检索结果-南通市图书馆

Evaluation and treatment of altered mental status patients in the emergency department:Life in the fast lane

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Emergency Medicine 2012年第4期3卷 270-277页

作者： Hai-yu Xiao Yu-xuan Wang Teng-da Xu Hua-dong Zhu Shu-bin Guo Zhong Wang Xue-zhong Yu Department of Medicine Beijing Puren Hospital Department of Behavioral Science and Health Education Emory University Rollins School of Public Health Department of Emergency Medicine Peking Union Medical College HospitalChinese Academy of Medical Sciences

BACKGROUND:altered mental status(AMS) is a very common emergency case,but the exact etiology of many AMS patients is *** often manifest vague symptoms,thus,AMS diagnosis and treatment are highly challenging for emergency *** aim of this study is to provide a framework for the assessment of AMS *** assessment should allow providers to better understand the etiology of mental status changes and therefore improve diagnostic skills and ***:This is a prospective cohort observational *** recruited all adult patients with undifferentiated AMS at a single center tertiary care academic emergency department over 24months(June 2009 to June 2011).Demographic characteristics,clinical manifestations,assessment approaches,causative factors,emergency treatments and outcomes were collected ***:In 1934 patients with AMS recruited,accounting for 0.93%of all emergency department(ED) patients,1 026(53.1%) were male,and 908(46.9%) *** average age was 51.95±15.71 *** factors were neurological(n=641;35.0%),pharmacological and toxicological(n=421;23.0%),systemic and organic(n=266;14.5%),infectious(n=167;9.1%),endocrine/metabolic(n=145;7.9%),psychiatric(n=71;3.9%),traumatic(n=38;2.1%),and gynecologic and obstetric(n=35;1.9%).Total mortality rate was 8.1%(n=156).The death rate was higher in elderly patients(≥60) than in younger patients(10.8%vs.6.9%,P=0.003).CONCLUSIONS:Patients with AMS pose a challenge for ED *** most frequently encountered diagnostic categories causing AMS were primary CNS disorders,intoxication,organ system dysfunction,and endocrine/metabolic *** has a high fatality rate in the *** is an important warning signal for ED patients because of its potentially fatal and reversible *** evaluation and treatment are essential to decreasing morbidity and mortality associated with AMS.

关键词： altered mental status Emergency department Demographic characteristics Clinical feature Assessment Etiology Mortality Algorithm

Herpes Simplex Virus Encephalitis Complicated by Acute Ischemic Stroke

维普期刊数据库

同方期刊数据库评论

在线全文

学校读者我要写书评

暂无评论

Advances in Infectious Diseases 2024年第2期14卷 387-392页

作者： Simona Zlatanova Oliana Boykinova Clinic of Infectious Diseases Parasitology University Hospital St George Plovdiv Bulgaria Department of Infectious Diseases Parasitology and Tropical Medicine Medical Faculty Medical University Plovdiv Plovdiv Bulgaria

Introduction: Herpes simplex virus is the most common etiology for life-threatening sporadic encephalitis worldwide. Antiviral therapy with acyclovir has been shown to reduce mortality and should be started promptly in patients with clinically suspected viral encephalitis before serological confirmation of the diagnosis. Despite antiviral treatment, it is associated with significant mortality and a wide range of neurologic sequelae or neuropsychiatric disorders. Clinical presentation includes fever, headache, altered mental status, and focal or generalized seizures. In some cases, it can present with focal neurological deficits, such as an acute stroke. The aim of this study is to identify rare complications of HSVE. Presentation: We present a case of a 71-year-old female patient with herpes virus encephalitis and an ischemic cerebral accident. The findings of CT scan of the brain revealed an extensive right temporal hypodensity. CSF findings include an elevated protein level, normal glucose level and pleocytosis with lymphocyte predominance. The lumbar tap confirmed the presence of herpes simplex virus type 1 with polymerase chain reaction (PCR) in the CSF. Neurological manifestations include focal neurological deficit with left-sided hemiparesis and coma. After 40 days of complex therapy, an improvement in the mental state was observed. Conclusion: There are varying degrees of neurologic sequelae among survivors in children and adults despite the antiviral treatment. Herpes simplex encephalitis has significant morbidity and high mortality due to the lack of prophylactic treatment and preventable strategies.

关键词： Herpes Virus Encephalitis Focal Neurological Deficit altered mental status Stroke Chameleon Persistently Positive CSF

Nonselective beta-blocker use is associated with increased hepatic encephalopathy-related readmissions in cirrhosis

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Clinical Cases 2022年第23期10卷 8097-8106页

作者： Mohammad Amin Fallahzadeh Sumeet K Asrani Elliot B Tapper Giovanna Saracino Robert S Rahimi Department of Internal Medicine Baylor University Medical CenterDallasTX 75246United States Division of Hepatology Baylor University Medical CenterDallasTX 75246United States Division of Hepatology University of MichiganAnn ArborMI 48109United States

BACKGROUND Hepatic encephalopathy(HE)is a neurocognitive condition in cirrhosis leading to frequent *** beta-blockers(NSBBs)are the mainstay of pharmacologic treatment in cirrhotic *** hypothesized that since NSBBs decrease cardiac output and portal flow,the decreased metabolic filtering process of liver parenchyma may lead to increased HE-related *** To evaluate the impact of NSBB administration on HE-related readmissions in cirrhotic *** In this retrospective cohort study,we included 393 patients admitted to Baylor University Medical Center for liver-related portal hypertension indications between January 2013 and July *** predictors of the first HErelated readmissions were identified using Cox proportional hazards *** cumulative incidence of the first HE-related readmissions between patients receiving NSBBs and not receiving NSBBs was examined using Fine-Gray modeling to account for the competing risk of death or liver *** The mean age was 58.1±10.2 years and most patients fell into Child class C(49.1%)or B(43.8%).The median Model for End-Stage Liver Disease-Sodium score was 22(IQR:11).The cumulative incidence of the first HE-related readmissions was significantly higher in patients taking NSBBs compared to patients not receiving NSBBs(71.8%vs 41.8%,P<0.0001).In multivariate analysis,after adjusting for demographics,markers of liver disease severity,selective beta-blocker,lactulose and rifaximin use,NSBB use[Hazard ratio:1.74(95%CI:1.29-2.34)]was independently associated with the first HE-related readmissions over a median follow-up of 3.8 *** NSBB use is independently associated with increased HE-related readmissions in patients with cirrhosis,regardless of liver disease severity.

关键词： altered mental status Ascites Esophageal varices Liver disease Portal hypertension Hospitalization

Can patients with non-convulsive seizure be identifi ed in the emergency department?

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Emergency Medicine 2017年第3期8卷 190-194页

作者： Gholamreza Sadeghipoor Roodsari Geetha Chari Bryan Mera Shahriar Zehtabchi Department of Emergency Medicine State University of New York Downstate Medical Center Department of Neurology State University of New York Downstate Medical Center

BACKGROUND: Non-convulsive seizure(NCS) is an underdiagnosed, potentially treatable emergency with significant mortality and morbidity. The objective of this study is to examine the characteristics of patients with NCS presenting with altered mental status(AMS) and diagnosed with electroencephalography(EEG), to identify the factors that could increase the pre-test probability of ***: Retrospective study using the data collected prospectively. Inclusion criteria: patients older than 13 years with AMS. Exclusion criteria:(1) immediately correctable AMS(e.g., hypoglycemia, opiod overdose);(2) inability to undergo EEG;(3) hemodynamic instability. Outcomes compared between NCS and non-NCS cases: vital signs, lactate level, gender, witnessed seizure, use of anticonvulsive in the field or in the ED, history of seizure or stroke, head injury, abnormal neurological finding and new abnormal findings on head CT. Data presented as medians and quartiles for categorical and percentages with 95%CI for continuous variables. Univariate analyses were performed with Man-Whitney U and Fisher's Exact tests. A multivariate analysis model was used to test the predictive value of clinical variables in identifying ***: From 332 patients(median age 66 years, quartiles 50–78), 16 were diagnosed with NCS(5%, 95%CI 3%–8%). Only age was signifi cantly different between the NCS vs. non-NCS groups in both univariate(P=0.032) and multivariate analyses(P=0.016).CONCLUSION: Other than age, no other clinically useful variable could identify patients at high risk of NCS. ED physicians should have a high suspicion for NCS and should order EEG for these patients more liberally.

关键词： altered mental status Seizure Non-convulsive Electroencephalography

Acute ethanol poisoning in a 6-year-old girl following ingestion of alcohol-based hand sanitizer at school

维普期刊数据库

同方期刊数据库评论

在线全文

学校读者我要写书评

暂无评论

World Journal of Emergency Medicine 2011年第3期2卷 232-233页

作者： Madeline Matar Joseph Cristina Zeretzke Sara Reader Dawn R. Sollee Division of Pediatric Emergency Medicine University of Florida Department of Emergency Medicine JacksonvilleFlorida USA Our Lady of the Lake Regional Medical Center Pediatric Residency Program Baton Rouge Louisiana USA University of Florida College of Pharmacy and College of Medicine Department of Emergency Medicine University of Florida Health Science Center-Jacksonville USA

BACKGROUND:Alcohol-based hand sanitizers (ABHSs) have been widely used in homes, workplaces and schools to prevent the spread of infectious diseases. We report a young child unintentionally ingested ABHS at a school, resulting in intoxication.;METHODS:The child was a 6-year-old girl who had been brought to the emergency department (ED) for hypothermia, altered mental status (AMS), periods of hypoventilation, hypothermia and vomiting. Computed tomography of her head revealed nothing abnormal in intracranial pathology. Urine drug screening was negative. Alcohol level was 205 mg/dL on admission. Other abnormal values included potassium of 2.8 mEq/L, osmolality of 340 mOsm/kg and no hypoglycemia. Further investigation revealed that the patient had gone frequently to the class restroom for ingestion of unknown quantities of ABHSs during the day. The patient was admitted for one day for intravenous fluid hydration and close observation of her mental status.;RESULTS:The patient was discharged from the hospital the next day without any complications.;CONCLUSIONS:Despite the large safety margin of ABHSs, emergency physicians need to be aware of the potential risk of ingestion of a large amount of such products in children and consider it in the assessment and management of school-age children with acute AMS.

关键词： altered mental status Ethanol Hand-sanitizer Pediatrics Toxicology