Neurosurgery clinics of North America
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Neurosurg. Clin. N. Am. · Oct 1995
ReviewThe prehospital and emergency department management of penetrating head injuries.
The prehospital and emergency department management of the patient with a penetrating cranial injury can be summarized by the following tenets: 1. Assume any alteration in level of consciousness to be a result of the brain injury and not from alcohol or illicit drug intoxication. 2. Have a low threshold to protect the patient's airway with endotracheal intubation and chemical paralysis if a surgical lesion is suspected, there is seizure activity, or the patient is too combative to obtain the necessary studies. 3. ⋯ Remember, first do no harm. The primary brain injury has already been done. The clinician maximizes preservation of viable brain tissue by preventing secondary injury.
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The major changes in health care delivery today further cloud the perspectives of patient autonomy, participation, and justice and the ideals of the virtuous practice of medicine. A Workable Integrative Negotiation approach with COAST permeating the medical setting and health agenda, however, can help promote effective and ethical participatory communication in medicine. Clearly, instituting such change in a non-surgical decision-making procedure requires a new culture among all participants. ⋯ Instituting an outcome-based reimbursement system among government and providers can serve as a quasi-selection process based on the superseding objectives of the community at large. Finally, a participatory citizenry (from physicians to patients to society-at-large) that balances violence prevention, communication, innovation, community involvement, and appropriate treatment could advance optimal civic health. The challenge is to initiate such change with the communication principles outlined herein.
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This article reviews the preoperative evaluation of the child with intractable epilepsy. The importance of the history and the clinical manifestations of the seizures, and the results of electrophysiology, neurophysiology, and neuroimaging studies are discussed.
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Children requiring surgical treatment of epilepsy present many perioperative challenges. They demand the skills of a pediatric neuroanesthesiologist who is familiar with the physiologic and psychological needs of the pediatric patient, in addition to understanding the effects of anesthetic agents on the central nervous system. Not only is it important for the anesthesiologist to be aware of the neurosurgeon's specific operative plans, but also it is essential that the neurosurgeon understand the issues facing the anesthesiologist to avoid preventable intraoperative problems and to facilitate an optimal outcome for the patient.
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The Chiari II malformation and associated hydrosyringomyelia represent a complex spectrum of anatomic changes and clinical presentations whose management is rapidly changing as more is discovered about the natural history of these patients. Trends toward earlier operation on milder symptoms in selected patients may lead to improved neurologic outcome in these patients.