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At least 1,045 records · Page 58Linked to original sources
PubMed1985

Is the auditory brain-stem response (ABR) effective in the assessment of post-traumatic coma?

The aim of the present study is to evaluate the capacity of ABRs to detect the limit between reversible dysfunction and irreversible damage to the brain-stem after severe head injuries. ABRs were recorded in 40 severely head-injured patients, strictly selected on the basis of clinical and CT scan findings and the absence of otologic disease. The interpeak latency of waves V-I (IPL V-I) was calculated and compared to that recorded in 19 healthy control subjects. The distribution curve for IPL V-I in surviving patients was analysed. The overall mortality was 47.5%; all the patients showing an IPL V-I greater than 4.48 msec died or remained vegetative, while all but 2 of the patients with IPL V-I less than 4.48 msec survived. The IPL V-I was significantly different from normal value in surviving patients, showing a brain-stem dysfunction in reversible post-traumatic coma. The 95% confidence limits for the mean IPL V-I in the surviving population were 4.08 and 4.24 msec. Our results confirm the high prognostic accuracy of ABR (P less than 0.001) and suggest the hypothesis that 95% of survivors have an IPL V-I ranging between 3.82 and 4.50 msec.

Adolescent↗
PubMed1985

Bruxism: its significance in coma.

Bruxism, the phenomenon of non-functional grinding of the teeth has been ascribed to various causes. Twenty patients with coma from different causes who displayed bruxism were studied with an attempt to correlate the phenomenon to the level of consciousness, eye movements, respiration, cold caloric test, motor deficits and sleep wake cycles. Bruxism was seen to appear at different levels of consciousness, but to disappear only after a significant improvement in the level of consciousness. A relationship with the appearance of sleep wake cycles was also seen.

Adolescent↗
PubMed1992

Insomnia-coma and auto-electrocution complicating general anesthesia. Incidental factors which also cause cerebral, respiratory and cardiac arrest.

Whatever induces general anesthesia, i.e. cerebral arrest, tends to cause respiratory and cardiac arrest also. However, general anesthesia does not necessarily exclude nor block all other mechanisms which can provoke one or more of these three phenomena. Amongst many such more or less equipotent factors are intracranial, intrapleural, intra-abdominal and intratracheal pressures. These mechanical factors occurring but unrecognized in surgical patients cause puzzling complications including, insomnia, coma and unexpected sudden death.

Adult↗
PubMed1984

Naloxone in shock and toxic coma.

In summary, naloxone has proved to be effective and safe during its years of use for narcotic antagonism. Its usefulness in non-narcotic coma and shock remains controversial, although some encouraging but inconclusive evidence exists. The final answer lies on the horizon of medicine; it awaits further delineation of the role of endogenous opioids in health and disease and clear statistical verification of naloxone's efficacy in such disease states.

Animals↗
PubMed1988

Hyperthermia, hypertension, hypertonia, and coma in a massive thioridazine overdose.

This report characterizes an atypical presentation of a thioridazine overdose. Clinical manifestations included wide Q.R.S. complex, hyperthermia, hypertension, hypertonia, and coma. Plasma catecholamine levels were markedly elevated. The patient was treated with dantrolene sodium and supportive care. The patient's condition improved over time, with questionable response to dantrolene sodium. Supportive care was the mainstay of treatment.

Acute Disease↗
PubMed1991

gamma-Hydroxybutyrate: a health-food product producing coma and seizurelike activity.

Sixteen cases of adverse effects due to a new health-food product, gamma-hydroxybutyrate (GHB), were reported to the San Francisco Bay Area Regional Poison Control Center in the 5-month period from June to October 1990. Cases have also been reported in eight other states. Adverse effects included coma (four patients) and tonic-clonic seizurelike activity (two patients). Doses ranged from 1/4 teaspoon to 4 tablespoons. Acute symptoms resolved within 7 hours. GHB was investigated as an anesthetic agent during the 1960s until seizures and lack of analgesia precluded its use. It was recently introduced in the health-food market as a food supplement for body builders with claims of anabolic effects by stimulating growth hormone release. GHB remains under investigational new drug status with the Food and Drug Administration and is illegal for over the counter sale. The Food and Drug Branch of the California Department of Health Services has prohibited further sale of this product in California as have health departments in Florida and South Carolina; however, new cases continue to be reported. Health professionals should be aware of the potential health hazards of GHB.

Adolescent↗
PubMed1984

Prehospital use of the Glasgow Coma Scale in severe head injury.

To determine the prognostic value of prehospital Glasgow Coma Scale (GCS) scores in severe blunt head injuries, the GCS at the scene of injury (INGCS) and the GCS in the emergency department (EDGCS) were compared with neurologic outcomes in 33 consecutive head-injured patients. Patients were categorized according to final outcome: Group I (n = 7) had no neurologic deficits, group II (n = 3) had only minor neurologic deficits, group III (n = 11) had major neurologic deficits, and group IV (n = 12) died. Mean INGCS was not significantly different for any of the four groups (range 4.14 to 4.67). However, mean EDGCS was significantly higher (P less than .05) for group I (9.43 +/- 4.08) than for group IV (5.17 +/- 3.13), and mean EDGCS for groups I and II (8.8 +/- 3.99) were significantly higher (P less than .05) than that of groups III and IV (5.7 +/- 2.88). The net change in GCS (EDGCS--INGCS) was significantly higher (P less than .05) for groups I and II (4.5 +/- 4.4) than for groups III and IV (1.3 +/- 2.91). We conclude that INGCS alone has no prognostic value, but that EDGCS and any prehospital change in GCS may have prognostic value for severely head-injured patients.

Allied Health Personnel↗
PubMedDate not supplied

Lithium toxicity and myxedema coma in an elderly woman.

The development of hypothyroidism as a side effect of lithium therapy is a well recognized phenomenon. However, the presentation of myxedema coma after lithium intoxication has not been previously documented. In this case lithium toxicity may have exacerbated preexisting hypothyroidism to the point of respiratory arrest. Based on this case, we recommend periodic monitoring of thyroid function in an effort to detect preexisting hypothyroidism or lithium-induced hypothyroidism.

Aged↗
PubMedDate not supplied

The use of Glasgow Coma Scale in poisoning.

A 12-month prospective study was undertaken to observe current practice and to determine if a Glasgow Coma Scale (GCS) of 8 or less on admission is a useful parameter to predict the need for airway protection in poisoning. For the period of September 1988 to August 1989, there were 414 admissions for poisoning with 3 fatalities (0.7%). A total of 41 patients (10%) were assessed by attending physicians as requiring airway protection. An initial GCS of 8 or less had a sensitivity of 90% and specificity of 95% for predicting the need for intubation. Logistic regression analysis showed an odds ratio of 0.48 for the relationship between GCS and intubation, significant at P < 0.001. In addition, the absence of a gag reflex on admission gave a sensitivity of 70% and specificity of 100% for predicting the need for airway protection. Further analysis showed that the presence or absence of a gag reflex added nothing to the GCS for the prediction of probability for intubation. In conclusion, an initial GCS of 8 or less was found to be a useful guideline for intubation. However, it should be used in conjunction with the clinical context.

Adolescent↗
PubMedDate not supplied

Coma and respiratory arrest after exposure to butyrolactone.

A 2-year-old male was found unresponsive approximately 40 min after oral exposure to butyrolactone (Figure 1), a solvent used to remove methacrylate glues. The patient was apneic, bradycardic, and flaccid. He was given atropine and orally intubated, and his heart rate increased and blood pressure remained normal. He remained unresponsive to deep painful stimuli. Six hours after admission, the patient was alert and breathing spontaneously. He was extubated and discharged home the following day. Previous cases of serious toxicity following oral exposure to butyrolactone reported in Denmark have shown a similar propensity to bradycardia and coma. The use of butyrolactone is likely to increase, paralleling the popularity of acrylate adhesives. Emergency physicians should be aware of its potential for life-threatening toxicity.

4-Butyrolactone↗
PubMedDate not supplied

Normal somatosensory evoked potentials in a child in persistent coma.

Somatosensory evoked potentials have been useful in predicting coma outcome in children. We present a patient who failed to recover consciousness after a near-drowning episode and has remained in a vegetative state. The initial and subsequent somatosensory evoked potentials have been normal, illustrating that normal results do not necessarily portend a favorable outcome.

Child, Preschool↗
PubMedDate not supplied

Intussusception encephalopathy: an underrecognized cause of coma in children.

Intestinal intussusception is a common cause of bowel obstruction in infancy and early childhood. Typically the presenting signs and symptoms are referable to the abdomen. On occasion the most prominent presenting feature is depressed level of consciousness. We describe 3 patients who presented with coma associated with intussusception.

Child, Preschool↗
PubMed1992

Hyponatremic coma under oxcarbazepine therapy.

Oxcarbazepine (OXC) is considered to be a promising new antiepileptic drug with similar efficacy and better tolerability compared to carbamazepine (CBZ). However, hyponatremia is supposed to occur even more often than with CBZ. We report on a patient who developed hyponatremic coma under OXC with a serum sodium level of 115 mmol/l, the second published case of OXC-induced hyponatremia with serious clinical adverse effects.

Anticonvulsants↗
PubMed1992

Aspects of neurosurgical assessment using the Glasgow Coma Scale.

The Glasgow Coma Scale (GCS) has become a cornerstone of the neurological/surgical assessment of patients used by both nursing and medical staff. Since its development in the 1970s it has been used in a variety of clinical situations to monitor changes in a number of key neurological functions, including level of consciousness, pupil reaction and limb movement. During this time, however, there have been suggestions that there are problems with some of the measurement principles underlying its use, which in part has stimulated the development of other neuro-assessment tools. Irrespective of measurement device, there is always the possibility of error or incorrect assessment. In the field of neurosurgery, as with other high dependency environments, a patient's condition can change rapidly. Additionally, there is the association of certain assessment responses with nursing and medical interventions. Thus, accuracy in all aspects of assessment and recording is paramount. Despite the growing body of literature surrounding the GCS, little is known about the pattern of errors made by nursing staff using the GCS to assess neurosurgical patients. This study compared the assessment findings of Registered General Nurses (RGNs), Enrolled Nurses and Student Nurses after viewing videotaped neuro-assessments of patients in a high dependency unit. The criterion for judging the accuracy of subject's assessments was established by a panel of experts. As expected, RGNs had the highest proportion of correct assessments and students the least. Subjects were identified as having difficulty in determining the relative amounts of weakness that a patient exhibited, and in correctly distinguishing between flexion and extension.

Glasgow Coma Scale↗
PubMed2004

Comparison of consciousness level assessment in the poisoned patient using the alert/verbal/painful/unresponsive scale and the Glasgow Coma Scale.

STUDY OBJECTIVE: We determine how the alert/verbal/painful/unresponsive (AVPU) responsiveness scale (alert, responsive to verbal stimulation, responsive to painful stimulation, and unresponsive) corresponds to the Glasgow Coma Scale (GCS) when assessing consciousness level in the poisoned patient. METHODS: Consciousness level was assessed using the AVPU responsiveness scale and the GCS in all patients admitted to the hospital during a 6-month period with deliberate or accidental poisoning. An AVPU responsiveness scale algorithm and details of the individual components of the GCS were provided. Data were recorded prospectively on admission to the toxicology ward by nursing staff in the majority of cases and from case records for the small number of patients admitted directly to the ICU. Nursing staff also recorded any difficulty assessing consciousness level using either scoring system. RESULTS: Of the 1,384 patients studied, 1,138 patients were alert, 114 patients responded to a verbal stimulus, 87 patients responded to a painful stimulus, and 15 patients were unresponsive. The median GCS scores with interquartile ranges (IQR) for each AVPU responsiveness category were 15 (IQR 15), 13 (IQR 12 to 14), 8 (IQR 7 to 9), and 3 (IQR 3), respectively. There was a degree of overlap between the range of GCS scores for each category. Nursing staff recorded more difficulty using the GCS than the AVPU responsiveness scale. Alcohol-intoxicated patients proved to be the most difficult to assess. All patients who were unresponsive required intubation. No patient with a GCS score greater than 6 was intubated. CONCLUSION: Each AVPU category can be shown to correspond to a range of GCS scores. The AVPU responsiveness scale appears to provide a rapid simple method of assessing consciousness level in most poisoned patients, but difficulty was still observed in assessing alcohol-intoxicated patients.

Cohort Studies↗