1) The NIH Stroke Scale is used to evaluate patients who may have had a stroke. It involves assessing various functions including level of consciousness, visual fields, facial palsy, limb movement, sensory loss, and language ability.
2) The exam is administered by having the patient perform specific tasks and answering questions to evaluate different neurological functions. Scores are recorded for each item to indicate the severity of any deficits.
3) The goal is to provide a quick but standardized evaluation of stroke signs and symptoms to help diagnose stroke and determine appropriate treatment.
This document provides information about the National Institutes of Health Stroke Scale (NIHSS), including how to administer and score it. The NIHSS is an 11-item neurological examination used to evaluate stroke severity. It assesses different functional domains, with higher scores indicating more severe strokes. An increase of 2 points or more on serial NIHSS exams indicates stroke progression. NIHSS scores can help predict outcomes and guide treatment decisions. The presenter reviews the components and administration of the full NIHSS exam.
This document appears to be a medical record containing instructions for administering a stroke scale assessment. It includes:
1. Fields for patient identification information and exam details.
2. Instructions and scoring definitions for 13 assessment items covering level of consciousness, gaze, visual fields, facial palsy, limb strength, ataxia, and sensation. Each item is scored on a scale of 0 to 3 or 4, with higher numbers indicating more severe neurological deficits.
3. The assessment is to be administered by recording the patient's performance on each item in the order listed, without returning to change scores. Performance is compared to defined criteria to determine the appropriate score.
Acute management of Stroke By Dr Sanjay jaiswal Neurologist sept2012Sanjay Jaiswal
The document discusses early management of ischemic stroke. It defines stroke as a sudden neurological deficit of vascular origin lasting more than 24 hours. It emphasizes that "time is brain" and every minute of untreated stroke causes the loss of 1.9 million neurons. It outlines risk factors, signs and symptoms of different types of stroke, and the definition of transient ischemic attack. Current acute treatments for ischemic stroke including thrombolysis within 3-4.5 hours and aspirin within 48 hours are discussed.
Global Medical Cures™| STROKE SCALE
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
This document provides information on assessing and managing patients with altered consciousness such as coma. It defines key terms like coma, delirium, and vegetative state. It describes how to perform a neurological examination to evaluate a patient's level of consciousness and determine if deficits are focal or diffuse. The examination should assess motor response, brainstem reflexes, respiratory pattern, and reflexes. Admission to the ICU is recommended for patients with a Glasgow Coma Scale of 8 or less or a deteriorating level of consciousness.
Recent Advances In Thrombolysis In Stroke PatientAdamya Gupta
1) Recent advances in thrombolysis for stroke patients include extending the treatment window for intravenous rt-PA from 3 hours to 4.5 hours post-stroke onset based on the ECASS III trial results.
2) Intravenous rt-PA is still the standard of care for eligible patients within 4.5 hours, but endovascular thrombectomy is now recommended for eligible patients with a large vessel occlusion up to 24 hours from last known normal.
3) Treatment protocols now focus on a rapid door-to-needle time of 60 minutes or less for intravenous rt-PA and include advances in imaging such as CTA and perfusion imaging to identify patients that may benefit from endovascular thrombectomy.
- EEG patterns change significantly during prenatal development and early childhood as brain maturation occurs rapidly, especially during the first year of life.
- In preterm infants, EEG organization into behavioral sleep states like wakefulness, active sleep, and quiet sleep is seen by 35 weeks gestation.
- In full-term newborns, active sleep makes up about 50% of total sleep and is characterized by features like anterior slow dysrhythmia and frontal sharp transients. Quiet sleep shows a trace alternans pattern.
- During infancy, features continue developing with sleep spindles and vertex sharp waves emerging between 2-6 months. The theta rhythm in wakefulness localizes to rolandic-occ
This ppt is created as part of faculty class for medicine and neurology residents , neurologist and neurosurgeons . Especially while attending a case of coma in emergency. How to approach a case of coma
This document provides information about the National Institutes of Health Stroke Scale (NIHSS), including how to administer and score it. The NIHSS is an 11-item neurological examination used to evaluate stroke severity. It assesses different functional domains, with higher scores indicating more severe strokes. An increase of 2 points or more on serial NIHSS exams indicates stroke progression. NIHSS scores can help predict outcomes and guide treatment decisions. The presenter reviews the components and administration of the full NIHSS exam.
This document appears to be a medical record containing instructions for administering a stroke scale assessment. It includes:
1. Fields for patient identification information and exam details.
2. Instructions and scoring definitions for 13 assessment items covering level of consciousness, gaze, visual fields, facial palsy, limb strength, ataxia, and sensation. Each item is scored on a scale of 0 to 3 or 4, with higher numbers indicating more severe neurological deficits.
3. The assessment is to be administered by recording the patient's performance on each item in the order listed, without returning to change scores. Performance is compared to defined criteria to determine the appropriate score.
Acute management of Stroke By Dr Sanjay jaiswal Neurologist sept2012Sanjay Jaiswal
The document discusses early management of ischemic stroke. It defines stroke as a sudden neurological deficit of vascular origin lasting more than 24 hours. It emphasizes that "time is brain" and every minute of untreated stroke causes the loss of 1.9 million neurons. It outlines risk factors, signs and symptoms of different types of stroke, and the definition of transient ischemic attack. Current acute treatments for ischemic stroke including thrombolysis within 3-4.5 hours and aspirin within 48 hours are discussed.
Global Medical Cures™| STROKE SCALE
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
This document provides information on assessing and managing patients with altered consciousness such as coma. It defines key terms like coma, delirium, and vegetative state. It describes how to perform a neurological examination to evaluate a patient's level of consciousness and determine if deficits are focal or diffuse. The examination should assess motor response, brainstem reflexes, respiratory pattern, and reflexes. Admission to the ICU is recommended for patients with a Glasgow Coma Scale of 8 or less or a deteriorating level of consciousness.
Recent Advances In Thrombolysis In Stroke PatientAdamya Gupta
1) Recent advances in thrombolysis for stroke patients include extending the treatment window for intravenous rt-PA from 3 hours to 4.5 hours post-stroke onset based on the ECASS III trial results.
2) Intravenous rt-PA is still the standard of care for eligible patients within 4.5 hours, but endovascular thrombectomy is now recommended for eligible patients with a large vessel occlusion up to 24 hours from last known normal.
3) Treatment protocols now focus on a rapid door-to-needle time of 60 minutes or less for intravenous rt-PA and include advances in imaging such as CTA and perfusion imaging to identify patients that may benefit from endovascular thrombectomy.
- EEG patterns change significantly during prenatal development and early childhood as brain maturation occurs rapidly, especially during the first year of life.
- In preterm infants, EEG organization into behavioral sleep states like wakefulness, active sleep, and quiet sleep is seen by 35 weeks gestation.
- In full-term newborns, active sleep makes up about 50% of total sleep and is characterized by features like anterior slow dysrhythmia and frontal sharp transients. Quiet sleep shows a trace alternans pattern.
- During infancy, features continue developing with sleep spindles and vertex sharp waves emerging between 2-6 months. The theta rhythm in wakefulness localizes to rolandic-occ
This ppt is created as part of faculty class for medicine and neurology residents , neurologist and neurosurgeons . Especially while attending a case of coma in emergency. How to approach a case of coma
Consciousness, ras and approach to comaNeurologyKota
This document provides information on examining patients presenting with coma. It defines consciousness and the reticular activating system. It describes the examination of a comatose patient, including assessing respiratory pattern, pupils, ocular motility, motor response, and differentiating structural from toxic-metabolic causes of coma. It also discusses signs of brain herniation seen in comatose patients.
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.
Bundle branch blocks occur when the left or right bundle branch is blocked, preventing normal conduction of electrical impulses through the ventricles. Right bundle branch block is usually benign but can worsen prognosis in acute myocardial infarction by indicating occlusion of the proximal left anterior descending artery. Left bundle branch block is more serious as it can mask signs of myocardial infarction and worsen prognosis in acute infarction. The Sgarbossa criteria can help diagnose myocardial infarction in the presence of left bundle branch block. Left anterior and posterior hemiblocks involve conduction abnormalities localized to one side of the ventricles.
Nurses as the primary care providers would be the immediate health care professional to assess the patient's response and to determine whether he is improving or deteriorating. Signs of brain death can be identified and reported early by a nurse with adequate knowledge.
1. Regional stroke centers should be established to provide thrombolysis and transport to endovascular treatment centers. Every hospital should have a stroke team and protocols for emergency evaluation.
2. Patients should receive IV alteplase as quickly as possible if eligible. Mechanical thrombectomy is recommended for large vessel occlusions within 6-24 hours of onset depending on criteria.
3. In-hospital prevention includes antiplatelet therapy, vascular imaging, and lipid management with statins to reduce cardiovascular risk.
This document summarizes sonothrombolysis as an adjuvant treatment for acute ischemic stroke. It discusses how ultrasound enhances the lytic effects of tPA to improve recanalization rates. Sonothrombolysis delivers ultrasound through acoustic windows in the skull to the occlusion site. Ultrasound may improve clot lysis mechanically and by promoting tPA activity. Two phase III trials, CLOTBUST and CLOTBUST-ER, found sonothrombolysis had a good safety profile but no additional clinical benefit over tPA alone. Current guidelines do not recommend sonothrombolysis outside of clinical trials due to lack of proven efficacy.
Case-1: A 45 years old lady presented with sudden severe chest discomfort with excessive sweating for last 2 hours. She was diabetic and dyslipidemic and hypertensive. She had history of taking oral contraceptive pills (OCP).. She had the following ECG.
Case: A 34 years old lady presented with shortness of breath , chest discomfort, palpitations , cough, fever , joint pain and skin rash. Her CXR showed nodular lesion in lung field and cardiomegaly. Her serum BNP level was raised. Her echocardiography showed dilated cardiomyopathy with low ejection fraction. She had the following ECG.
Case: A 34 years old lady presented with shortness of breath , chest discomfort, palpitations , cough, fever , joint pain and skin rash. Her CXR showed nodular lesion in lung field and cardiomegaly. Her serum BNP level was raised. Her echocardiography showed dilated cardiomyopathy with low ejection fraction. She had the following ECG.
Case: A 51 years old gentleman presented with occasional chest discomfort. He was diabetic and smoker. He had a history of myocardial infarction 6 weeks back. He had the following ECG.
Takayasu arteritis is an idiopathic inflammatory disease that primarily affects large elastic arteries, especially the aorta and its branches. It most commonly occurs in young females. The disease involves occlusive or ectatic changes in the arteries and can present with nonspecific early symptoms or later with signs of ischemia due to arterial occlusion. Diagnosis is based on criteria that consider clinical features, imaging findings, and laboratory tests showing inflammation. Treatment involves management of symptoms and immunosuppression.
This document discusses different types of agnosia, which are disorders that cause inability to recognize sensory stimuli despite normal sensory perception. It defines agnosia and describes its classification into visual, auditory and tactile modalities. It provides details on visual processing pathways and disorders of the ventral "what" and dorsal "where" streams. Specific visual agnosias discussed include apperceptive, associative, integrative, prosopagnosia, color agnosia and simultanagnosia. Neuroanatomical bases and diagnostic criteria for each are outlined.
The Glasgow Coma Scale (GCS) is a neurological scale used to assess level of consciousness after head injury. It was published in 1974 and aims to provide an objective way to record a person's conscious state. The scale evaluates eye opening, verbal response, and motor response on a scale of 1 to 6 for each, with lower scores indicating worse impairment. A total score of 13 or above indicates minor brain injury, 9 to 12 indicates moderate injury, and 8 or lower indicates severe injury. The Mini-Mental State Examination (MMSE) is a 30-point questionnaire used to screen for cognitive impairment and dementia. It samples functions like orientation, registration, attention, calculation, recall, and language. Scores of
INTRODUCTION OF GBS,
TYPES OF GBS,
INCUDENCE OF GBS,
ETIOLOGY OF GBS,
PATHOLOGY OF OF GBS,
CLINICAL FEATURES OF GBS,
INVESTIGATION OF GBS,
DIAGNOSTIC CRITERIA OF GBS,
PROGNOSIS OF GBS,
TRATMENT OF GBS,
PHYSIOTHERAPY MANAGEMENT IN CASE OF OF GBS,
1) The document defines wide complex tachycardia as a rhythm with a QRS duration ≥120ms and heart rate >100 bpm.
2) The main causes listed are ventricular tachycardia (80% of cases) and supraventricular tachycardia with aberrancy.
3) Key features that can help differentiate the underlying rhythm include QRS duration, axis, morphology, and the presence or absence of AV dissociation on electrocardiogram.
A persistent vegetative state is a disorder of consciousness where a patient is awake but not aware due to an absence of cognitive functions despite intact brain stem activity allowing for vegetative functions like breathing and digestion. Key signs include unresponsiveness to external stimuli while displaying sleep-wake cycles through actions like opening eyes during feeding or shedding tears. Common causes are hypoxic-ischemic brain injuries, trauma, degenerative changes, or metabolic disorders.
This document discusses the Glasgow Coma Scale (GCS), which is used to assess head injuries. It provides background on head injuries and their causes before explaining the components of the GCS. The GCS assesses eye opening, verbal response, and motor response on a scale of 1-6 to determine a patient's level of consciousness following a head injury. Scores are categorized as mild, moderate, or severe injury. Though widely used to predict outcomes, the GCS does not account for all factors like focal signs or intoxication.
NEUROLOGICAL SCALES FOR ASSESSMENT OF CONSCIOUSNESS.pptxNeurologyKota
The document discusses neurological scales used to assess consciousness. It describes the Glasgow Coma Scale (GCS), which evaluates best eye opening, best verbal response, and best motor response on a scale of 3 to 15. The Full Outline of UnResponsiveness (FOUR) score is also discussed, which measures eye responses, motor responses, brainstem reflexes, and respiratory patterns on a scale of 0 to 16. The FOUR score is presented as having advantages over the GCS in certain clinical situations. A new scale, the FIVE score, is also mentioned which builds upon the FOUR score.
This document describes different types of supraventricular tachycardias (SVTs), which are rapid heart rhythms originating above the ventricles. It defines SVTs and paroxysmal supraventricular tachycardia (PSVT), and lists common symptoms. The types of SVTs are categorized based on their origin in the sinoatrial node, atria, or atrioventricular node/junction. Each type has a distinct electrocardiogram appearance and cause, such as reentry circuits, ectopic foci, or increased node automaticity. Common examples include AV nodal reentrant tachycardia, atrial fibrillation, atrial flutter, and Wolff-Parkinson-
2015 ESC guidelines for the management of patients with ventricular arrhyth...João Antônio Granzotti
This document provides guidelines from the European Society of Cardiology (ESC) for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. It was created by a Task Force of experts and endorsed by several ESC associations and councils. The guidelines cover definitions, epidemiology, risk prediction, screening and evaluation of patients, pharmacological and device-based therapies, and management recommendations for specific cardiac conditions like coronary artery disease and heart failure.
This document discusses various aspects of evaluating and surgically treating epilepsy. It begins by outlining when epilepsy surgery should be considered, such as when seizures persist despite adequate medication. The aim of presurgical evaluation is to accurately map the epileptogenic zone and completely resect or disconnect the area responsible for seizures. Noninvasive and invasive testing methods are described to localize the seizure focus. Common surgical approaches like temporal lobectomy and extra-temporal lobectomy are explained. Outcomes of different procedures and factors influencing prognosis are also summarized.
James Marcus passed the National Institutes of Health Stroke Scale exam online through Apex Innovations with a score of 98% on March 29, 2016. The certification is valid for one year and was issued by Patrick Lyden, MD as the program coordinator at Cedars-Sinai Medical Center, certifying that James Marcus successfully completed the NIHSS exam.
The document presents an NIH Stroke Scale assessment form used to evaluate patients who have experienced a stroke, with sections evaluating different factors such as level of consciousness, eye movements, motor strength, sensory changes, and language ability. The assessment involves testing various physical and cognitive functions and assigning a score to indicate normal, mild, moderate, or severe impairment in each category. It provides guidance for administrators on techniques for evaluating patients with different impairments or limitations.
Consciousness, ras and approach to comaNeurologyKota
This document provides information on examining patients presenting with coma. It defines consciousness and the reticular activating system. It describes the examination of a comatose patient, including assessing respiratory pattern, pupils, ocular motility, motor response, and differentiating structural from toxic-metabolic causes of coma. It also discusses signs of brain herniation seen in comatose patients.
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.
Bundle branch blocks occur when the left or right bundle branch is blocked, preventing normal conduction of electrical impulses through the ventricles. Right bundle branch block is usually benign but can worsen prognosis in acute myocardial infarction by indicating occlusion of the proximal left anterior descending artery. Left bundle branch block is more serious as it can mask signs of myocardial infarction and worsen prognosis in acute infarction. The Sgarbossa criteria can help diagnose myocardial infarction in the presence of left bundle branch block. Left anterior and posterior hemiblocks involve conduction abnormalities localized to one side of the ventricles.
Nurses as the primary care providers would be the immediate health care professional to assess the patient's response and to determine whether he is improving or deteriorating. Signs of brain death can be identified and reported early by a nurse with adequate knowledge.
1. Regional stroke centers should be established to provide thrombolysis and transport to endovascular treatment centers. Every hospital should have a stroke team and protocols for emergency evaluation.
2. Patients should receive IV alteplase as quickly as possible if eligible. Mechanical thrombectomy is recommended for large vessel occlusions within 6-24 hours of onset depending on criteria.
3. In-hospital prevention includes antiplatelet therapy, vascular imaging, and lipid management with statins to reduce cardiovascular risk.
This document summarizes sonothrombolysis as an adjuvant treatment for acute ischemic stroke. It discusses how ultrasound enhances the lytic effects of tPA to improve recanalization rates. Sonothrombolysis delivers ultrasound through acoustic windows in the skull to the occlusion site. Ultrasound may improve clot lysis mechanically and by promoting tPA activity. Two phase III trials, CLOTBUST and CLOTBUST-ER, found sonothrombolysis had a good safety profile but no additional clinical benefit over tPA alone. Current guidelines do not recommend sonothrombolysis outside of clinical trials due to lack of proven efficacy.
Case-1: A 45 years old lady presented with sudden severe chest discomfort with excessive sweating for last 2 hours. She was diabetic and dyslipidemic and hypertensive. She had history of taking oral contraceptive pills (OCP).. She had the following ECG.
Case: A 34 years old lady presented with shortness of breath , chest discomfort, palpitations , cough, fever , joint pain and skin rash. Her CXR showed nodular lesion in lung field and cardiomegaly. Her serum BNP level was raised. Her echocardiography showed dilated cardiomyopathy with low ejection fraction. She had the following ECG.
Case: A 34 years old lady presented with shortness of breath , chest discomfort, palpitations , cough, fever , joint pain and skin rash. Her CXR showed nodular lesion in lung field and cardiomegaly. Her serum BNP level was raised. Her echocardiography showed dilated cardiomyopathy with low ejection fraction. She had the following ECG.
Case: A 51 years old gentleman presented with occasional chest discomfort. He was diabetic and smoker. He had a history of myocardial infarction 6 weeks back. He had the following ECG.
Takayasu arteritis is an idiopathic inflammatory disease that primarily affects large elastic arteries, especially the aorta and its branches. It most commonly occurs in young females. The disease involves occlusive or ectatic changes in the arteries and can present with nonspecific early symptoms or later with signs of ischemia due to arterial occlusion. Diagnosis is based on criteria that consider clinical features, imaging findings, and laboratory tests showing inflammation. Treatment involves management of symptoms and immunosuppression.
This document discusses different types of agnosia, which are disorders that cause inability to recognize sensory stimuli despite normal sensory perception. It defines agnosia and describes its classification into visual, auditory and tactile modalities. It provides details on visual processing pathways and disorders of the ventral "what" and dorsal "where" streams. Specific visual agnosias discussed include apperceptive, associative, integrative, prosopagnosia, color agnosia and simultanagnosia. Neuroanatomical bases and diagnostic criteria for each are outlined.
The Glasgow Coma Scale (GCS) is a neurological scale used to assess level of consciousness after head injury. It was published in 1974 and aims to provide an objective way to record a person's conscious state. The scale evaluates eye opening, verbal response, and motor response on a scale of 1 to 6 for each, with lower scores indicating worse impairment. A total score of 13 or above indicates minor brain injury, 9 to 12 indicates moderate injury, and 8 or lower indicates severe injury. The Mini-Mental State Examination (MMSE) is a 30-point questionnaire used to screen for cognitive impairment and dementia. It samples functions like orientation, registration, attention, calculation, recall, and language. Scores of
INTRODUCTION OF GBS,
TYPES OF GBS,
INCUDENCE OF GBS,
ETIOLOGY OF GBS,
PATHOLOGY OF OF GBS,
CLINICAL FEATURES OF GBS,
INVESTIGATION OF GBS,
DIAGNOSTIC CRITERIA OF GBS,
PROGNOSIS OF GBS,
TRATMENT OF GBS,
PHYSIOTHERAPY MANAGEMENT IN CASE OF OF GBS,
1) The document defines wide complex tachycardia as a rhythm with a QRS duration ≥120ms and heart rate >100 bpm.
2) The main causes listed are ventricular tachycardia (80% of cases) and supraventricular tachycardia with aberrancy.
3) Key features that can help differentiate the underlying rhythm include QRS duration, axis, morphology, and the presence or absence of AV dissociation on electrocardiogram.
A persistent vegetative state is a disorder of consciousness where a patient is awake but not aware due to an absence of cognitive functions despite intact brain stem activity allowing for vegetative functions like breathing and digestion. Key signs include unresponsiveness to external stimuli while displaying sleep-wake cycles through actions like opening eyes during feeding or shedding tears. Common causes are hypoxic-ischemic brain injuries, trauma, degenerative changes, or metabolic disorders.
This document discusses the Glasgow Coma Scale (GCS), which is used to assess head injuries. It provides background on head injuries and their causes before explaining the components of the GCS. The GCS assesses eye opening, verbal response, and motor response on a scale of 1-6 to determine a patient's level of consciousness following a head injury. Scores are categorized as mild, moderate, or severe injury. Though widely used to predict outcomes, the GCS does not account for all factors like focal signs or intoxication.
NEUROLOGICAL SCALES FOR ASSESSMENT OF CONSCIOUSNESS.pptxNeurologyKota
The document discusses neurological scales used to assess consciousness. It describes the Glasgow Coma Scale (GCS), which evaluates best eye opening, best verbal response, and best motor response on a scale of 3 to 15. The Full Outline of UnResponsiveness (FOUR) score is also discussed, which measures eye responses, motor responses, brainstem reflexes, and respiratory patterns on a scale of 0 to 16. The FOUR score is presented as having advantages over the GCS in certain clinical situations. A new scale, the FIVE score, is also mentioned which builds upon the FOUR score.
This document describes different types of supraventricular tachycardias (SVTs), which are rapid heart rhythms originating above the ventricles. It defines SVTs and paroxysmal supraventricular tachycardia (PSVT), and lists common symptoms. The types of SVTs are categorized based on their origin in the sinoatrial node, atria, or atrioventricular node/junction. Each type has a distinct electrocardiogram appearance and cause, such as reentry circuits, ectopic foci, or increased node automaticity. Common examples include AV nodal reentrant tachycardia, atrial fibrillation, atrial flutter, and Wolff-Parkinson-
2015 ESC guidelines for the management of patients with ventricular arrhyth...João Antônio Granzotti
This document provides guidelines from the European Society of Cardiology (ESC) for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. It was created by a Task Force of experts and endorsed by several ESC associations and councils. The guidelines cover definitions, epidemiology, risk prediction, screening and evaluation of patients, pharmacological and device-based therapies, and management recommendations for specific cardiac conditions like coronary artery disease and heart failure.
This document discusses various aspects of evaluating and surgically treating epilepsy. It begins by outlining when epilepsy surgery should be considered, such as when seizures persist despite adequate medication. The aim of presurgical evaluation is to accurately map the epileptogenic zone and completely resect or disconnect the area responsible for seizures. Noninvasive and invasive testing methods are described to localize the seizure focus. Common surgical approaches like temporal lobectomy and extra-temporal lobectomy are explained. Outcomes of different procedures and factors influencing prognosis are also summarized.
James Marcus passed the National Institutes of Health Stroke Scale exam online through Apex Innovations with a score of 98% on March 29, 2016. The certification is valid for one year and was issued by Patrick Lyden, MD as the program coordinator at Cedars-Sinai Medical Center, certifying that James Marcus successfully completed the NIHSS exam.
The document presents an NIH Stroke Scale assessment form used to evaluate patients who have experienced a stroke, with sections evaluating different factors such as level of consciousness, eye movements, motor strength, sensory changes, and language ability. The assessment involves testing various physical and cognitive functions and assigning a score to indicate normal, mild, moderate, or severe impairment in each category. It provides guidance for administrators on techniques for evaluating patients with different impairments or limitations.
1. Hyperacute management of stroke focuses on reperfusion through thrombolysis or mechanical disruption of clots, reducing infarct size, and treating complications like raised intracranial pressure.
2. For intracerebral hemorrhage, the goals are to stop or slow the initial bleeding, control blood pressure, and reduce edema through hematoma evacuation, osmotherapy, or neuroprotective measures.
3. Specific treatments discussed include thrombolysis within 4.5 hours, aspirin, anticoagulants, blood pressure control, osmotherapy with mannitol or hypertonic saline, hematoma evacuation, seizure control with antiepileptics only for clinical seizures, and avoiding
1. An ischemic stroke occurs when a blood clot or fat deposit blocks an artery in the brain, cutting off blood flow and oxygen to brain cells.
2. There are two main types - arterial thrombosis where a clot forms in the brain artery, and cerebral embolism where a clot forms elsewhere and travels to the brain.
3. Risk factors include age, gender, medical conditions like high blood pressure, smoking, high cholesterol, prior transient ischemic attacks, and family history.
1. The document discusses various neurological emergencies including coma, seizures, syncope, and stroke. It provides guidance on assessing and managing the airway, breathing, and circulation for patients with an altered mental status.
2. For seizures, it describes different seizure types and emphasizes protecting the patient during a seizure and assessing them afterwards.
3. Syncope or fainting is discussed as a temporary loss of consciousness often due to low blood pressure or cardiac issues. Stroke signs like paralysis and speech problems are also outlined.
The document discusses ischemic stroke, including its epidemiology, classification, risk factors, and etiopathogenesis. Some key points:
- Stroke occurs every 5 seconds worldwide and is a leading cause of death and disability globally. Incidence and prevalence varies significantly between countries and regions.
- Strokes are classified based on their underlying cause (ischemic vs hemorrhagic) and further subtyped based on etiology (large vessel atherosclerosis, cardioembolism, small vessel disease, etc).
- Major risk factors for ischemic stroke include hypertension, atrial fibrillation, diabetes, smoking, obesity, high cholesterol, lack of physical activity, and a family history of stroke.
This document provides an overview of strokes, including:
- Strokes are caused by a blockage or rupture of an artery to the brain, cutting off oxygen flow.
- Symptoms include weakness, paralysis, difficulty speaking or swallowing.
- Diagnosis involves medical imaging, blood tests, and physical exams to determine the type and location of blockage or rupture.
- Treatment depends on the type of stroke but may include clot-busting drugs, surgery, medication, and lifestyle changes to prevent future strokes.
The document discusses stroke, including risk factors, signs and symptoms, and the importance of rapid treatment. It outlines the "Stroke Chain of Survival and Recovery" which includes early detection, emergency dispatch, pre-hospital transport and management, emergency department triage, evaluation and specific therapies, and fibrinolytic drug therapy. Rapid recognition of stroke, emergency medical response, and treatment are critical to limiting neurological damage and improving patient outcomes.
localization of stroke, CVS, stroke, for post graduates Kurian Joseph
New localization of stroke syndromes
1.Clinical localization of the site of the lesion.
2.Identifying the vascular territory and the vessel involved.
3.Correlating with the imaging findings.
The document provides guidance on performing a neurological assessment. It discusses assessing level of consciousness, cranial nerves, movement, sensation, and reflexes. The neurological exam establishes baseline data to monitor any changes in the patient's condition. The assessment of cranial nerves includes testing each nerve's sensory and motor functions.
Introduction, principles of sensory re-education hypersensitivity and hyposensitivity, stages of training after nerve repair, uses and benefits, sensory reeducation in stroke - its principle. Actve and passive Sensory reeducation in stroke, orofacial sensory retraining
Week 4 the neural basis of consciousness introduction to the visual systemNao (Naotsugu) Tsuchiya
12-week lecture series on "the neural basis of consciousness" by Prof Nao Tsuchiya.
Given to 3rd year undergraduate level. No prerequisites.
Contents:
1) What are behavioral and neural signatures of nonconscious processing?
2) Can blindsight-like behavior induced in monkeys? What are the evidence?
3) How can we discriminate nonconscious from conscious behaviors using a concept of metacognition?
4) What is the structure of eye and how does it shape our conscious vision?
This document provides an overview of performing a neurological exam. It discusses the basic functions of the nervous system and outlines the components to assess including level of consciousness, orientation, mental status, cranial nerves, reflexes, sensory function, and motor skills. Modifications for different ages are addressed. Assessment of cerebral function and interpretation of exam findings are also covered.
This document provides guidance on performing a neurological exam, including assessment of level of consciousness, motor function, sensation, reflexes, and cranial nerves. It emphasizes the importance of establishing a baseline, monitoring for subtle changes, and comparing findings to prior exams. Performing a thorough yet focused neuro exam allows for early detection of deterioration, which is critical for stroke patients. Consistent documentation and communication between caregivers helps ensure any changes are properly identified and addressed.
Unconsciousness - Advance Nursing PracticeJaice Mary Joy
Unconsciousness is a state of depressed cerebral functioning and unresponsiveness. It can be caused by neurological, toxicological, or metabolic factors that disturb the reticular activating system in the brainstem. There are different levels of unconsciousness ranging from excitatory to vegetative. Assessment tools like the Glasgow Coma Scale and FOUR Score are used to evaluate level of consciousness. The medical management aims to preserve brain function while nursing management focuses on airway protection, injury prevention, fluid balance, skin integrity, and oral care.
gcs(Glasgow Coma Scale) ppt to understand.pptxjkm36403
The Glasgow Coma Scale (GCS) is a standardized system used to assess consciousness by evaluating eye opening, verbal response, and motor response. Each category is scored from 1 to 4 or 6 and the total score ranges from 3 to 15, with lower scores indicating worse neurological function or coma. The GCS is used to assess patients with impaired consciousness due to head injuries, seizures, overdoses, or other neurological impairments. It provides important information about a patient's brain functioning that can help determine if their condition is stable, improving, or deteriorating over time.
The document outlines the consciousness system and levels of consciousness. It defines consciousness as having two main functions - arousal and awareness. The reticular activating system (ARAS) located in the brainstem and diencephalon maintains consciousness by keeping sensory pathways and cortical areas excited. There are five points on the continuum of arousal from alert to comatose. Conditions that can mimic coma include locked-in syndrome, vegetative state, minimally conscious state, akinetic mutism, abulia, and catatonia. Lesions that alter consciousness are located in the brainstem, thalamus, or diffuse cortical areas.
This document discusses response inhibition and delay aversion as two subtypes of impulsivity. Response inhibition is the ability to inhibit planned or ongoing behaviors when they are no longer appropriate. It can be measured using tasks like the stop-signal task. Delay aversion refers to an inability to wait for delayed rewards, causing the subjective value of rewards to decrease faster with delays. The document reviews evidence that these subtypes have distinct neural underpinnings and pharmacology, but may also interact in ways that can lead to impulsive behavior. It aims to establish the subtypes as separate concepts while proposing a framework for their integration.
Appropriate for GNM, B.Sc. Nursing, P.B.B.Sc.Nursing & M.Sc. Nursing
Behavior therapy, also known as behavior modification or behavior change therapy, is a psychological approach used in mental health nursing to address and modify maladaptive or undesirable behaviors in individuals dealing with various mental health conditions. The aim is to help patients develop more adaptive and functional behaviors, reduce distress, and improve their overall well-being. Behavior therapy is based on the principles of learning theory, particularly classical conditioning, operant conditioning, and social learning.
Behavior therapy in mental health nursing is often tailored to each patient's unique needs, diagnosis, and circumstances. The approach focuses on collaboration, patient education, reinforcement, and gradual progression to help individuals overcome behavioral challenges and improve their quality of life. Mental health nurses play a crucial role in implementing and facilitating behavior therapy interventions, closely monitoring progress, and providing ongoing support to patients.
This is explanation about the motor relearning technique, which is one of the approach used to treat patient in rehabilitation with neurological conditions.
Acs0811 Coma, Cognitive Impairment, And Seizuresmedbookonline
This document provides an overview of the evaluation and management of patients presenting with coma. It describes the spectrum of consciousness and differentiation of conscious from unconscious states. Key aspects of the initial evaluation of a comatose patient are stabilization of airway, breathing, and circulation followed by a focused neurologic examination assessing spontaneous movements, pupillary response, ocular motility, and motor response to assign a Glasgow Coma Scale score. The differential diagnosis of coma is then narrowed by history, examination findings, and initial laboratory studies to guide further testing and management.
The behavioral assessment through interviewsNishryn Angkad
Careful behavioral assessment is at the core of behavioral therapy interventions. There are two broad categories of behavior: respondents, which are reflexive reactions to stimuli, and operants, which are consequence-driven actions and thoughts. The assessment tasks for behavioral therapists are to identify behaviors of concern and their antecedents and consequences, classify behaviors as respondents or operants, predict future behaviors, specify treatment goals, and evaluate treatment effectiveness.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
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2. Instructions
Administer stroke scale items in the
1a
Instructions
Level of Consciousness
Scale Definition
order listed. Record performance in
each category after each subscale exam.
Do not go back and change scores.
Level of Consciousness:
The investigator must choose a response
if a full evaluation is prevented by such
0 Alert; keenly responsive.
Follow directions provided for each Not alert; but arousable by minor
exam technique. Scores should reflect
what the patient does, not what the
obstacles as an endotracheal tube, language
barrier, orotracheal trauma/bandages. A 3 is
scored only if the patient makes no movement
1 stimulation to obey, answer,
or respond.
clinician thinks the patient can do. (other than reflexive posturing) in response to
The clinician should record answers while noxious stimulation. Not alert; requires repeated
stimulation to attend, or is
2
administering the exam and work quickly.
Except where indicated, the patient obtunded and requires strong
should not be coached (i.e., repeated or painful stimulation to make
requests to patient to make a movements (not stereotyped).
special effort).
Responds only with reflex motor
3 or autonomic effects, or totally
unresponsive, flaccid, and areflexic.
Score
3. Level of Consciousness
Instructions
1b
Scale Definition
1c
Instructions
Level of Consciousness
Scale Definition
LOC Questions:
The patient is asked the month and his/her
age. The answer must be correct — there is
0 Answers both questions correctly. LOC Commands:
The patient is asked to open and close
the eyes and then to grip and release
0 Performs both tasks correctly.
no partial credit for being close. Aphasic and the non-paretic hand. Substitute
stuporous patients who do not comprehend another one-step command if the hands
the questions will score 2. Patients unable cannot be used. Credit is given if an
to speak because of endotracheal intubation,
orotracheal trauma, severe dysarthria from any
cause, language barrier, or any other problem
1 Answers one question correctly. unequivocal attempt is made but not
completed due to weakness. If the
patient does not respond to command,
1 Performs one task correctly.
not secondary to aphasia are given a 1. It the task should be demonstrated to
is important that only the initial answer be him or her (pantomime), and the result scored
graded and that the examiner not “help” the (i.e., follows none, one, or two commands).
2 2
patient with verbal or non-verbal cues. Patients with trauma, amputation, or
Answers neither question correctly. other physical impediments should be Performs neither task correctly.
given suitable one-step commands.
Only the first attempt is scored.
Score Score
4. Best Gaze
Instructions
2
Scale Definition
3
Instructions
Visual
Scale Definition
Best Gaze:
Only horizontal eye movements will be tested.
Voluntary or reflexive (oculocephalic) eye
0 Normal. Visual:
Visual fields (upper and lower quadrants) are
tested by confrontation, using finger counting
0 No visual loss.
movements will be scored, but caloric testing or visual threat, as appropriate. Patients may
is not done. If the patient has a conjugate
deviation of the eyes that can be overcome
by voluntary or reflexive activity, the score 1
Partial gaze palsy; gaze is abnormal
in one or both eyes, but forced
deviation or total gaze paresis is
be encouraged, but if they look at the side of
the moving fingers appropriately, this can
be scored as normal. If there is unilateral
1 Partial hemianopia.
will be 1. If a patient has an isolated not present. blindness or enucleation, visual fields in the
peripheral nerve paresis (CN III, IV, or VI), remaining eye are scored. Score 1 only if a
score a 1. Gaze is testable in all aphasic
patients. Patients with ocular trauma,
bandages, pre-existing blindness, or other
clear-cut asymmetry, including quadrantanopia,
is found. If patient is blind from any cause,
score 3. Double simultaneous stimulation is
2 Complete hemianopia.
Forced deviation, or total
disorder of visual acuity or fields should be
tested with reflexive movements, and a choice
made by the investigator. Establishing eye
2 gaze paresis is not overcome by the
oculocephalic maneuver.
performed at this point. If there is extinction,
patient receives a 1, and the results
are used to respond to item 11. 3 Bilateral hemianopia (blind including
cortical blindness).
contact and then moving about the patient
from side to side will occasionally clarify the
presence of a partial gaze palsy.
Score Score
5. Facial Palsy
Instructions
4
Scale Definition
5
Instructions
Motor Arm
Scale Definition
Facial Palsy:
Ask — or use pantomime to encourage — the
patient to show teeth or raise eyebrows and
0 Normal symmetrical movements. Motor Arm:
The limb is placed in the appropriate position:
extend the arms (palms down) 90 degrees
0 No drift; limb holds 90 (or 45) degrees
for full 10 seconds.
Drift; limb holds 90 (or 45) degrees,
close eyes. Score symmetry of grimace in
response to noxious stimuli in the poorly
responsive or non-comprehending patient. 1 Minor paralysis (flattened nasolabial
fold, asymmetry on smiling).
(if sitting) or 45 degrees (if supine). Drift is
scored if the arm falls before 10 seconds. The
aphasic patient is encouraged using urgency
1 but drifts down before full 10 seconds;
does not hit bed or other support.
If facial trauma/bandages, orotracheal tube, Some effort against gravity; limb
in the voice and pantomime, but not noxious
2
tape, or other physical barriers obscure stimulation. Each limb is tested in turn, cannot get to or maintain (if cued) 90
the face, these should be removed to the beginning with the non-paretic arm. Only (or 45) degrees, drifts down to bed,
extent possible. but has some effort against gravity.
2 Partial paralysis (total or near-total in the case of amputation or joint fusion at
paralysis of lower face). the shoulder, the examiner should record the
score as untestable (UN) and clearly write the 3 No effort against gravity; limb falls.
4
explanation for this choice.
No movement.
Complete paralysis of one or both
3 sides (absence of facial movement in
the upper and lower face).
5b a Left Arm
Score UN Amputation or joint fusion, explain:
Score
5 Right Arm Score
6. Motor Leg
Instructions
6
Scale Definition
7
Instructions
Limb Ataxia
Scale Definition
Motor Leg:
The limb is placed in the appropriate position:
hold the leg at 30 degrees (always tested
0 No drift; leg holds 30-degree position
for full 5 seconds.
Limb Ataxia:
This item is aimed at finding evidence of a
unilateral cerebellar lesion. Test with eyes
0 Absent.
supine). Drift is scored if the leg falls before
5 seconds. The aphasic patient is encouraged 1 Drift; leg falls by the end of the 5-
second period but does not hit the bed.
open. In case of visual defect, ensure testing
is done in intact visual field. The finger-
using urgency in the voice and pantomime but
not noxious stimulation. Each limb is tested
in turn, beginning with the non-paretic leg. 2
Some effort against gravity; leg falls
to bed by 5 seconds but has some
effort against gravity.
nose-finger and heel-shin tests are performed
on both sides, and ataxia is scored only if
present out of proportion to weakness. Ataxia
1 Present in one limb.
Only in the case of amputation or joint fusion is absent in the patient who cannot under-
at the hip, the examiner should record the
score as untestable (UN) and clearly write the
explanation for this choice.
3 No effort against gravity; leg falls to
bed immediately.
stand or is paralyzed. Only in the case of
amputation or joint fusion, the examiner
should record the score as untestable (UN) 2 Present in two limbs.
4 No movement.
and clearly write the explanation for this
choice. In case of blindness, test by having
the patient touch nose from extended arm
a UN Amputation or joint fusion, explain:
position.
UN
6b
Score Amputation or joint fusion, explain:
Left Leg
6 Right Leg Score Score
7. Sensory
Instructions
8
Scale Definition
9
Instructions
Best Language
Scale Definition
Sensory:
Sensation or grimace to pinprick when tested,
or withdrawal from noxious stimulus in the
0 Normal; no sensory loss. Best Language:
A great deal of information about
comprehension will be obtained during the
0 No aphasia; normal.
Mild-to-moderate aphasia; some obvious
loss of fluency or facility of comprehension,
obtunded or aphasic patient. Only sensory preceding sections of the examination. For without significant limitation on ideas
loss attributed to stroke is scored as abnormal Mild-to-moderate sensory loss; this scale item, the patient is asked to expressed or form of expression. Reduction
and the examiner should test as many body
areas [arms (not hands), legs, trunk, face]
patient feels pinprick is less sharp describe what is happening in the attached
1 of speech and/or comprehension, however,
makes conversation about provided materials
1 or is dull on the affected side; or picture, to name the items on the attached difficult or impossible. For example, in
as needed to accurately check for hemisensory there is a loss of superficial pain naming sheet, and to read from the attached conversation about provided materials,
loss. A score of 2, “severe or total sensory with pinprick, but patient is aware list of sentences. Comprehension is judged examiner can identify picture or naming card
loss,” should only be given when a severe from responses here, as well as to all of the content from patient’s response.
of being touched.
or total loss of sensation can be clearly commands in the preceding general neurological Severe aphasia; all communication is
demonstrated. Stuporous and aphasic patients exam. If visual loss interferes with the tests, through fragmentary expression; great need
will, therefore, probably score 1 or 0. The for inference, questioning, and guessing by
ask the patient to identify objects placed in
patient with brainstem stroke who has bilateral
Severe or total sensory loss; patient the hand, repeat, and produce speech. The
2 the listener. Range of information that can
be exchanged is limited; listener carries
loss of sensation is scored 2. If the patient
does not respond and is quadriplegic, score 2.
Patients in a coma (item 1a=3) are automati-
2 is not aware of being touched in the
face, arm, and leg.
intubated patient should be asked to write.
The patient in a coma (item 1a=3) will
automatically score 3 on this item. The examiner
burden of communication. Examiner cannot
identify materials provided from patient
response.
cally given a 2 on this item.
Score
must choose a score for the patient with stupor
or limited cooperation, but a score of 3 should
be used only if the patient is mute and follows
3 Mute, global aphasia; no usable speech
or auditory comprehension.
Score
no one-step commands.
8. Dysarthria
Instructions
10
Scale Definition
11
Instructions
Extinction and Inattention
Scale Definition
Dysarthria:
If patient is thought to be normal, an
adequate sample of speech must be obtained
0 Normal. Extinction and Inattention (formerly Neglect):
Sufficient information to identify neglect may
be obtained during the prior testing. If the
0 No abnormality.
by asking patient to read or repeat words from Mild-to-moderate dysarthria; patient has a severe visual loss preventing
the attached list. If the patient has severe
aphasia, the clarity of articulation of 1 patient slurs at least some words visual double simultaneous stimulation, and
the cutaneous stimuli are normal, the score is
Visual, tactile, auditory, spatial, or
1
and, at worst, can be understood personal inattention, or extinction to
spontaneous speech can be rated. Only if the with some difficulty. normal. If the patient has aphasia but does bilateral simultaneous stimulation in
patient is intubated or has other physical appear to attend to both sides, the score is one of the sensory modalities.
barriers to producing speech, the examiner normal. The presence of visual spatial neglect
should record the score as untestable (UN) and Severe dysarthria; patient’s speech or anosagnosia may also be taken as evidence
2
clearly write the explanation for this choice. is so slurred as to be unintelligible of abnormality. Since the abnormality is
Do not tell the patient why he/she is being in the absence of or out of scored only if present, the item is never Profound hemi-inattention or extinction
tested. proportion to any dysphasia, or is untestable.
2
to more than one modality; does not
mute/anarthric.
recognize own hand or orients to only one
side of space.
UN Intubated or other physical barrier,
explain:
Score Score
9.
10. You know how. MAMA
Down to earth. TIP – TOP
I got home from work. FIFTY – FIFTY
Near the table in the dining room. THANKS
They heard him speak on the HUCKLEBERRY
radio last night.
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