersebut membahas tentang definisi, manfaat, parameter, dan prosedur pemeriksaan Glasgow Coma Scale (GCS) untuk menilai tingkat kesadaran pasien. GCS digunakan untuk menentukan derajat kesadaran pada pasien dengan kecelakaan, hipoksia, shock, keracunan obat atau alkohol, dan gangguan metabolik. Parameter GCS terdiri dari penilaian respon mata, verbal, dan motorik pasien. Contoh penerapan GCS juga dijelask
pemeriksaan GCS.ppt
ppt ini merupakan tugas dari mata kuliah ilmu komputer tentang pembuatan media pembelajaran
ECMO in NZ by McGuinness
This document summarizes New Zealand's national adult ECMO service based in Auckland City Hospital. ECMO uses an extracorporeal circuit to support the lungs and/or heart for extended periods. The national service began in 1993 and established a mobile ECMO retrieval team in 2005 to place and transport patients on ECMO anywhere in New Zealand. The mobile ECMO system was designed to be lightweight and portable to transport patients by road, fixed wing aircraft, or helicopter. During the 2009 H1N1 influenza pandemic, the service experienced a surge in ECMO cases and transports across New Zealand.
Neurological Assessment & Artificial Airway Management
NEW BLOGSITE ADDRESS:
"Nurses Information Site"
http://nursesinfosite.blogspot.com
Please leave a comment after downloading.
Thank You
Heroism vs Safety in Healthcare by Peter Brindley
The battle is on...who will win out: the heroic healthcare individual or the faceless safety checklist? Well, obviously, it's not that simple...but, then again, nor is it that complicated. We need to harness the best of both and this talk hopes to strike that balance. This requires a discussion of human strengths and weaknesses, and ditto for computers and checklists. This talk hopes to ensure that the Human Factor is always a factor, and to suggest what can be learnt if we understand healthcare in sociology and psychology terms. It also hopes to explain why a team of experts is not necessarily an expert team, and why our verbal dexterity is likely our greatest skill or liability. This talk offers practical examples of how to improve teamwork, communication, situational awareness, resource utilization and decision making, in other words, our crisis management skills. While it is time to stop searching for simple answers to complex problems, it is also time to stop ignoring all those lessons that can be learnt from others. Above all this talk hopes to put the patient's needs back where they belong: at the very centre of a complex, beguiling, but also magnificent health system. If this talks fails in that noble goal then the speaker wants to hear from you: he doesn't want to be wrong a moment longer than is absolutely necessary
Cutting Edge Resuscitation in the Community ED by Bellezo
This document discusses prehospital resuscitation strategies for cardiac arrest patients, including the use of extracorporeal membrane oxygenation (ECMO) in the emergency department. It outlines goals for chest compression rate, depth, and fraction during cardiopulmonary resuscitation based on American Heart Association guidelines. The document also describes setting up "Room 22" in the emergency department for resuscitation efforts and the use of devices like arterial lines, mechanical chest compression, and intra-aortic balloon pumps. Survival rates for cardiac arrest patients increased from 13% in 2010 to 28% in 2014 with these resuscitation approaches.
How to use ketamine fearlessly for all its indications smacc 2015 no builds
SMACC Conference Reuben Strayer Ketamine is best known for producing dissociative anesthesia by a unique mechanism where cardio-respiratory function is preserved. It has an extraordinary safety profile that lends itself well to a variety of uses in the emergency department, intensive care, and pre-hospital environments. We will discuss many of these applications, with a focus on the myths and controversies that might discourage emergency clinicians from taking advantage of this remarkable agent.
Managing the Transected Airway by Georgie Harris
The management of the transected airway is frightening because it is a rare airway emergency and one that does not fit the usual plan A,B,C airway management algorithms. An approach is presented which considers two principal anatomical distinctions for injuries both above and below the cricoid cartilage.
Secondly, the mechanism of injury is classified according to whether it is either penetrating or blunt trauma. Finally the airway management urgency is described according to either an immediate or semi-urgent approach being required. These three approaches, the location of the injury relative to the cricoid, the mechanism of the injury and thirdly, the urgency of the airway intervention required are then applied together to provide a guide to management of the transected airway.
Andrew Naidech - Intracerebral Hemorrhage: Down, Not Out
Intracerebral hemorrhage (ICH) can lead to disability and complications that drive patients away from neurology. While some patients may have a "good outcome" of modified Rankin scale score of 3 or less, their applied cognition and physical function may be impaired in different ways. New strategies are being developed and tested to minimize hematoma growth, evacuate blood clots, prevent complications, and better assess outcomes in order to improve prognosis for patients with ICH.
Coping with a Terrible Error by Simon Carley
Error is almost inevitable in our clinical practice so we should be prepared to help and prepare those individuals involved for the benefit of them, our systems and our patients.
Do you remember that patient you saw last night?': A phrase the strikes terror into the hearts of all physicians. The prospect of a patient coming to harm as a result of a mistake is terrifying but it can and does happen.
The consequences for the patient and their family are often tragic but what of the clinicians who made the error? For many the result of making a terrible error is life changing.
Those permanently harmed by error are often referred to as second victims with the consequences of terrible events being life-long.
This talk explores the predictable course for clinicians who are involved in error and asks whether we can prepare and support such individuals through a difficult time.
Mike Winters - Don’t Forget A and B!
Don't Forget A & B!
Over 500,000 patients per year suffer sudden cardiac arrest. Despite advances in our understanding and management of cardiac arrest, less than 15% of patients survive to hospital discharge with meaningful neurologic survival. In recent years, the focus of cardiac arrest resuscitation has been the delivery of high-quality chest compressions and early defibrillation for those with a shockable rhythm. As a result, airway interventions and ventilation now follow attempts to optimize circulation in cardiac arrest patients. Though high-quality CPR and early defibrillation are essential in the initial stages of resuscitation, advanced airway placement and appropriate ventilation are critical to overall patient survival.
Dr. Winters' discusses the current literature on the timing of advanced airway placement, oxygenation, and ventilation for the cardiac arrest patient. In addition, he discusses optimal targets for oxygenation and ventilation in the patient with return of spontaneous circulation from sudden cardiac arrest.
10 Things you Need to Know about TBI by Knight
This document discusses traumatic brain injury (TBI) and strategies for treatment. It provides the following key points:
1. TBI is a major public health problem in the US, resulting in over 50,000 deaths, 100,000 hospitalizations, and 1.1 million emergency department visits annually.
2. Secondary injury after initial TBI can lead to further brain damage through various pathological mechanisms like excitotoxicity, inflammation, and apoptosis.
3. There are established and emerging pharmacological strategies to reverse the effects of drugs that may exacerbate bleeding after TBI, like aspirin, Plavix, warfarin, and newer oral anticoagulants, but more research is still needed
Meditation Performance and Critical Care: Scott Weingart
The document discusses the results of a study on the impact of COVID-19 lockdowns on air pollution. Researchers found that lockdowns led to significant short-term reductions in nitrogen dioxide and fine particulate matter pollution globally as economic activities slowed. However, the impacts on greenhouse gases and long-term air quality improvements remain uncertain without permanent behavior and economic changes.
Forgotten Cardiovascular Physiology by Myburgh
The human circulation is a complex system that has evolved over millenia, primarily designed to promptly respond to conditions of stress - the fight and flight response. The traditional physiological approach focuses on the heart as a pump, adapting to changes in volume and metabolic states.
These principles are underpinned by the Starling equation and incorporated into an adaptation of Ohm\'s law. These principles have been maladapted, punctuated by an increasing reliance on surrogate and derived variables that have little to do with teleological haemodyanamic responses. Insights into the central role of the autonomic nervous system are provided by Guytonian theory that in part explain the physiological fallacy germane to many clinical protocols and practices. These fallacies have been amplified by commercial studies directed at short-term physiological improvements that have little to do with patient-centred outcomes in the medium and longer term. Such effects have been demonstrated in recent high-quality RCTs that force a re-appraisal of seductive short-term physiologically-based gratification.
Breaking Bad (News) by David Anderson
What is the problem?
Delivering bad news and having an end of life conversation are core skills for any practitioner who deals with critically ill patients. Current data show that while 22% of deaths in the USA now occur in ICU, 54% of families surveyed have a poor understanding of patient’s diagnosis, treatment plan and prognosis. Dr. Kate Granger found this out first hand while admitted to hospital in the UK and started the #hellomynameis campaign.
What is the evidence?
While families feel more validated if given longer to speak, doctors speak for 71% of the time in family meetings. -Longer meetings are also associated with greater patient and family member satisfaction. -Patients perceive that doctors spend longer with them if the doctor is sitting down. -Use of a simple mnemonic increases satisfaction and reduced the incidence of PTSD in family members.
What do experts do?
1. Prepare for the meeting. Decide who will attend, what you will talk about and what your goals are.
2. Introduce everyone and explain the agenda.
3. Gather everyone’s understanding
4. Listen and don’t interrupt5Empathise (physicians express no empathy in 1/3 of family meetings)
6. Make the patient’s voice heard
7. Make your recommendation to go forward
8. Reflect on the meeting after it concludes
What about the difficult situations?
Hope is an issue that comes up often. Many other specialties emphasise the importance of hope, while intensivists are often seen as being nihilistic. But we can still foster a degree of hope in patients and families without being unrealistic. -Techniques for managing conflict are discussed such as identifying discord in the family and avoiding mixed messages from staff. -The importance of spirituality is discussed.
Remote Ischaemic Conditioning and Critical Care
Remote Ischaemic Conditioning and Critical Care by Paul Young. Paul delves into the pitfalls of clinical research. Coda Podcasts.
1455 wilson
Martin Smith
The management of severe traumatic brain injury (TBI) has undergone extensive revision following evidence that longstanding and established practices are not as efficacious or innocuous as previously believed. Very few specific interventions have been shown to improve outcome in large randomized controlled trials and, with the possible exception of avoidance of hypotension and hypoxaemia, most are based on observational studies or analysis of physiology and pathophysiology. Further, the substantial temporal and regional pathophysiological heterogeneity after TBI means that some interventions may be ineffective, unnecessary or even harmful in certain patients at certain times.
Improved understanding of pathophysiology and advances in neuromonitoring and imaging techniques have led to the introduction of more effective and individualised treatment strategies that have translated into improved outcomes for patients. In particular, the sole goal of identifying and treating intracranial hypertension has been superseded by a focus on the prevention of secondary brain insults using a systematic, stepwise approach to maintenance of adequate cerebral perfusion and oxygenation. As well as being used to guide treatment interventions, multimodal neuromonitoring also gives clinicians confidence to withhold potentially dangerous therapy in those with no evidence of brain ischemia/hypoxia or metabolic disturbance.
The days of blind adherence to generic physiological targets in the management of severe TBI have been replaced by an individualised approach to optimisation of physiology which has translated into improved outcomes for patients.
Mark Wilson
The New England Journal of Medicine has published a number of articles recently that demonstrate no benefit from classic neurotrauma interventions (ICP monitoring, cooling, decompression). This is because factors such as ICP and CPP are associated with bad outcome by association rather than causation. This debate will demonstrate that critical care just complicates things and it is high time for the randomised trial between the very best Neurocritical care and NOB therapy (Naso-pharyngeal, Oxygen and a Blanket).
Learning from excellence in critical care
Adrian Plunkett describes how to learn from excellence in critical care. Learning from excellence is an initiative which began at Birmingham Children’s Hospital.
Firstly, Adrian shares an anecdote regarding how the initiative begun. He sent a letter to the CEO of a hospital appreciating one of the doctors who treated him for cancer. The doctor unfortunately never received it. This caused Adrian to ask - is appreciation and gratitude undervalued?
Evidently, noticing excellence will lead to two things: learning new insights and increasing staff morale.
Adrian raises the question, why we do we not focus on the good things? We spend all our time improving safety and quality even though accidents and disasters are only a small percentage of what we do.
Moreover, Adrian claims that people inherently have negative biases. This is evident in healthcare, so how can we combat this?
The solution is to focus on excellent care. This led to the formation of a reporting system called Learning from Excellence (LfE), where people answer two questions: Who did something excellent? What did they do?
LfE is a formal system for reporting and providing positive feedback and appreciation to the healthcare workers. It is a beneficial and constructive way of learning from excellence.
Finally, Adrian explains, “Saying ‘thank you’ or ‘well done’ is the easiest quality improvement intervention of all.”
Learning from excellence in critical care by Adrian Plunkett
For more like this head to our podcast page. #CodaPodcast
Viewers also liked (20)
Neurological Assessment & Artificial Airway Management
Neurological Assessment & Artificial Airway Management
Cutting Edge Resuscitation in the Community ED by Bellezo
Cutting Edge Resuscitation in the Community ED by Bellezo
How to use ketamine fearlessly for all its indications smacc 2015 no builds
How to use ketamine fearlessly for all its indications smacc 2015 no builds
Andrew Naidech - Intracerebral Hemorrhage: Down, Not Out
Andrew Naidech - Intracerebral Hemorrhage: Down, Not Out
Meditation Performance and Critical Care: Scott Weingart
Meditation Performance and Critical Care: Scott Weingart
Similar to Goodbye GCS! - Mark Wilson
Neuroradiology in ms
Neuroradiology in multiple sclerosis
MRI in diagnosis of MS
MRI in D.D. of MS
MRI in monitoring disease progression and response to DMT
New imaging techniques
Ptsd professional surfer
The document discusses a case study of a professional surfer who developed PTSD after a traumatic accident during a surfing trip in Fiji. He experienced symptoms like insomnia, panic attacks, and flashbacks. A QEEG brain scan showed abnormalities in areas associated with PTSD. The surfer underwent 20 sessions of remote neurofeedback therapy. This treatment helped reduce his PTSD symptoms and balance his brainwaves, as shown on a post-treatment QEEG. As a result, he was able to return to competitive surfing successfully. While PTSD cannot be cured, neurofeedback can significantly reduce symptoms and improve functioning.
Dr Trevor Pickersgill - Diagnosing a Relapse
1) Diagnosing relapses in multiple sclerosis (MS) patients can be complex, as relapses can mimic other conditions and symptoms are not always clearly MS-related.
2) It is important to properly diagnose relapses to determine the MS disease course, guide treatment decisions, and understand the patient's prognosis.
3) In addition to traditional relapses, atypical presentations must be considered, such as relapses related to MS treatments, infections, neurological conditions mimicking MS, and non-neurological or functional issues. A thorough examination is needed.
Mild cognitive impairment
What is normal aging? What is mild cognitive impairment (MCI)? How do I know if I have Alzheimer's disease?
Preventing dementia.
Multiple sclerosis current and emerging treatments personalized strategies
Multiple sclerosis current and emerging treatments personalized strategiesPeople with Multiple Sclerosis (Vic) Inc.
This document discusses multiple sclerosis (MS), including its diagnostic criteria, classification, clinical courses, and current and emerging treatments. It begins by defining radiologically isolated syndrome, clinically isolated syndrome, relapsing-remitting MS, secondary progressive MS, and primary progressive MS. It then discusses the McDonald criteria for diagnosing MS and provides a case study example. Current MS therapies discussed include interferon-β, glatiramer acetate, natalizumab, mitoxantrone, and teriflunomide. The document concludes by discussing considerations for deciding which MS medication to use based on whether therapeutic goals are being met or not.Progress in Multiple Sclerosis Research
This document discusses multiple sclerosis (MS), including its diagnostic criteria, classification, clinical courses, and current and emerging treatments. It describes the typical demyelinating diseases associated with MS, including radiologically isolated syndrome, clinically isolated syndrome, relapsing-remitting MS, secondary progressive MS, and primary progressive MS. It also covers the McDonald criteria for diagnosing MS and examines radiological and clinical evidence for dissemination in space and time. The document discusses approaches for determining treatment goals and assessing whether those goals are being met, and considerations for switching or changing MS disease-modifying therapies.
Dementia updates
1) Cognitive decline is a normal part of aging, but dementia is characterized by multiple cognitive deficits severe enough to interfere with daily life. The DSM-V criteria distinguish between mild and major neurocognitive disorders.
2) Mild cognitive impairment (MCI) represents an intermediate stage between normal aging and dementia, with greater cognitive decline than normal but preserved independence. Amnestic MCI is highly predictive of Alzheimer's disease.
3) Biomarkers like MRI, CSF analysis, PET imaging, and genetics can help predict conversion from MCI to dementia and distinguish Alzheimer's disease from other causes. Biomarkers show changes decades before symptoms appear in preclinical Alzheimer's disease.
Ms
This document discusses multiple sclerosis (MS), including:
1) Epidemiology shows it is most common in young white women at northern latitudes and those with Scandinavian ancestry or vitamin D deficiency.
2) Diagnosis relies on clinical patterns and exclusion of other causes, supported by MRI, CSF, and evoked potential studies showing lesions in white matter tracts.
3) The 2010 McDonald criteria provide guidelines for diagnosing MS based on demonstrations of dissemination of lesions in space and time through clinical attacks and imaging/laboratory results.
[DSC Croatia 22] Can we measure depression? - Eda Jovicic & Damir Mulc
Recently, problems related to depression have been recognized as one of the leading issues in healthcare. The question of equalizing and validating different qualitative states of depression has become inevitable, because although every depressed person is unhappy in their own way, some features are common. Our goal is to try and find those features, using electroencephalography (EEG) to record electrical activity of the brain. Processing and analyzing recorded signals using machine learning methods, we tried to distinguish whether there is a difference between healthy and depressed people.
Understanding, Diagnosing, and Classifying MS Symptom Management
Understanding, Diagnosing, and Classifying MS Symptom Management. Presented by Tricia Pagnotta, MSN, ARNP, CNRN, MSCN at the MS Views and News Education Seminar Maitland, Fl on April 2013
The neurobiology of everyday life final project
1. The document is a final project by a clinical psychologist analyzing how understanding the brain course helped her work with children with developmental disabilities including Down syndrome.
2. It summarizes what is known about the neurobiology of Down syndrome including smaller brain volumes and impaired functions like language and memory.
3. The course helped the psychologist better understand the complexity of intelligence and disabilities, reminded her it's a common problem with varied impacts, and emphasized seeing the whole person beyond just impairments.
Glasgow Coma Scale
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.
Level of consciousness (GCS)
1) Level of consciousness refers to how responsive a person is to external stimuli and can be altered due to structural issues like trauma or tumors, metabolic derangements like hypoglycemia, or infections in the brain.
2) The Glasgow Coma Scale is used to objectively measure a person's level of consciousness on a scale of 3 to 15 to determine the severity of a brain injury.
3) Investigations like blood tests, imaging studies, and monitoring of vital signs are used to identify potential medical causes of an altered level of consciousness in order to guide management and resuscitation.
Therapy With The Traumatized
This was presented with Lynn Stacy for students attending Psychotherapy 340 class at Methodist Theological School in Delaware, Ohio
Hanipsych, updates on neurobiology and neurotoxicity of depression
The depressed brain shows structural and functional differences compared to a non-depressed brain. Specifically, decreased gray matter is seen in cortical and limbic regions that control emotion, mood, and cognition. Abnormal changes in white matter include glial hypertrophy and compromised integrity. Some evidence suggests the brain changes have a progressive nature.
The Efficacy of Post Traumatic Stress Disorder Research for Former High Deman...
This document reviews research on diagnostic techniques and therapeutic options for Post Cult Trauma Syndrome (PCTS), including those informed by Post Traumatic Stress Disorder (PTSD) research. It summarizes findings on neuroimaging techniques for PTSD diagnosis and treatments such as neurofeedback, eye movement desensitization and reprocessing (EMDR), emotional freedom techniques, and somatic techniques. The document concludes that former group members struggling with PCTS may benefit from PTSD research findings and therapies, as well as trauma-specific therapies, which could open new avenues of study.
Autoimmune Encephalitis
1. Autoimmune encephalitis is a debilitating form of encephalitis caused by inflammation of the brain due to an autoimmune response.
2. It is diagnosed based on subacute onset of neurological or psychiatric symptoms, MRI and CSF findings, and exclusion of alternative causes.
3. First line treatment involves steroids, IVIG, and plasmapheresis, while second line may include rituximab and cyclophosphamide if the first line treatments are not effective.
20110810_wickwire.ppt
This document discusses a comprehensive, interdisciplinary approach to treating sleep disorders. It argues that insomnia and sleep-related breathing disorders (SRBD) like sleep apnea often co-occur and should be treated concurrently. Treating both disorders can improve outcomes more than treating either one alone. The document provides an overview of insomnia and SRBD, including definitions, epidemiology, consequences, evaluation methods, and treatment options like cognitive behavioral therapy and positive airway pressure. It emphasizes that multi-system sleep problems require evaluating and addressing all relevant factors through a multi-pronged treatment approach.
James_Fitch_Poster Presentation
This study analyzed microhemorrhages (MH) in brain tissue samples from individuals with Down syndrome (DS), Alzheimer's disease (AD), and DS with AD, compared to age-matched controls. Brain tissue was stained to identify iron-rich MH near blood vessels. MH counts were significantly higher in samples from individuals with DS/AD compared to all other groups, as well as higher in AD samples compared to controls. The results suggest cerebrovascular dysfunction may contribute to brain aging in DS, and that DS combined with AD further increases MH counts more than AD alone.
MCI REVIEW 2013
Mild cognitive impairment (MCI) refers to slight declines in cognitive abilities that are greater than normal aging but do not significantly interfere with daily life. The document discusses the criteria for diagnosing MCI, controversies around the definition, prevalence increasing with age from 1-34%, and high risk of progression to dementia at a rate of 10-15% per year. While no treatments have proven effective, lifestyle factors like exercise, diet, and cognitive stimulation may help prevent further decline.
Similar to Goodbye GCS! - Mark Wilson (20)
Multiple sclerosis current and emerging treatments personalized strategies
Multiple sclerosis current and emerging treatments personalized strategies
[DSC Croatia 22] Can we measure depression? - Eda Jovicic & Damir Mulc
[DSC Croatia 22] Can we measure depression? - Eda Jovicic & Damir Mulc
Understanding, Diagnosing, and Classifying MS Symptom Management
Understanding, Diagnosing, and Classifying MS Symptom Management
Hanipsych, updates on neurobiology and neurotoxicity of depression
Hanipsych, updates on neurobiology and neurotoxicity of depression
The Efficacy of Post Traumatic Stress Disorder Research for Former High Deman...
The Efficacy of Post Traumatic Stress Disorder Research for Former High Deman...
More from SMACC Conference
Precision Medicine in Acute Brain Injury
Systematic review of 26 studies with 55,792 patients found that dedicated neurocritical care (NCC) was associated with decreased risk of mortality (17% relative risk reduction) and decreased risk of poor functional outcomes (17% relative risk reduction) in critically ill brain-injured adults. A survey of Australian ICUs found limited availability of NCC, with only 4 centers specializing in it and 9 employing an intensivist subspecializing in NCC. Continuous EEG monitoring was found to have higher sensitivity for detecting nonconvulsive seizures than routine EEG monitoring, and was associated with reduced in-hospital mortality, though barriers to its universal use include infrastructure and personnel requirements.
CSD by Jeffcote Coda 22.pdf
CORTICAL SPREADING DEPOLARISATION IN NEUROLOGICAL DISEASE – AN INTRODUCTION
By Toby Jeffcote
Cortical spreading depolarization (CSD) is a spreading loss of ion homeostasis, altered vascular response, change in synaptic architecture, and subsequent depression in electrical activity following an inciting neurological injury.
It was first described by Leão in 1944, a disturbance in neuronal electrophysiology has since been demonstrated in a number of animal studies, and recently a few human studies that examine the occurrence of this depolarizing phenomenon in the setting of a variety of pathological states, including migraines, cerebrovascular accidents, epilepsy, intracranial hemorrhages, and traumatic brain injuries. The onset of CSD has been demonstrated experimentally following a disruption in the neuronal environment leading to glutamate-induced toxicity. This initial event leads to pathological changes in the activity of ion channels that maintain membrane potential. Recovery mechanisms such as sodium-potassium pumps that aim to restore homeostasis fail, leading to osmolar shifts of fluid, swelling of the neuron, and ultimately a measurable depression in cortical activity that spreads in the order of millimeters per minute. Equally important is the resulting change in vascular response. In healthy tissue, increased electrical activity is coupled with release of vasodilatory factors such as nitric oxide and arachidonic acid metabolites that increase local blood flow to meet increased energy expenditure. In damaged tissue, not only is the restorative vascular response lacking but a vasoconstrictive response is promoted and the ischemia that follows adds to the severity of the initial injury. Tissue threatened by this ischemic response is then at elevated risk for CSD propagation and falls into a vicious cycle of electrical and hemodynamic disturbance. Efforts have been made to halt this spreading cortical depression using N-methyl-D-aspartate receptor antagonists and other ion channel blockers to minimize the damaging effects of CSD that can persist long after the triggering insult.
Subdural Haemorrhage and MMA embolisation
Celia Bradford takes us through the latest on the management of subdural haemorrhage (SDH). She covers acute SDH, chronic SDH and middle meningeal artery embolisation, a novel treatment for chronic SDH management in certain circumstances.
Andy Neill - More neuroanatomy pearls for neurocritical care
Andy Neill shares some more neuroanatomy wisdom that's highly practical for anyone working with neuro emergencies. This time he covers brain herniation syndromes, hydrocephalus, extradural vs subdural haematomas, cervical spinal imaging, vertebral artery dissection and "things you read on CT reports but don't know what they mean"!
The BONANZA Trial and PbTO2 Monitoring
Andrew Udy talks about Brain Tissue Oxygen Monitoring:
It’s Not What You’ve Got It’s What You Do With It
The BONANZA Trial
Andrew Udy talks about the ongoing BONANZA Trial which is assessing whether an algorithm that incorporates both ICP and brain tissue oxygen (PbTO2) can improve outcomes after traumatic brain injury (TBI). Like with all monitoring, how the PbTO2 is interpreted and managed is critical and the devil is in the detail!
More on BONANZA here
More on BOOST3 here
Dilating the Dogma of Vasospasm
R. Loch Macdonald, M.D., Ph.D.
Community Neurosciences Institute
Fresno, California, USA
Angiographic vasospasm and more accurately, delayed cerebral ischemia, continue to contribute to morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (SAH). It is known that angiographic vasospasm is common after SAH, occurring in two-thirds of patients. Cerebral infarctions that developed days after the SAH have been attributed to angiographic vasospasm, occuring in about a third of patients, although this has always been controversial. Angiographic vasospasm theoretically can only damage the brain by restricting blood flow but there is no easy, accurate, widely available method to measure cerebral blood flow and this is not the measurement we need. Blood flow depends on metabolic demand so what we need to know to determine if angiographic vasospasm is causing ischemia is oxygen extraction fraction in the brain tissue supplied the the spastic artery. Without this measurement, the attribution of ischemia to vasospasm is subjective. Since angiographic vasospasm is essentially the only detectable delayed phenomenon after SAH, we focus on it and apply tremendous resources to preventing or reversing the vasospasm. Undoubtedly angiographic vasospasm can cause cerebral infarctions, but it has to be severe and flow limiting. But SAH is a complex disease. There are many other causes for cerebral infarctions after SAH, the most common being due to the aneurysm repair procedure. And a given degree of vasospasm may cause infarction in a volume-depleted patient with poor collateral blood supply but not in a patient without these things. There also are hypodense brain lesions after SAH that are due to intracerebral hemorrhages. There can be hypodensities in the brain directly under usually thick SAH where the brain dies. This observation in particular supports a role for cortical spreading depolarizations/ischemia as a cause of infarction after SAH. Other macromolecular processes that are hypothesized to cause brain damage after SAH include microthromboembolism, changes in the microcirculation, delayed brain cell apoptosis and capillary transit time heterogeneity. Determining the importance of these things is hindered by the lack of an easy way to detect them in patients. It is also known that poor grade patients, who presumably have more early brain injury and ischemia than good grade patients, are more prone to delayed cerebral ischemia, suggesting increased sensitivity to secondary insults of the already injured brain. We also assume delayed neurological deterioration when attributed to vasospasm or delayed cerebral ischemia, is purely due to ischemia. While knowledge about what happens pathophysiologically after SAH is increasing, management of delayed cerebral ischemia still focuses on detecting angiographic vasospasm and then augmenting the blood pressure to improve cerebral blood flow or dilating the spastic arteries with balloons or drugs.
EVD Tips and Tricks
By Catherine Bell and Andrew Udy
Catherine Bell takes us through how to troubleshoot problems commonly encountered when looking after patients who have an external ventricular drain (EVD) in situ. Issues with using brain tissue oxygen monitors are also discussed. A highly practical session aimed at bedside clinicians.
There is no such thing as mild, moderate and severe TBI - by Andrew Udy
Part 2 of a debate over the classification of TBI. Andrew Udy then argues that this classification is fundamentally flawed. He discusses the issues with the Glasgow Coma Scale, and therefore the follow-on issues in TBI classification, including all the confounders to the GCS, the issues with timing of the score as well as GCS not taking baseline function or specifics subtypes of TBI into account. He makes teh argument that biomarkers may better categorise the diffuse entity we call TBI.
TBI Debate - Mild, moderate and severe categories work
Andrew Chow, Intensivist with a neurosurgical background, argues that the current categorisation system for traumatic brain injury (TBI) works, and makes sense! He tackles us through the history of this system, and why it’s important to differentiate different types of TBI. The arguments in favour of this categorisation include the consistency and benefits of a universal language, the implications for triage and management, and the fact that this system has been endorsed by all major organisations
TBI: when to stop and when to give time
Dr Nick Little is an experienced Neurosurgeon who's looked after patients with traumatic brain injury for his whole career. Here he discusses the difficulties of prognostication following traumatic brain injury (TBI). He talks about the statistics of outcomes following mild, moderate and severe TBI and then goes on to tackle the harder topic of how we try to work out what an individual would want if they knew the spectrum of outcomes that they may face. The issues with the clinical examination findings we use to prognosticate are covered, as well as which imaging findings he finds most helpful. He also mentions the difficulties with current prognostic calculators.
Ketamine in Brain Injury by Toby Jeffcote
Historically, when it came to brain injury, ketamine had a bad rap. Much of that dogma was dispelled in the last decade, and ketamine is now frequently used as an induction agent in acute brain injury, especially traumatic brain injury, due to it’s favorable effects on haemodynamics.
However a new application of ketamine is now being explored - whether ketamine may be able to reduce secondary brain injury.
Managing Complications of Chronic SCI by Bonne Lee
20 million people around the world are living with a spinal cord injury (SCI). The medical issues they develop over the years differ to any other patient cohort.
These complications include autonomic dysreflexia, management of pressure areas, specific infections, nuanced peri-operative care and highly specific issues such as baclofen pump management and syringomyelia
Do look at the NeuroResus section on this and listen to Spinal Rehab Specialist Bonne Lee talk about this side of SCI care.
Keywords
SCI, spinal, spinal cord injury, autonomic dysreflexia, pressure areas, infection, peri-operative care, baclofen pump, syringomyelia, chronic SCI, spinal trauma, spinal rehab, incomplete SCI
EEG and Status Eplilepticus by Tania Farrar
Tania is a neurologist and epileptologist with expertise in continuous EEG (cEEG) and status epilepticus (SE). This talk covers what a seizure is, what status is, including focal and generalised status epilepticus.
So why do we do cEEGs for patients with suspected SE?
To confirm the diagnosis
To see if patient just post ictal or still seizing
To establish that the clinical and electric seizures have stopped
To see if burst suppression is achieved
To exclude other differential diagnoses
She makes a good argument for why cEEG is such an important tool in managing SE.
In the questions after the talk, the issue of availability of cEEG in the Australian setting was discussed. Limited montage EEGs are discussed including their pros and cons.
Browne Neuro symposium.pptx
Stuart Browne is a Neuro Rehab specialist from Sydney. These slides accompany a talk he gave at the Brian Symposium in 2023. He discusses what "severe disability" really means.
Severe disability is more common than many realise - about 6% of the Australian population.
Stuart discusses how health is more than simply physical recovery and how it is a multidimensional construct. He covers how permanent disability doesn't necessarily equate to a poor quality of life. He also discusses the long timespan of recovery, which is often much longer than appreciated.
He specifically discusses "Locked-in Syndrome" and how the survivors have surprisingly positive self-reported health-related quality of life and well-being.
Stuart also covers how severely disabled people face various forms of discrimination.
Paediatric Stroke by Shree Basu
Shree Basu is a Paediatirc Intensivist in Sydney. These slides from the Brain Symposium 2023 accompany the talk she gave. She discusses how Paediatric stroke presents, what neuroimaging is required and what interventions are available, including thrombolysis and the role of endovascular thrombectomy.
Hypertensing Spinal Cord Injury - gold standard or wacky?
This document discusses the concept of maintaining higher blood pressure levels, known as hypertension, after a spinal cord injury to improve spinal cord perfusion pressure and reduce secondary injury. It notes that while animal studies and some human trials have shown improved neurological outcomes, the evidence is still limited. It calls for larger randomized controlled trials in humans that also incorporate multi-modal monitoring and standardized outcome measures to further evaluate if inducing hypertension after spinal cord injury should be considered the gold standard of care.
Optimal Cerebral Perfusion Pressure
Mark Weedon takes us through the increasingly utilised concept of an optimal cerebral perfusion pressure (CPPopt) for each unique patient. He discusses the background to CPPopt, including intrcranial pressure (ICP), the Monroe Kelly hypothesis, neurovascular coupling, and cerebral autoregulation in health and following brain injury. He shows how intracranial pressure is affected by intracranial compliance and how this affects ICP waveforms. Cerebral perfusion pressure in relation to the Brain Trauma Foundation guidelines is covered including management of elevated ICP (EICP). The currently recommended tiered approach to managing cerebral perfusion pressure and EICP is mentioned citing recent guidelines. He uses a clinical case of a TBI to illustrate how the CPPopt can be ascertained and used to guide therapy, including the easy to perform “MAP Challenge”. Mark also describes the Pressure Reactivity Index (PRx) and how it can be used as a target for therapy. Finally, he covers the exciting results of the preliminary COGiTATE pilot study.
The Power of Words - Death and Language.ppt
Social Worker Victoria Whitfield and Bereavement councilor Louise Sayers discuss the power of words when health professionals are communicating topics around of death and serious injury with relatives and patients in critical care. They use role plays to bring theories to life.
Sepsis and Antimicrobial Stewardship - Two Sides of the Same Coin
Undertreatment of sepsis can lead to mortality, while overdiagnosis and overtreatment can increase future risk of antimicrobial resistance. Antimicrobial stewardship aims to balance these risks by prioritizing patient safety and appropriate antimicrobial use. Data shows variability in appropriateness of antimicrobial prescribing between different types of hospitals. Embedding antimicrobial stewardship principles throughout sepsis diagnosis and treatment, from initial microbiology testing to post-treatment review, can help standardize care and optimize outcomes.
Brain injury outcomes and predictors
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.
We end with three brief vignettes which highlight the fraught nature of long term outcome prediction.
More from SMACC Conference (20)
Andy Neill - More neuroanatomy pearls for neurocritical care
Andy Neill - More neuroanatomy pearls for neurocritical care
There is no such thing as mild, moderate and severe TBI - by Andrew Udy
There is no such thing as mild, moderate and severe TBI - by Andrew Udy
TBI Debate - Mild, moderate and severe categories work
TBI Debate - Mild, moderate and severe categories work
Managing Complications of Chronic SCI by Bonne Lee
Managing Complications of Chronic SCI by Bonne Lee
Hypertensing Spinal Cord Injury - gold standard or wacky?
Hypertensing Spinal Cord Injury - gold standard or wacky?
Sepsis and Antimicrobial Stewardship - Two Sides of the Same Coin
Sepsis and Antimicrobial Stewardship - Two Sides of the Same Coin
Recently uploaded
biomechanics of running. Dr.dhwani.pptx
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
SENSORY NEEDS B.SC. NURSING SEMESTER II.
Sensation is the neurological process by which we become aware of surrounding environment.
Pharmacology of 5-hydroxytryptamine and Antagonist
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montrealFoundation of Yoga, YCB Level-3, Unit-1
Unit -1 of Yoga certification board, level 3, all topics covered. An exam conducted by ministry of Ayush for yoga enthusiastic students.
Acute Gout Care & Urate Lowering Therapy .pdf
In this document , the management of acute gout attacks and a description of urate lowering therapy is mentioned.
Top Travel Vaccinations in Manchester
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Post-Menstrual Smell- When to Suspect Vaginitis.pptx
Do you have abnormal smell after periods? It may be vaginitis. Do not worry, herbal medicine Fuyan Pill can help you get a cure.
Cervical Disc Arthroplasty ORSI 2024.pptx
Indication and installation of a mobile cervical disc prosthesis. Benefits of the PRODISC C VIVO mobile disc prosthesis (Centinel Spine)
NARCOTICS- POLICY AND PROCEDURES FOR ITS USE
This document outlines policies and procedures for handling narcotic and controlled drugs in NABH accredited hospitals.
Artificial Intelligence Symposium (THAIS)
Artificial Intelligence Symposium (THAIS). Parc Taulí. Sabadell
Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...
Fallopian tube blockage may cause female infertility. For treatment, herbal medicine Fuyan Pill can be a solution.
Travel Clinic Cardiff: Health Advice for International Travelers
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
Patellar Instability: Diagnosis Management
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.
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdf
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
June 2024 Oncology Cartoons By Dr Kanhu Charan Patro
une 2024 Oncology Cartoons By Dr Kanhu Charan Patro
Know the difference between Endodontics and Orthodontics.
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
Breast cancer: Post menopausal endocrine therapy
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.
Histololgy of Female Reproductive System.pptx
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Recently uploaded (20)
Pharmacology of 5-hydroxytryptamine and Antagonist
Pharmacology of 5-hydroxytryptamine and Antagonist
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...
Post-Menstrual Smell- When to Suspect Vaginitis.pptx
Post-Menstrual Smell- When to Suspect Vaginitis.pptx
Tele Optometry (kunj'sppt) / Basics of tele optometry.
Tele Optometry (kunj'sppt) / Basics of tele optometry.
Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...
Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...
Travel Clinic Cardiff: Health Advice for International Travelers
Travel Clinic Cardiff: Health Advice for International Travelers
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdf
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdf
June 2024 Oncology Cartoons By Dr Kanhu Charan Patro
June 2024 Oncology Cartoons By Dr Kanhu Charan Patro
Know the difference between Endodontics and Orthodontics.
Know the difference between Endodontics and Orthodontics.
Goodbye GCS! - Mark Wilson
- 1. G O O D B Y E G C S M A R K W I L S O N Scale = individual components Score = the total
- 3. “ L E V E L S O F C O N S C I O U S N E S S " • Metaconscious • Conscious • Confused • Delirious • Somnolent • Obtunded • Stuporous • Comatose. Bart Hughes 1962 Children have a higher state of consciousness and since children's skulls are not fully closed one can return to an earlier child like state of consciousness by self trephination
- 4. Bryan Jennett 1926-2008 Sir Graham Teasdale
- 5. cited > 6,000 times
- 6. What was it meant for? “The assessment of coma and impaired conciousness”
- 7. TREND MONITOR NOT A TOTAL NUMBER
- 8. But what do we use it for now? • Communication about all neuro patients • Head Injury Severity Measure • Prognostication tool • Sedation Scale • Depth of Coma • All cause MENTAL STATUS MONITOR
- 9. • Mild - GCS 13-15 • Moderate - GCS 9-12 • Severe - GCS < 8 (trauma coma data bank) But PVS can be E4, V2, M3 Brain Injury Severity Subarachnoid Severity WFNS scale Grade GCS Motor Deficit 1 15 - 2 13-14 - 3 13-14 + 4 12-7 +/- 5 3-6 +/-
- 11. E1 V1 M2 = 48% E1 V2 M1 = 27% E2 V1 M1 = 19% Mortality of GCS 4 Healey C, Osler TM, Rogers FB, et al. Improving the Glasgow Coma Scale score: motor score alone is a better predictor J Trauma. 2003;54:671-678.
- 12. ITU GCS “12” is not the same as Pre-Hospital “12” E3, V4, M5
- 13. S C O R I N G S Y S T E M S I N C O R P O R A T I N G G C S • APACHE II • RTS • TRISS • CRAMS • + TBI Models eg IMPACT (motor score)
- 14. P R O B L E M S W I T H G C S • People Intubated prior Arrival • No V when intubated • Nothing about Brain Stem Reflexes • The abnormal flexion bit… • It is not linear - M score “more important” • Low Interrupter reliability (30% of paired assessments are > 2 different)
- 15. 3 , 8 , 1 5 0 22.5 45 67.5 90 3 4 5 6 7 8 9 10 11 12 13 14 15
- 17. H I S T O R Y O F S C O R E S • Jouvet Coma Scale • Moscow Coma Scale • Glasgow Coma Scale • Japan Coma Scale • Bozza-Marrumbini Scale • Grady Coma Scale • Four Score
- 18. Full Outline of UnResponsiveness Score
- 24. S I M P L E A S S E S S M E N T S C A L E S • Alert • Voice • Pain • Unresponsive • Alert • Confused • Drowsy • Unresponsive • Obeys Commands • Localises • Less (/ withdrawal) Simplified Motor Scales
- 25. W H A T C A U S E S F I X E D D I L A T E D P U P I L S • Hypoxia • Seizures • Drugs • Orbital Trauma • Brain Stem Injury … and pressure on the occulomotor nerve.
- 26. FUCD Meta-Analysis EDH SDH Mortality Good Outcome Good Outcome Mortality 29% 54% 66% 7%
- 28. It is underlying pathology that should predict outcome - not a “score”
- 29. W H A T ’ S T H E F U T U R E ?
- 31. • NIRS • Ultrasound • Mobile CT
- 32. T R Y T O L O O K T H R O U G H P A T I E N T S
- 33. W H Y S T I C K W I T H G C S ? • It’s understood • Do you really want different coma scores for TBI, stroke, sedation…? • It is ingrained in so many scoring systems / models.
- 34. T A K E H O M E M E S S A G E DESCRIBE WHAT YOU SEE using the scale + pupils But also think about the underlying pathology @markhwilson