Status epilepticus is defined as continuous seizure activity lasting longer than 5 minutes or recurrent seizures without regaining consciousness between seizures for greater than 30 minutes. It requires immediate treatment to prevent neurological damage. Initial treatment involves airway management, IV access, glucose/thiamine administration, and first line anti-seizure medications like lorazepam, midazolam, or diazepam. Second and third line agents are used if seizures continue. Continuous EEG monitoring is important for detecting both overt and subtle seizures. Prompt treatment is crucial as delays can reduce effectiveness.
This slide was prepared for teaching purpose to medical students. It contain information from different books and medical journals. please inform if any of the information given need to be changed.
the causes, pathophysiology, clinical manifestations, diagnosis and treatment of epilepsy has been discussed in detail with the perspective of a subject called pathophysiology in both medical sciences as well as the pharmaceutical sciences
Seizure disorder is one of the important topic in children and adult also. here i explained the seizure disorder in pediatrics, include all most content for nurses level
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
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- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
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The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
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Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
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2. Definition of Status Epilepticus(Lowenstein DH. 1999)
• Traditionally defined as continuous, unremitting
seizure lasting longer than 30 minutes, or
recurrent seizures without regaining
consciousness between seizures for greater than
30 minutes.
• Newer literature and common neurology practice
usually accepts 5 minutes or longer as definition
for status epilepticus.
3. ETIOLOGIEs
Antiepileptic drug (AED)
noncompliance/insufficien
t dosing 20%
CNS infection 5%
Old brain injury 15% Cerebral tumor 5%
Acute vascular injury 15% Acute Trauma 5%
Alcohol related 10% Drug toxicity < 5%
Metabolic/electrolyte
disturbances 10%
Global hypoxic injury < 5%
Unknown/cryptogenic 10% Idiopathic epilepsy < 5%
4. TIME IS BRAIN
• Status should always be
treated as an emergency and
be treated promptly!
5. Types of Seizures
• Seizures can manifest as motor, sensory, or cognitive
dysfunction
• Classification of seizures
– Partial – seizures localized to an area of the brain resulting
in a corresponding localized dysfunction. Often described by
presence of absence of automatisms (ie lip smacking, jaw
mvmts, swallowing, fumbling with nearby objects) or
repeated subconscious or involuntary movements .
• Simple (w/o impairment of consciousness)
• Complex (w/ impairment of consciousness)
**Please note partial seizures can develop into secondarily
generalized seizures as abnormal electrical activity
spreads through the brain
6. Classification of Seizures
- Generalized seizures are characterized by the resulting
dysfunction
-Absence (loss of consciousness with no motor dysfunction)
-Myoclonic (bilaterally synchronous, arrythmic jerking)
-Clonic (repetitive and rhythmic motor movement)
-Tonic (extension of the arms, legs, & trunk)
-Tonic-clonic (extension of the arms, legs, & trunk followed
by repetitive, rhythmic movement)
-Atonic (aka drop-attack, absence of motor movement)
[Parillo & Dellinger, 2008]
9. Types of Status Epilepticus
• CONVULSIVE
– Generalized (Most common presentation of SE)
• Myoclonic
• Clonic
• Tonic
• Tonic-Clonic
– Partial
• Simple
• Complex
• Secondarily Generalized
10. Types of Status Epilepticus
• SUBTLE CONVULSIVE
– About 30% SE population
– Longer duration & more difficult to treat
– Clinical features:
• Continuous rhythmic subtle motor phenomena
• Facial twitching, nystagmoid eye jerks
• Subtle twitching of extremities
• Cognitive impairment (altered awareness)
• Head or eye deviation
• Automatisms
11. Possible Findings in Convulsive Status
• Generalized convulsions w/ bilaterally
symmetric myoclonic, tonic, clonic, or tonic-
clonic movements
• Convulsions on 1 side of body (not
symmetric) with repetitive involuntary
movements
13. Responsiveness of Treatment of SE
• Treatment with 1st
line therapy within 30
minutes of onset stopped status in 80% of
patients
• Treatment with first line therapy started
>/= 2 hrs after onset stopped status in 40%
of patients
14. Monitoring For Status in the ICU……
• Continuous EEG [cEEG] (continuous EEG 24 hr
order in WIZ) is ideal for capturing seizure activity
• Using cEEG captures 56% of seizures in first hour
and 88% of seizures in first 24 hrs
• Note: some factors which may limit obtaining
and/or interpreting EEG include head bandages,
delerium w/ mvmts, sweating, and aritifact from
electrical interference of mechanical devices ie
vent, ECT, dialysis. Also availability of EEGs in the
hospital plays a role
15. INITIAL MEDICAL MANAGEMENT
• ABCS (airway, breathing, circulation)
• Obtain IV access (2 sites preferably)
• Check finger stick glucose
• Give thiamine 100mg IV prior to Dextrose D50W 50ml
IV if low or unknown glucose
• Continuous monitoring (ECG, BP, HR, oxygen)
• Send stat labs (CBC, BMP, LFTs, Ca, Mg, PO4,
troponins, ABGs, AED lvls if on seizure meds, tox
screen (urine, blood), Hcg if pregnancy possible
• Continuous EEG monitoring if possible
16. Obtain history & exam
• History of epilepsy & AED use, structural brain
lesion (stroke, intracranial hemorrhage, tumor),
head trauma, meningitis, social history (illegal
drug or ETOH use), pregnancy
• Medical History including medications
• Seizure onset & duration, description of seizure
• Full neurologic exam including mental status,
cranial nerves, motor exam, sensory exam,
reflexes, cerebellar testing
17. Treatment of Convulsive SE
First Line Agents:
•▪Lorazepam Load IV 0.1mg/kg up to 4mg (2mg/min)
•▪Midazolam Load IM 0.2mg/kg up to 10mg IM
•▪Diazepam Load 0.2mg/kg (20mg rectally or 10mg IV)
Second-Line Agents
•▪Fosphenytoin 20mg/kg infused at a rate of 150mg/min
•▪Valproate 20-40mg/kg infused at a rate of 6mg/kg/min
•▪Levetiracetam 1500-4000mg infuse 500mg/min
•▪Lacosamide 400mg IV infuse over 5 mins
•▪Phenobarbital 20mg/kg IV infuse 60mg/min
18. • Initial Treatment
• ▪Lorazepam Load IV 0.1mg/kg up to 4mg (2mg/min)
• ▪Midazolam Load IM 0.2mg/kg up to 10mg IM
• ▪Diazepam Load 0.2mg/kg (20mg rectally or 10mg IV)
• Second-Line Agents
• ▪Fosphenytoin 20mg/kg infused at a rate of 150mg/min
• ▪Valproate 20-40mg/kg infused at a rate of 6mg/kg/min
19. Treatment of Convulsive SE
Third Line Agents
• ▪Midazolam infusion (Hypotension, withdrawl seizures)
• ▪Propofol infusion (Hypotension, propofol infusion syndrome)
• ▪Pentobarbital (Ileus, metabolic acidosis, thrombocytopenia,
immunosuppression)
• ▪Ketamine infusion (Hypertension, possible rise in ICP)
• ▪Etomidate infusion (Adrenal insufficiency, non-epileptic
myoclonus)
• ▪Lidocaine administration every 5 minutes (cardiac
arrhythmia)
20.
21.
22. Management on Bedside
Treatment of an Ongoing Seizure
1. Keep calm.
1. It is likely that others in the room are reacting with fear or
panic.
2. Ask family members to leave the room.
3. Tell them you will speak with them as soon as the
situation is evaluated and under control.
2. Have one or two people maintain the patient in a lateral
decubitus position.
3. Administer oxygen by nasal cannula or face mask.
4. Watch and wait for 2 minutes. A majority of seizures will
stop spontaneously within a short time..
23. Check the finger stick glucose level.
Make sure there are two IV setups available, at least one
with 0.9% normal saline (NS). If the patient has no IV access,
start an IV line. IV insertion and blood drawing will be much
easier.
Draw Diazepam 5mg IV slowly.
Elicit any further history not obtained initially.
Is this a first-ever seizure? Is the patient on anticonvulsants?
What is the patient’s admitting diagnosis? Is the patient
diabetic? Has the patient been febrile in the last 24 hours? Ask
for the chart to be brought to the bedside.
Observe the seizure type.
24. Order the following blood tests: (CBC), electrolytes, glucose,
magnesium (Mg), calcium (Ca), EtOH level, toxicology screen, and
anticonvulsant level (if applicable).
If the patient is hypoglycemic, give glucose (50 ml of D50W). If
there is any history or suspicion of alcoholism, administer thiamine
100 mg by slow, direct injection over 3 to 5 minutes. If
hypoglycemia is the cause of the seizure, the seizure should stop,
and the patient should wake up soon after the glucose
administration.
An Ambu bag with face mask should be at the bedside
because benzodiazepines can cause respiratory depression.
25. Summary
• Status is an emergency & requires
immediate treatment
• Remember sometimes status seizures are
not obvious, symptoms can be very subtle
or may only present as altered mental
status
• If you are concerned about seizures, consult
neurology right away for continuous EEG
monitoring
26. References
• Lowenstein DH. Status epilepticus: an overview of the clinical problem.
Epilepsia 1999; 40(Suppl 1); discussion S21-22
• Jordan KG. Status epilepticus. A perspective from the neuroscience intensive
care unit. Neurosurg Clin N Am. 1994;5:671-686
• Allredge BK, Gelb AM, Isaacs SM, et al. A comparison of lorazepam, diazepam,
and placebo fo the treatment of out of hospital status epilepticus. N Engl J Med
2001; 345(9):631-637.
• Towne AR, Waterhouse EJ, Boggs JG, Garnett LK, Brown AJ, Smith JR Jr,
DeLorenzo RJ. Presence of nonconvulsive status epilepticus in comatose
patients. Neurology 2000;54:340-345
• Parillo JE & Dellinger RP. (2008). Critical Care Medicine: Principles of Diagnosis
and Management in the Adult. St Louis, MO: Mosby Elsevier
• Sutter, R, Stevens R, and Kaplan P. Continuous Electroencephalographic
Monitoring in Critically Ill Patients: Indications, Limitations, and Strategies.
CCM Journal. 2013, 41(4) 1124-1132