Neurocritical care
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Therapeutic hypothermia is becoming the standard-of-care for coma following out-of-hospital cardiac arrest. Pregnancy has been considered a contraindication for therapeutic hypothermia. ⋯ During pregnancy, beneficence toward the pregnant woman must be the primary ethical guideline in emergent, life-threatening situations. Pregnancy should not be a contraindication to therapeutic hypothermia following cardiac arrest.
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Neurosurgical trainees regularly encounter critical care situations. Traditionally, education was accomplished through lecture and experience. Increasingly, human patient simulators (HPS) are employed, allowing trainees to sharpen skills in a safe and realistic environment. We describe our experience using HPS in neurosurgical training. ⋯ Neurosurgical critical care education is important for safe and effective care for patients. Clinical experience and didactic lectures help trainees obtain a solid knowledge base, but do not provide the benefit for learning in a fail-safe environment. Through the use of HPS, we have enhanced the critical care education of our trainees.
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Clinical recognition of acute bacterial meningitis (ABM) and its early prognostication would guide the degree of intensive treatment required. We aimed to study the clinical features and factors associated with death in patients with community acquired ABM. ⋯ In the present study, most of the factors predicting death were identified at the time of admission. Identification of these factors could help prioritizing patients needing intensive care facilities, especially in resource poor setting.
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Randomized Controlled Trial Multicenter Study
Impact of systemic inflammatory response syndrome on vasospasm, cerebral infarction, and outcome after subarachnoid hemorrhage: exploratory analysis of CONSCIOUS-1 database.
Systemic inflammatory response syndrome (SIRS) may develop after aneurysmal subarachnoid hemorrhage (SAH). We investigated factors associated with SIRS after SAH, whether SIRS was associated with complications of SAH such as vasospasm, cerebral infarction, and clinical outcome, and whether SIRS could contribute to a difference in outcome between patients treated by endovascular coiling or neurosurgical clipping of the ruptured aneurysm. ⋯ SIRS was associated with poor outcome but not angiographic vasospasm, DIND, or cerebral infarction after SAH in the CONSCIOUS-1 data. There was no support for the notion that neurosurgical clipping is associated with a greater risk of SIRS than endovascular coiling.
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Prognostication for survivors of cardiac arrest is a frequent challenge to neurologists. Our aim was to determine whether the FOUR (Full Outline of UnResponsiveness) score is an accurate predictor of outcome in patients after cardiac arrest and to compare its performance to the Glasgow Coma Scale (GCS). ⋯ The FOUR score, a simple clinical tool, is an accurate predictor of outcome in patients surviving cardiac arrest.