Articles: trauma.
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Severe complications such as spinal epidural haematoma and an array of adverse neurological events leading to temporary or permanent disability have been ascribed to central neuraxial blocks. Infections (meningitis, abscesses), chemical injuries and very rarely cerebral ischaemia or haemorrhage, or both, have also been ascribed directly or indirectly to spinal and/or epidural anaesthesia. ⋯ The attention of investigators and practitioners is focused both on understanding the causative mechanisms of such accidents and in identifying 'alarm events' that can arise during the administration of a central block, if any. We reviewed the international literature for the neurological complications of central neuraxial blocks to identify some events that, if they occurred during the block procedure, could be perceived as dangerous.
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Induced hypothermia to treat various neurologic emergencies, which had initially been introduced into clinical practice in the 1940s and 1950s, had become obsolete by the 1980s. In the early 1990s, however, it made a comeback in the treatment of severe traumatic brain injury. The success of mild hypothermia led to the broadening of its application to many other neurologic emergencies. ⋯ Mild hypothermia has been applied with varying degrees of success in many neurologic emergencies, including traumatic brain injury, spinal cord injury, ischemic stroke, subarachnoid hemorrhage, out-of-hospital cardiopulmonary arrest, hepatic encephalopathy, perinatal asphyxia (hypoxic-anoxic encephalopathy), and infantile viral encephalopathy. At present, the efficacy and safety of mild hypothermia remain unproved. Although the preliminary clinical studies have shown that mild hypothermia can be a feasible and relatively safe treatment, multicenter randomized, controlled trials are warranted to define the indications for induced hypothermia in an evidence-based fashion.
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Neuropathic pain can originate from a variety of conditions. Early treatment is vital. Nurses have an important role in initiating treatment and providing ongoing pain management and support for patients.
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Folia medica Cracoviensia · Jan 2001
Review Comparative Study[Point systems for evaluating coma in patients with injuries of the central nervous system (CNS)].
Paper reviews various coma scales which are used to monitor consciousness after sustaining severe injuries of CNS. Glasgow Coma Scale, at present the most frequently used, was compared to recently developed scales, which are more useful for monitoring persistent comas, allows to evaluate discrete changes in patient's state more precisely and to predict the outcome. The necessity of evoked potentials' measurements, such as Trigeminal-Auditory Glasgow (Coma Scale) has been stressed.