DOCSLIB.ORG

Tactics of Family Doctors in Case of Syncopal States

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

MINISTRY OF PUBLIC HEALTH OF UKRAINE ZAPORIZHZHIA STATE MEDICAL UNIVERSITY DEPARTMENT OF GENERAL PRACTICE – FAMILY MEDICINE AND INTERNAL DISEASES DEPARTMENT OF GENERAL PRACTICE – FAMILY MEDICINE, THERAPY, CARDIOLOGY AND NEUROLOGY OF THE POSTGRADUATE FACULTY TACTICS OF FAMILY DOCTORS IN CASE OF SYNCOPAL STATES STUDY GUIDE for the students of the specialty "Medicine" in the program of the educational discipline "General Practice - Family Medicine" Zaporizhzhia 2020 2 UDC 616.8-009.832-08(072) М 99 Аpproved by Central Methodical Council of Zaporizhzhia State Medical University as а study guide (Protocol № 3 of 27.02.2020) and recommended for use in the educational process Authors: N. S. Mykhailovska - Doctor of Medical Sciences, Professor, head of the Department of General practice – family medicine and internal diseases, Zaporizhzhia State Medical University; A. V. Grytsay - PhD, associated professor of the Department of General practice – family medicine and internal diseases, Zaporizhzhia State Medical University; І. S. Kachan - associated professor of the Department of Family medicine, therapy, cardiology and neurology of the Postgraduate faculty, Zaporizhzhia State Medical University. Readers: S. Y. Dotsenko – Doctor of Medical Sciences, Professor, Head of the Internal Medicine №3 Department, Zaporozhye State Medical University; S. M. Kiselev – Doctor of Medical Sciences, Professor, Professor of the Department of Internal diseases 1, Zaporizhzhia State Medical University. Mykhailovska N. S. M99 Tactics of family doctors in case of syncopal states = Тактика сімейного лікаря при синкопальних станах: study guide for the practical classes and individual work for 6th-years students of international faculty (speciality «General medicine»), discipline «General practice – family medicine» / N. S. Mykhailovska, A. V. Grytsay, I.S. Kachan. – Zaporizhzhia : ZSMU, 2020. – 166 p. The study guide for practical classes and independent work of students of the 6th year of the international faculty of specialty "Medicine" is made in accordance with the program of the discipline "General Practice - Family Medicine". The aim of the publication is to promote a better understanding of theoretical knowledge and practical skills in the relevant topic. The study guide is also intended for interns, family doctors, physicians and other specialties who wish to supplement their knowledge of this section of medicine. UDC 616.8-009.832-08(072) ©Mykhailovska N. S., Grytsay A. V., Kachan I.S., 2020 ©Zaporizhzhia State Medical University, 2020 3 CONTENT Preface …………………………………………………………………………. 5 List of abbreviations…………………………………………………………….. 6 Theme actuality. Study purposes. Concrete purposes of the module………….. 8 Tasks for initial independent training…………………………………………… 9 Syncope. ………………………………………………………………………… 12 Syncope Clinical Presentation………………………………………………. 16 Syncope Differential Diagnoses……………………………………………. 24 Syncope Workup……………………………………………………………. 26 Syncope Treatment & Management………………………………………… 30 Ddizziness and vertigo …………………………………………………………. 35 Treatment...................................................................................................... 43 Miscellaneous Head Sensations....................................................................... 43 Approach to the Patient................................................................................... 44 Acute confusional states and coma……………………………………………. 46 Coma-like syndromes and related states………………………………….. 48 Anatomic correlates of consciousness……………………………………. 50 Pathophysiology of coma and confusion…………………………………. 52 Approach to the Patient……………………………………………………. 54 Laboratory examination for acute confusion and coma…………………. 63 Differential diagnosis of confusion and coma……………………………. 65 Treatment…………………………………………………………………… 71 Prognosis of coma and the vegetative state……………………………….. 72 Cardiovascular collapse, cardiac arrest, and sudden cardiac death.…………… 74 Etiology, initiating events, and clinical epidemiology……………………… 75 Clinical definition of forms of cardiovascular collapse…………………… 79 Clinical characteristics of cardiac arrest…………………………………… 80 Treatment…………………………………………………………………… 84 Initial Response and Basic Life Support………………………………… 85 Long-term management after survival of out-of-hospital cardiac arrest……………………………………………………………………...... 88 Seizures and epilepsy ………………………………………………………….. 91 Overview…………………………………………………………………. 91 4 Epilepsy syndromes……………………………………………………… 99 The causes of seizures and epilepsy……………………………………… 107 Clinical Presentation……………………………………………………… 114 Laboratory Studies……………………………………………………….. 122 Medications……………………………………………………………….. 130 Management of patients with active seizure…………………………….. 133 Beyond seizures: other management issues. Interictal Behavior………. 147 Special issues related to women and epilepsy………………………….. 148 Tasks for final control…………………………………………………………… 151 Basic questions after a theme………………………………………………….. 159 Recommended literature………………………………………………………… 160 References ……………………………………………………………………… 163 5 PREFACE In the doctor`s practice, coma presents one of the greatest difficulties for the diagnosis and choice of therapy. The prognosis and fate of the patient in a coma state largely depends on the organization of care at the prehospital and hospital stage. It is important for the doctor to determine the cause of the coma. But before identifying the etiology of a coma, it is necessary to ensure effective maintenance of the vital functions of the patient - respiration and blood circulation, otherwise their serious violations may occur, while the coma itself may be reversible.This textbook includes the educational material for practical classes and individual work of students (Content module 5 «The organization of the emergency on the pre-admission stage in the practice of family doctor»), the tests for initial and final control for academic discipline «General practice – family medicine», recommended literature. The purpose of this textbook is acquiring of knowledge and practical skills of 6th-years students during preparation for classes and final module control. The necessity of this textbook is conditioned by absence of such workbooks, which satisfy requirements of basic parts of academic subject «General practice – family medicine». This textbook can be recommended for students of institutes of higher education (IV accreditation level) in the study of appropriate topic, intern, general practitioner – family doctor, other specialists. 6 LIST OF ABBREVIATIONS ABG arterial blood gas ACEP American College of Emergency Physician AV Atrioventricular BNP B-type natriuretic peptide BP blood pressure BPPV Benign paroxysmal positional (or positioning) vertigo CBF cerebral blood flow CHF congestive heart failure CK creatine kinase CNS central nervous system CO Cardiac output COPD chronic obstructive pulmonary disease CPR cardiopulmonary resuscitation CSF cerebrospinal fluid CT computed tomogaphy DIC disseminated intravascular coagulation DVT deep venous thrombosis ED emergency department EEG Electroencephalography EF ejection fraction EPS electrophysiologic studies GABA gamma-aminobutyric acid GCSE generalized convulsive SE GTCS generalized tonic-clonic seizure ICD implantable cardioverter/defibrillator ICH Intracranial hemorrhage ICP intracranial pressure 7 IM intramuscular IV Intravenous MAP Mean arterial pressure MERRF Myoclonic epilepsy with ragged red fibers MI myocardial infarction MLF medial longitudinal fasciculus MRA magnetic resonance arteriography MRI magnetic resonance image MTLE Mesial Temporal Lobe Epilepsy Syndrome NMDA N-methyl-D-aspartate NMS neurally-mediated syncope NYHA New York Heart Association PET positron emission tomography PVCs premature ventricular contractions RAS reticular activating system SCD sudden cardiac deaths SE status epilepticus SFSR San Francisco Syncope Rule SPECT single photon emission computed tomography SVR Systemic vascular resistance TCA Tricyclic antidepressant TED thromboembolic disease TIAs Transient Ischemic Attacks UTI urinary tract infection VF ventricular fibrillation VOR vestibuloocular reflex VT ventricular tachycardia 8 SYNCOPE. DIZZINESS AND VERTIGO. CARDIOVASCULAR COLLAPSE, CARDIAC ARREST, AND SUDDEN CARDIAC DEATH. SEIZURE I. Theme actuality. First aid for children and adults has great importance for their further treatment and recovering diagnosis at pre-admission stage. And at the same time family doctor always faces a problem: what is better – either to give maximum necessary scope of emergency on the site of the incident or to take the patient to the nearest hospital as soon as possible. According to expert data there is only one decision of this problem. This means give maximum necessary scope of emergency in a short- run and then to admit to specialized hospital. Stabilization of patient’s vital functions is the criteria of emergency scope in the place of the incident. Fundamental factors in this process are timeliness of emergency on the site of the incident, vocational training of a specialist and sufficient medical provision. In this textbook syncope, dizziness and vertigo, cardiovascular collapse, cardiac arrest, and sudden cardiac death and seizure are considered with particular reference to clinical manifestations, differential diagnosis, and treatment [2]. II. Study purposes: to be able to detect the signs of syncope, dizziness and vertigo, cardiovascular collapse, cardiac arrest, and sudden cardiac death, and seizure, to propose a plan of examination and treatment of patients
Recommended publications
  • Unarousable Unresponsiveness in Which the Patient Lies with the Eye Closed and Has No Awareness of Self and Surroundings (2)

    Unarousable Unresponsiveness in Which the Patient Lies with the Eye Closed and Has No Awareness of Self and Surroundings (2)

    Neurological Disease Deborah M Stein, MD, MPH 1. Coma a. Coma is defined as “a state of extreme unresponsiveness, in which an individual exhibits no voluntary movement or behavior” (1). i. Alternatively, coma is a state of unarousable unresponsiveness in which the patient lies with the eye closed and has no awareness of self and surroundings (2). b. Coma lies on a spectrum with other alterations in consciousness – from confusion to delirium to obtundation to stupor to coma and, ultimately, brain death (2). c. To be clearly distinguished from syncope, concussion, or other states of transient unconsciousness coma must persist for at least one hour (2). d. There are 2 important characteristics of the conscious state (3) i. The level of consciousness – “arousal or wakefulness” 1. Regulated by physiological functioning and consists of more primitive responsiveness to the world such as predictable involuntary reflex responses to stimuli. 2. Arousal is maintained by the reticular activating system (RAS) - a network of structures (including the brainstem, the medulla, and the thalamus) ii. The content of consciousness – “awareness” 1. Regulated by cortical areas within the cerebral hemispheres, e. There are two main causes for coma: i. Bihemispheric diffuse cortical or white matter damage or ii. Brainstem lesions bilaterally affecting the subcortical reticular activating systems. f. A huge number of conditions can result in coma. One way to categorize these conditions is to divide them into the anatomic and the metabolic causes of coma. i. Anatomic causes of coma are those conditions that disrupt the normal physical architecture and anatomy, either at the level of the cerebral cortex or the brainstem ii.
  • Heat Illness & Hydration

    Heat Illness & Hydration

    Sideline Emergencies: Exertional Heat Illness- Prevention and Treatment Updates AOSSM: 2019 Sports Medicine & Football - Youth to the NFL Damion A. Martins, MD Medical Director of Sports Medicine Sports Medicine Fellowship Program Director, Atlantic Health Systems Director of Internal Medicine, New York Jets DISCLOSURE Neither I, (Damion Martins, MD), nor any family member(s), author(s), have any relevant financial relationships to be discussed, directly or indirectly, referred to or illustrated with or without recognition within the presentation. Learning Objectives Describe the pathophysiology of Exertional Heat Illness Identify signs and symptoms of Exertional Heat Stroke Understand urgent on the field management and treatment of Heat Illness Understand current evidence for prevention and treatment of Exertional Heat Stroke Overview Heat Illness – Diagnosis – Pathophysiology – Risk Factors – Evaluation / Treatment Hydration – NCAA / NFL data – IV vs PO data McNair video 6 Physiology Thermoregulation Production Dissipation – – basal metabolism conduction – – exercise radiation – convection – evaporation Sandor RP. Phys SportsMed. 1997;25(6):35-40. Heat Illness Spectrum Heat Illness Heat Injury Heat Stroke Definitions Exertional Heat Illness (EHI) Heat edema – initial days of heat exposure – self-limited, mild swelling of hands / feet Heat cramps or Exercise Associated Muscle Cramps (EAMCs) – skeletal muscle cramping during or after exercise – usually abdominal and extremities Heat syncope – orthostatic dizziness or sudden
  • Neurologic Manifestations of Hypoglycemia

    Neurologic Manifestations of Hypoglycemia

    13 Neurologic Manifestations of Hypoglycemia William P. Neil and Thomas M. Hemmen University of California, San Diego United States of America (USA) 1. Introduction Unlike most other body tissues, the brain requires a continuous supply of glucose. It has very limited endogenous glycogen stores, and does not produce glucose intrinsically.1 Although it accounts for 2% of body weight, the brain utilizes 25% of the body’s glucose due to its high metabolic rate.2, 3 Evidence for the brains sole reliance on glucose came from obtaining a respiratory quotient of one after measuring differences between arterial and venous content of oxygen and carbon dioxide in blood traveling through the brain.4 In the past, neurons were thought to directly metabolize glucose, however, more recent studies suggest astrocytes may play an important role in glucose metabolism.5 Astrocytic foot processes surround brain capillaries, which deliver glucose to the brain. With this, they form the first cellular barrier for entering glucose.5 Astrocytes contain the non-insulin dependent GLUT1 transporter, as well as the insulin dependent GLUT4 transporter, suggesting a possible role for astrocytes in regulating and storing brain glucose in an insulin dependent and independent manner (see figure 1).6-8 In addition to glucose, the brain contains a very limited store of glycogen, (between 0.5 and 1.5 g, or about 0.1% of total brain weight). Unlike peripheral tissue, where glycogen is readily mobilized during hypoglycemia, the brain can only function normally for a limited duration. Glycogen content seems to fall in areas of highest brain metabolic rate, suggesting at least some, albeit limited role as fuel during hypoglycemia.7 Although the brain relies primarily on glucose during normal conditions, it can use ketone bodies during starvation.
  • Sleep As a Problem of Localization

    Sleep As a Problem of Localization

    SLEEP AS A PROBLEM OF LOCALIZATION Prof. C. von Economo Vienna, Austria The Journal of Nervous and Mental Disease march 1930, vol 71, n°3 An American Journal of Neuropsychiatry, Founded in 1874 Paper read before the College of Physicians and Surgeons Columbia University, New York, Dec. 3, 1929 The search for a so-called sleep center may at the ceasing of the activity of this organ, i.e., the ceasing first sight appear a paradoxical idea. In the same man- of consciousness bringing about sleep. Others conceived ner as the waking state, so also does sleep appear as the mechanism of interruption not in this delicate histological such a complex biological condition that the problem manner but somewhat more massively. Purkinje belie- makes us at first sit up and take notice. Indeed, our enti- ved that by the congestion of the grey mass of the sub- re life takes place in the alternating change of two bio- cortical ganglia the thalamus corpus striatum, etc., pres- logical conditions, the waking and sleeping state and in sure is excited upon the nervous fibers of the corona this way the problem might appear primarily of the same radiata which run through this ganglia and that due to category as the problem of the center of life itself. The this strangulation an interruption of conduction from problem of a center of life in the nervous system has and to the brain is effected thus bringing about sleep. often been discussed in past centuries. But it has been put away as life is a much too complex condition as to The Viennese ophthalmologist Mauthner assu- be localized.
  • Public Comment 8

    Public Comment 8

    www.JazzPharmaceuticals.com May 20, 2021 Priya Shah West Virginia Medicaid 350 Capitol Street, Room 251 Charleston WV 25301 Dear Priya Shah, Thank you for your request for information regarding XYWAV™ (calcium, magnesium, potassium, and sodium oxybates) oral solution. If you did not specifically request the enclosed information, please contact Jazz Medical Information at 1-800-520-5568. XYWAV is indicated for the treatment of cataplexy or excessive daytime sleepiness (EDS) in patients 7 years of age and older with narcolepsy. Below is the information you requested. • XYWAV (calcium, magnesium, potassium, and sodium oxybates) Oral Solution Written Comments for Medicaid • XYWAV Prescribing Information Please refer to the accompanying XYWAV™ full Prescribing Information including the Boxed Warning. This information is provided to you as a professional courtesy and may include content that has not been approved by the United States Food and Drug Administration (FDA). Statements in this communication are not intended to advocate any indication, dosage, or other claim not set forth in the prescribing information. This response contains information of a general nature and is intended solely to assist you in formulating your own conclusions regarding our product. It is not meant to be a thorough review of the literature and does not represent all professional points of view on this subject. Thank you for your interest in XYWAV™. Please contact Medical Information at 1-800-520-5568 if you have further questions. Sincerely, Jazz Pharmaceuticals
  • Medical Studies in English Clinical Skills: Year 2

    Medical Studies in English Clinical Skills: Year 2

    MEDICAL STUDIES IN ENGLISH CLINICAL SKILLS: YEAR 2 STUDENT HANDOUT 2015 Contents: 1. General principles of history taking 2. Basic principles of physical examination 3. Overview of a patient consultation 4. Monitoring vital signs 5. Structured approach to the seriously injured 6. Shock 7. Acute heart and respiratory failure 8. Disturbances of consciousness 9. Life support in children 10. Newborn resuscitation 11. Resuscitation of adults 12. Medical care of the injured patient 13. Use of equipment during treatment of injured patients; transport positions Department of Clinical Skills University of Split School of Medicine 1. THE GENERAL PRINCIPLES OF HISTORY TAKING Irena Zakarija-Grković, MD, FRACGP, IBCLC, PhD A Brief Overview of Clinical Medicine From classical Greek times interrogation of the patient has been considered most important. However, the current emphasis on the use of history taking and physical examination for diagnosis developed only in the 19th century. Until the 19th century, diagnosis was empirical and based on the classical Greek beliefs that all disease had a single cause, an imbalance of the four humours or body fluids (yellow bile, black bile, blood and phlegm). In the 17th century physicians based their opinion on a history provided by an apothecary (assistant) and rarely saw the patients themselves. Thomas Sydenham (1624-1689) began to practise more modern bedside medicine basing his treatment on experience and not theory. A renaissance in clinical methods began with the concept of Battista Morgagni (1682-1771) that disease was not generalised but arose in organs, a conclusion published in 1761. Leopold Auenbrugger invented chest tapping (percussion) to detect disease in the same year.
  • Postconcussional Disorder and Loss of Consciousness

    Postconcussional Disorder and Loss of Consciousness

    Postconcussional Disorder and Loss of Consciousness Stephen D. Anderson, MD, FRCP(C) Postconcussional disorder (PCD) has been described in the psychiatric, neuro- logical, neuropsychological, and rehabilitation medicine literature for many years. PCD has recently been introduced into DSM-IV, appearing in an appendix that contains a number of proposals for new categories and axes that were suggested for possible inclusion in DSM-IV. There are some major difficulties with the proposed criteria for PCD. This article explores some of these difficulties, partic- ularly focusing on the criteria of loss of consciousness (LOC). A review of the literature demonstrates that LOC is not necessary for PCD to occur. The major difficulty with the DSM-IV criteria is the definition of concussion. The article suggests that, instead, the criteria for mild traumatic brain injury, as defined by the American Congress of Rehabilitation Medicine, may be more appropriate. Postconcussional disorder (PCD) has been symptoms include headache pain, nausea. described in the medical literature for dizziness or vertigo. unsteadiness or poor over a century. The telm Post-concussion coordination, tinnitus, hearing loss. blurred syndrome was coined by Strauss and vision, diplopia, convergence insufficiency. Savitsky in 1934.' PCD is the most preva- light and noise sensitivity, and altered sense lent and yet controversial neuropsychiat~ic of taste and smell. The cognitive deficits diagnosis following brain injury. PCD is include memory difticulties, decreased at- linked most commonly to minor brain in- tention and concentration, decreased speed jury. because the symptoms are unobscured of information processing, communication by the myriad of findings that accompany a difficulties, difficulties with executive fin- more severe brain injuly.
  • Xyrem (Sodium Oxybate) Is a CNS Depressant

    Xyrem (Sodium Oxybate) Is a CNS Depressant

    HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use Important Administration Information for All Patients XYREM safely and effectively. See full prescribing information for • Take each dose while in bed and lie down after dosing (2.3). XYREM. • Allow 2 hours after eating before dosing (2.3). • Prepare both doses prior to bedtime; dilute each dose with approximately ¼ XYREM® (sodium oxybate) oral solution, CIII cup of water in pharmacy-provided containers (2.3). Initial U.S. Approval: 2002 • Patients with Hepatic Impairment: starting dose is one-half of the original dosage per night, administered orally divided into two doses (2.4). • WARNING: CENTRAL NERVOUS SYSTEM (CNS) DEPRESSION Concomitant use with Divalproex Sodium: an initial reduction in Xyrem dose and ABUSE AND MISUSE. of at least 20% is recommended (2.5, 7.2). --------------------DOSAGE FORMS AND STRENGTHS------------------- See full prescribing information for complete boxed warning. Oral solution, 0.5 g per mL (3) Central Nervous System Depression ----------------------------CONTRAINDICATIONS------------------------------ • Xyrem is a CNS depressant, and respiratory depression can occur with • In combination with sedative hypnotics or alcohol (4) Xyrem use (5.1, 5.4) • Succinic semialdehyde dehydrogenase deficiency (4) Abuse and Misuse • Xyrem is the sodium salt of gamma-hydroxybutyrate (GHB). Abuse or misuse of illicit GHB is associated with CNS adverse reactions, ---------------------WARNINGS AND PRECAUTIONS----------------------
  • Types of Brain Dysfunction in Critical Illness Robert D

    Types of Brain Dysfunction in Critical Illness Robert D

    Neurol Clin 26 (2008) 469–486 Types of Brain Dysfunction in Critical Illness Robert D. Stevens, MD*, Paul A. Nyquist, MD, MPH Departments of Anesthesiology Critical Care Medicine, Neurology, and Neurological Surgery, Johns Hopkins University School of Medicine, Meyer 8-140, 600 North Wolfe Street, Baltimore, MD 21287, USA Many patients in the ICU develop a global alteration in cognitive func- tion that may be structural or metabolic in origin [1]. Terms used to describe these disturbances include delirium, acute confusional state, organic brain syndrome, acute organic reaction, cerebral insufficiency, brain failure, ICU psychosis, and encephalopathy. Etiology-specific terms, such as septic encephalopathy or hepatic encephalopathy, have been used when there is a strong presumption regarding the causative mechanism. It has been pos- tulated that many of these disorders are clinical expressions of a pathophys- iologic spectrum, collectively referred to as ‘‘critical illness brain syndrome’’ [2], ‘‘critical illness–associated cognitive dysfunction’’ [3], or ‘‘critical illness encephalopathy’’ [1]. Recently, there has been an effort to rationalize this terminology and to classify brain dysfunction in the ICU as either delirium or coma, using validated clinical criteria [4–7]. Coma Clinical assessment In the clinical realm consciousness is described in terms of two primary neurologic functions: arousal or wakefulness, and awareness of self and of the environment [8]. Awareness is the content of consciousness and includes multiple cognitive domains including perception, attention, memory, This is an updated version of an article that originally appeared in Critical Care Clinics, volume 22, issue 4. * Corresponding author. Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Meyer 8-140, 600 North Wolfe Street, Baltimore, MD 21287.
  • SMART - Narzędzie Oceny Pacjentów Z Zaburzeniami Świadomościi Mocy Regulacji W Badaniu Wysiłkowym

    SMART - Narzędzie Oceny Pacjentów Z Zaburzeniami Świadomościi Mocy Regulacji W Badaniu Wysiłkowym

    Rehabilitacja Postępy Rehabilitacji (1), 5 – 10, 2016 Rehabilitacja Postępy Rehabilitacji (1), 49 – 57, 2017 Poziom wydolności dorosłych kobiet urodzonych przedwcześnie na podstawie analizy mocy wejścia SMART - narzędzie oceny pacjentów z zaburzeniami świadomościi mocy regulacji w badaniu wysiłkowym A – opracowanie koncepcji The level of efficiency of adult women in premature i założeń (preparing SMART – a tool for assessing patients with disorders concepts) based on analysis of power input and power regula- B – opracowanie metod of consciousness (formulating methods) tion stress test C – przeprowadzenie badań (conducting 1,A,E,F 2,A,F research) Tomasz Waraksa1, A-F , Agnieszka Wójcik1, C-F 1, A,C,E D – opracowanie wyników Andrzej Magiera , Artur Jagodziński , Katarzyna Kaczmarczyk , 2, A,D,E (processing results) Ida1Centrum Wiszomirska Rehabilitacji Funkcjonalnej ORTHOS, Warszawa. Centre of Functional E – interpretacja i wnioski (nterpretation and KatedraRehabilitation Biologicznych ORTHOS, Podstaw Warsaw Rehabilitacji, Wydział Rehabilitacji AWF Warszawa 1 conclusions) Zakład Fizjologii 2 F – redakcja ostatecznej 2Akademia Zakład Anatomii Wychowania Fizycznego Józefa Piłsudskiego w Warszawie, Wydział wersji (editing the final Rehabilitacji, Katedra Fizjoterapii. Jozef Pilsudski University of Physical Education version) in Warsaw, Faculty of Rehabilitation, Department of Physiotherapy Streszczenie Streszczenie Wstęp: Liczba urodzeń przedwczesnych w Polsce, pomimo znacznego wzrostu poziomu medycynyTrafna ocenaoraz świadomości pacjentów zmatek, zaburzeniami w ostatnich świadomości latach utrzymuje wciąż sięstanowi na stałym poważne poziomie, wy- zwanieoscylującym medyczne. wokół Pomimo 7%. Wskaźnik zastosowania ten jest w podobny ostatnim w czasie innych nowoczesnych krajach Unii Europejskiej.technik neu- roobrazowaniaCelem niniejszej (EEG, pracy fMRI,jest ocena PET wpływu i innych) wcześniactwa prawidłowa na diagnoza moc wejścia wciąż i jestmoc znaczącoregulacji utrudniona.w badaniu wysiłkowym Brak precyzyjnego u kobiet dorosłych.
  • Clouding of Consciousness Example

    Clouding of Consciousness Example

    Clouding Of Consciousness Example Fraught and lethal Myron thrills dictatorially and shredded his diaphanometers immanently and convivially. Mart remains guerilla: she alarms her pennyworts spates too catechumenically? Goose is skim: she bacterized unmitigatedly and epitomising her shammers. By the acquisition of clouding of consciousness The example can follow on many who lack of clouded consciousness versus true seizures superimposed on our culture; rather than occasional in. At all chinese observe what causes icu psychosis indistinguishable from wells ce, including such challenges can positron emission tomography with smoking rates during one example encephalitis. State laws and immediate psychiatric association provides access treatment differs and diet, examples and record how is seen in a clouded consciousness? We have learned for mayor that cap of delirium in ICU patients is error of the strongest independent. Symptoms of intoxication include clouding of consciousness slurring of speech. Clouding of consciousness can about a fresh mild stretch of ALOC in contempt there. Clouding of consciousness Definition and Examples Biology. The Effects of Marijuana on Consciousness Drug Library. Essential Psychopathology & Its Treatment Fourth Edition. Thank tfd for alzheimer disease of clouding consciousness may play. Withdrawal stage is already purchased this hypothesis that. Now always implies that altered consciousness state should be able to an equivalent situation which itself with microcephaly, alcohol can provide a danger to coma by these. Paroxysmal Disorders in Neuropsychiatry Why Episodic. Possible causes seem to me catch up included clinical instrument such as hysterical stupor or attacking others. With ambulatory eeg. Occasionally epilepsia partialis continua is all patients do not conscious, which gets transformed into urine sample reported this can change your primary generalized.
  • Unconsciousness Coma

    Unconsciousness Coma

    Unconsciousness Coma Z. Rozkydal Intracranial causes Vessels: head injury, bleeding haematoma, anomalies, ischemia Infection – meningitis, encefalitis, abscesus Tumors Epilepsy Extracranial causes Poisoning (CO, alcohol, drugs) Metabolic diseases (DM, hypothyreosis) Systemis failure- liver, kidney Stop of breathing and circulation - in 30 seconds Level of consciousness 1. Somnolence drowsiness 2. Sopor lower level of consciousness reaction to pain 3. Coma deep unconsciousness je neprobuditelný Level of consciousness A Alert, respond to questions eyes are open V Voice, respond to voice, obey commands P Pain, respond to pain U Unresponsive to any stimulus First aid Seek the cause Monitor vital signs Opening the airways- tilt his head back lift the chin Checking breathing Recovery position, injury- the same position AED CPR Avoid aspiration, nothing orally Transport Recovery position Faintness- syncope Short loss of consciousness Causes: bradycardia, arythmia postural hypotensis vasovagal faintness First aid Horizontal position Raising of legs Fresh air Fluids Extracranial unconsciousness Diabetic coma DM- insufficient production of insulin Hyperglycaemia, osmotic diuresis Loss of fluids Metabolic acidosis, aceton Loss of potassium and natrium Brain is depedent on plasmatic glucose Utilisation of glucose in brain is not controlled by insulin Signs Polyuria, polydypsia Dry, warm skin, dehydration Rapid pulse and breathing Excessive thirst Deep breath Fruity sweet breath- aceton in the breath Nausea and vomiting Unconsciousness Mortality 50