THE PROGNOSIS of MEDICAL COMA David Bates I20*
Total Page:16
File Type:pdf, Size:1020Kb
Load more
Recommended publications
-
Diagnosis, Treatment, and Prognosis of Glioma Five New Things
Diagnosis, treatment, and prognosis of glioma Five new things s the profession of neurology becomes in- creasingly subspecialized, it becomes more A and more difficult for general neurologists to feel comfortable with every category of disease. At no time is this felt more keenly than when an imaging procedure has been performed on a pa- tient for a seizure, headache, or focal neurologic complaint and a brain tumor is discovered. In con- trast to consulting with a patient with a movement disorder or neuromuscular disease, there is no time to craft the discussion and discuss a differential diag- nosis. As with demyelinating disease or stroke, the scan result dictates an immediate conversation with the patient, but in contrast to those disorders this takes place from the perspective of a provider who understands that the eventual outcome for the pa- tient is likely to be guarded. How to give that message with tact, candor, and some optimism could be the sole topic of this article but, instead, we focus on 5 new ideas that are changing the management of brain tumor patients in the hopes that these points might prove useful during those times. Lynne P. Taylor, MD PROGNOSIS AND GLIOMA SUBTYPES In his pioneering work “Death Foretold,” Dr. Nicholas Chris- takis1 says “prognosis gives diagnosis its affective component, striking fear in patients and physicians Address correspondence and alike.” There has traditionally been a lot of therapeutic nihilism about the treatment of glioblastoma, but reprint requests to Dr. Lynne P. that is now changing. Previously believed to be one homogeneous group of tumors based on clinicopath- Taylor, X7NEU, Virginia Mason Medical Center, 1100 9th ologic and histologic assessments, we are now finding that subgroups exist within these tumors that one Avenue, Seattle, WA 98101 day may allow us to better predict which chemotherapy option is best for each individual patient. -
Forensic Medicine
YEREVAN STATE MEDICAL UNIVERSITY AFTER M. HERATSI DEPARTMENT OF Sh. Vardanyan K. Avagyan S. Hakobyan FORENSIC MEDICINE Handout for foreign students YEREVAN 2007 This handbook is adopted by the Methodical Council of Foreign Students of the University DEATH AND ITS CAUSES Thanatology deals with death in all its aspects. Death is of two types: (1) somatic, systemic or clinical, and (2) molecular or cellular. Somatic Death: It is the complete and irreversible stoppage of the circulation, respiration and brain functions, but there is no legal definition of death. THE MOMENT OF DEATH: Historically (medically and legally), the concept of death was that of "heart and respiration death", i.e. stoppage of spontaneous heart and breathing functions. Heart-lung bypass machines, mechanical respirators, and other devices, however have changed this medically in favor of a new concept "brain death", that is, irreversible loss of Cerebral function. Brain death is of three types: (1) Cortical or cerebral death with an intact brain stem. This produces a vegetative state in which respiration continues, but there is total loss of power of perception by the senses. This state of deep coma can be produced by cerebral hypoxia, toxic conditions or widespread brain injury. (2) Brain stem death, where the cerebrum may be intact, though cut off functionally by the stem lesion. The loss of the vital centers that control respiration, and of the ascending reticular activating system that sustains consciousness, cause the victim to be irreversibly comatose and incapable of spontaneous breathing. This can be produced by raised intracranial pressure, cerebral oedema, intracranial haemorrhage, etc.(3) Whole brain death (combination of 1 and 2). -
Coma Stimulation: Suggested Activities
Coma stimulation: suggested activities Headway’s publications are all available to freely download from the information library on the charity’s website, while individuals and families can request hard copies of the booklets via the helpline. As a charity, we rely on donations from people like you to continue providing free information to people affected by brain injury. Donate today: www.headway.org.uk/donate. Introduction It is quite common for family members to feel ‘useless’ when a relative is in a coma, and to be desperate to do something to help. A coma stimulation programme (sometimes called a coma arousal programme) is an approach based on stimulating the unconscious person’s senses of hearing, touch, smell, taste and vision individually in order to help their recovery. There is still controversy over how effective it is to try to stimulate a person in coma. However, most would say that such programmes have some beneficial effect, even if only to provide something constructive for the family to do. It is very important that the activities used would have been enjoyable for the patient before the injury. For example, only play music they like and talk to them about subjects they are interested in. Try not to do anything for too long in order to avoid tiring the person out. A stimulation programme must only be started after discussion with the clinical staff, who will advise you what might be appropriate at any particular stage in the recovery process. Activity suggestions Here are some examples of activities that could form part of a coma stimulation programme: • Make sure that a few friends and family members visit regularly, rather than in large groups at a time. -
Evaluation and Management in an Urgent Care Setting
Syncope Evaluation and Management in an Urgent Care Setting Urgent message: When a patient presents to urgent care after a syncopal event, the clinician’s charge is to determine whether the episode was of benign or potentially life-threatening etiology and whether the patient should be transferred for further evaluation. Kenneth V. Iserson, MD, MBA, FACEP, FAAEM, Professor of Emergency Medicine, The University of Arizona, Tucson, AZ Introduction yncope is a sudden, transient loss of consciousness with a loss of postural tone (typically, falling). It results from an abrupt, transient, and diffuse cerebral Smalfunction and is quickly followed by sponta- neous recovery. The term syncope excludes seizures, coma, shock, or other states of altered consciousness. Many patients will ascribe their syncopal episode to a sit- uationally mediated vasovagal episode. Despite this, the goals in the urgent care setting include the following: Ⅲ Determining whether the patient’s episode was actually a syncopal or presyncopal event, and if it could have a life-threatening etiology Ⅲ Stabilizing the patient Ⅲ Transferring those patients who need further diag- nostic studies or therapeutic interventions © John Bolesky, Artville © John Bolesky, Epidemiology Syncope accounts for up to 3% of emergency depart- common in young adults, while cardiac syncope ment (ED) visits and up to 6% of hospital admissions becomes increasingly more frequent with advancing each year in the United States.1,2 At some time in their age.4 The chance of having at least one syncopal episode lives, up to about half the population (12% to 48%) of in childhood is between 15% and 50%.5 Though a people may experience syncope.3 benign cause is usually found, syncope in children war- Syncope occurs in all age groups, but it is most com- rants prompt detailed evaluation.6 mon in adults. -
Study Guide Medical Terminology by Thea Liza Batan About the Author
Study Guide Medical Terminology By Thea Liza Batan About the Author Thea Liza Batan earned a Master of Science in Nursing Administration in 2007 from Xavier University in Cincinnati, Ohio. She has worked as a staff nurse, nurse instructor, and level department head. She currently works as a simulation coordinator and a free- lance writer specializing in nursing and healthcare. All terms mentioned in this text that are known to be trademarks or service marks have been appropriately capitalized. Use of a term in this text shouldn’t be regarded as affecting the validity of any trademark or service mark. Copyright © 2017 by Penn Foster, Inc. All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner. Requests for permission to make copies of any part of the work should be mailed to Copyright Permissions, Penn Foster, 925 Oak Street, Scranton, Pennsylvania 18515. Printed in the United States of America CONTENTS INSTRUCTIONS 1 READING ASSIGNMENTS 3 LESSON 1: THE FUNDAMENTALS OF MEDICAL TERMINOLOGY 5 LESSON 2: DIAGNOSIS, INTERVENTION, AND HUMAN BODY TERMS 28 LESSON 3: MUSCULOSKELETAL, CIRCULATORY, AND RESPIRATORY SYSTEM TERMS 44 LESSON 4: DIGESTIVE, URINARY, AND REPRODUCTIVE SYSTEM TERMS 69 LESSON 5: INTEGUMENTARY, NERVOUS, AND ENDOCRINE S YSTEM TERMS 96 SELF-CHECK ANSWERS 134 © PENN FOSTER, INC. 2017 MEDICAL TERMINOLOGY PAGE III Contents INSTRUCTIONS INTRODUCTION Welcome to your course on medical terminology. You’re taking this course because you’re most likely interested in pursuing a health and science career, which entails proficiencyincommunicatingwithhealthcareprofessionalssuchasphysicians,nurses, or dentists. -
Melanoma Review
Philip J. Bergman DVM, MS, PhD Diplomate ACVIM-Oncology Director, Clinical Studies, VCA Antech Medical Director, Katonah-Bedford Veterinary Center (#893) 546 North Bedford Rd., Bedford Hills, NY 10507 Office 914-241-7700, Fax 914-241-7708 Adjunct Associate, Memorial Sloan-Kettering Cancer Center, NYC MELANOMA REVIEW Melanomas in dogs have extremely diverse biologic behaviors depending on a variety of factors. A greater understanding of these factors significantly helps the clinician to delineate in advance the appropriate staging, prognosis and treatments. The primary factors which determine the biologic behavior of a melanoma in a dog are site, size, stage and histologic parameters. Unfortunately, even with an understanding of all of these factors, there will be occasional melanomas which have an unreliable biologic behavior; hence the desperate need for additional research into this relatively common (~ 4% of all canine tumors), heterogeneous, but frequently extremely malignant tumor. This review will assume the diagnosis of melanoma has already been made, which in of itself can be fraught with difficulty, and will focus on the aforementioned biologic behavior parameters, the staging and the treatment of canine melanoma. Biologic Behavior The biologic behavior of canine melanoma is extremely variable and best characterized based on anatomic site, size, stage and histologic parameters. On divergent ends of the spectrum would be a 0.5 cm haired-skin melanoma with an extremely low grade likely to be cured with simple surgical removal vs. a 5.0 cm high-grade malignant oral melanoma with a poor-grave prognosis. Similar to the development of a rational staging, prognostic and therapeutic plan for any tumor, two primary questions must be answered; what is the local invasiveness of the tumor and what is the metastatic propensity? The answers to these questions will determine the prognosis, and to be discussed later, the treatment. -
Cancer Treatment and Survivorship Facts & Figures 2019-2021
Cancer Treatment & Survivorship Facts & Figures 2019-2021 Estimated Numbers of Cancer Survivors by State as of January 1, 2019 WA 386,540 NH MT VT 84,080 ME ND 95,540 59,970 38,430 34,360 OR MN 213,620 300,980 MA ID 434,230 77,860 SD WI NY 42,810 313,370 1,105,550 WY MI 33,310 RI 570,760 67,900 IA PA NE CT 243,410 NV 185,720 771,120 108,500 OH 132,950 NJ 543,190 UT IL IN 581,350 115,840 651,810 296,940 DE 55,460 CA CO WV 225,470 1,888,480 KS 117,070 VA MO MD 275,420 151,950 408,060 300,200 KY 254,780 DC 18,750 NC TN 470,120 AZ OK 326,530 NM 207,260 AR 392,530 111,620 SC 143,320 280,890 GA AL MS 446,900 135,260 244,320 TX 1,140,170 LA 232,100 AK 36,550 FL 1,482,090 US 16,920,370 HI 84,960 States estimates do not sum to US total due to rounding. Source: Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute. Contents Introduction 1 Long-term Survivorship 24 Who Are Cancer Survivors? 1 Quality of Life 24 How Many People Have a History of Cancer? 2 Financial Hardship among Cancer Survivors 26 Cancer Treatment and Common Side Effects 4 Regaining and Improving Health through Healthy Behaviors 26 Cancer Survival and Access to Care 5 Concerns of Caregivers and Families 28 Selected Cancers 6 The Future of Cancer Survivorship in Breast (Female) 6 the United States 28 Cancers in Children and Adolescents 9 The American Cancer Society 30 Colon and Rectum 10 How the American Cancer Society Saves Lives 30 Leukemia and Lymphoma 12 Research 34 Lung and Bronchus 15 Advocacy 34 Melanoma of the Skin 16 Prostate 16 Sources of Statistics 36 Testis 17 References 37 Thyroid 19 Acknowledgments 45 Urinary Bladder 19 Uterine Corpus 21 Navigating the Cancer Experience: Treatment and Supportive Care 22 Making Decisions about Cancer Care 22 Cancer Rehabilitation 22 Psychosocial Care 23 Palliative Care 23 Transitioning to Long-term Survivorship 23 This publication attempts to summarize current scientific information about Global Headquarters: American Cancer Society Inc. -
The Vegetative State: Guidance on Diagnosis and Management
n CLINICAL GUIDANCE The vegetative state: guidance on diagnosis and management A report of a working party of the Royal College of Physicians contrasts with sleep, a state of eye closure and motor Clin Med 1INTRODUCTION quiescence. There are degrees of wakefulness. 2003;3:249–54 Wakefulness is normally associated with conscious awareness, but the VS indicates that wakefulness and Background awareness can be dissociated. This can occur because 1.1 This guidance has been compiled to replace the brain systems controlling wakefulness, in the the recommendations published by the Royal College upper brainstem and thalamus, are largely distinct of Physicians in 1996, 1 in response to requests for from those which mediate awareness. 6 clarification from the Official Solicitor. The guidance applies primarily to adult patients and older children Awareness in whom it is possible to apply the criteria for diagnosis discussed below. 1.6 Awareness refers to the ability to have, and the having of, experience of any kind. We are typically aware of our surroundings and of bodily sensations, Wakefulness without awareness but the contents of awareness can also include our 1.2 Consciousness is an ambiguous term, encom- memories, thoughts, emotions and intentions. passing both wakefulness and awareness. This dis- Although understanding of the brain mechanisms of tinction is crucial to the concept of the vegetative awareness is incomplete, structures in the cerebral state, in which wakefulness recovers after brain hemispheres clearly play a key role. Awareness is not injury without recovery of awareness. 2–5 a single indivisible capacity: brain damage can selectively impair some aspects of awareness, leaving others intact. -
Factors Predicting Acute Brain Injury in Cases of Carbon Monoxide Poisoning: a Prospective Registry-Based Study
toxics Article Factors Predicting Acute Brain Injury in Cases of Carbon Monoxide Poisoning: A Prospective Registry-Based Study Hoon Lim 1,†, Young Hwan Lee 1,†, Sangun Nah 1 , Sungwoo Choi 1 , Young Soon Cho 1, Gi Woon Kim 1, Ji Eun Moon 2 and Sangsoo Han 1,* 1 Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea; [email protected] (H.L.); [email protected] (Y.H.L.); [email protected] (S.N.); [email protected] (S.C.); [email protected] (Y.S.C.); [email protected] (G.W.K.) 2 Department of Biostatistics, Clinical Trial Center, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea; [email protected] * Correspondence: [email protected] † Hoon Lim and Young Hwan Lee contributed equally to this work. Abstract: Carbon monoxide (CO) is one of the most common poisoning substances worldwide. Since acute brain injury (ABI) is an important determinant of the neurological outcome in CO poisoning, screening for patients at a high risk of developing ABI is essential for the proper treatment. This study identified predictors of ABI in patients with CO poisoning. This prospective registry-based study was conducted in patients who visited a tertiary care hospital for CO poisoning from August 2016 to June 2020. ABI was defined as the presence of acute hypoxic lesions on diffusion-weighted magnetic resonance imaging. Multiple logistic regression analysis was performed to identify the predictors of ABI. Of 231 patients, 64 (27.7%) showed ABI. Multiple logistic regression analysis showed that a Citation: Lim, H.; Lee, Y.H.; Nah, S.; Glasgow Coma Scale (GCS) score <9 at presentation (odds ratio [OR] 3.28, 95% confidence interval Choi, S.; Cho, Y.S.; Kim, G.W.; Moon, (CI) 1.08–10.01), creatinine level >1.2 mg/dL (OR 3.04, 95% CI 1.16–8.01), and C-reactive protein J.E.; Han, S. -
The History of Medicine a Beginner’S Guide
The History of Medicine A Beginner’s Guide Mark Jackson A Oneworld Paperback Published in North America, Great Britain & Australia by Oneworld Publications, 2014 Copyright © Mark Jackson 2014 The right of Mark Jackson to be identified as the Author of this work has been asserted by him in accordance with the Copyright, Designs and Patents Act 1988 All rights reserved Copyright under Berne Convention A CIP record for this title is available from the British Library ISBN 978-1-78074-520-6 eISBN 978-1-78074-527-5 Typeset by Siliconchips Services Ltd, UK Printed and bound in Denmark by Nørhaven Oneworld Publications 10 Bloomsbury Street London WC1B 3SR England Stay up to date with the latest books, special offers, and exclusive content from Oneworld with our monthly newsletter Sign up on our website www.oneworld-publications.com For Ciara, Riordan and Conall ‘A heart is what a heart can do.’ Sir James Mackenzie, 1910 Contents List of illustrations viii Preface x Introduction xiii 1 Balance and flow: the ancient world 1 2 Regimen and religion: medieval medicine 25 3 Bodies and books: a medical Renaissance? 50 4 Hospitals and hope: the Enlightenment 84 5 Science and surgery: medicine in the nineteenth century 120 6 War and welfare: the modern world 159 Conclusion 197 Timeline 201 Further reading 214 Index 221 List of illustrations Figure 1 Chinese acupuncture chart Figure 2 Vessel for cupping (a form of blood-letting) discov- ered in Pompeii, dating from the first century CE Figure 3 Text and illustration on ‘urinomancy’ or urine analysis Figure 4 Mortuary crosses placed on the bodies of plague victims, c. -
Canine Multicentric Lymphoma
MEDICAL ONCOLOGY Canine Multicentric Lymphoma WHAT IS LYMPHOMA? Lymphoma is a cancer of the cells of the immune system called lymphocytes. Lymphocytes are present throughout the body, so dogs can develop lymphoma in multiple organs. Lymphoma most often affects lymph nodes, but can also affect the liver, spleen, bone marrow, and other sites. Lymphoma is typically diagnosed using aspirates collected from enlarged lymph nodes. In some cases, diagnosis may require sampling of bone marrow or other organs, tissue biopsy, or molecular testing (flow cytometry, PARR). Once a diagnosis is made, staging tests are recommended to assess the extent of disease. Complete staging includes blood and urine testing, non-invasive imaging (chest X-rays, abdominal ultrasound), and additional aspirates. This evaluation provides prognostic information, a baseline for monitoring, and information regarding organ function and involvement. Results may influence treatment recommendations or help anticipate potential complications. Lymphoma is categorized into five stages, depending on the extent of the disease in the body: single lymph node enlargement (stage I), regional lymph node enlargement (stage II), generalized lymph node enlargement (stage III), liver and/or spleen involvement (stage IV), and bone marrow and blood involvement (stage V). Patients are further categorized into a substage, with substage “a” being patients who show no clinical signs of illness and “b” being patients who show signs of illness (such as vomiting, weight loss, lethargy, fever, decreased appetite, etc.). WHAT IS THE DIFFERENCE BETWEEN B CELL AND T CELL LYMPHOMA? In addition to staging and substaging, lymphoma can be further characterized based on the type of lymphocyte (T cell or B cell) that becomes cancerous. -
Prognosis: How Do We Estimate It and Why Is It Important?
Prognosis: How do we estimate it and why is it important? Allie Halpern, MS4 Palliative Medicine Service August 27, 2014 prog·no·sis noun \präg-ˈnō-səs\ : a doctor's opinion about how someone will recover from an illness or injury : a judgment about what is going to happen in the future Prognosis: The Definition < http://www.merriam-webster.com/dictionary/prognosis> Many cultures recognize impending death. In the holy city of Varanasi (Hindu capital of India), families and priests bring dying people to end their lives in charity hospices. When asked how they know when to bring patients to the hospice the family members and priests answered, "when the patient no longer wanted to eat or drink". A 14-day stay is allowed but 10% died on the day of admission, 84% in the first week, and all by 17 days. Our system is very different from this, but still faces the same prognostication concerns. http://www.independent.co.uk/news/world/asia/varanasi-the-last-stop-before-nirvana-1805245.html Basu, M. Hotel Dealth. CNN Interactive Online. http://www.cnn.com/interactive/2014/04/world/india-hotel-death/index.html Survival Estimation in Palliative Care. Prtenoy, RK and Bruera E. Topics in Palliative Care. Volume 4. Oxford University Press, Mar 30, 2000. Photograph by Atul Loke/Panos Pictures for CNN. http://www.cnn.com/interactive/2014/04/world/india-hotel-death/index.html Prognosis: Why Bother? Patient autonomy and need to know: Palliative care patients recognize that their disease is progressing inexorably, but deserve to share the physician's estimation of life expectancy in order to make their own end of life decisions, both practical and spiritual.