Articles: brain-injuries.
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Arch Pediat Adol Med · Feb 1998
Predictors of death and neurologic impairment in pediatric submersion injuries. The Pediatric Risk of Mortality Score.
To evaluate the Pediatric Risk of Morality Score (PRISM score) as a tool to distinguish which patients presenting to the emergency department (ED) or pediatric intensive care unit (PICU) would survive neurologically intact from those who would die or survive with severe neurologic impairment following a submersion incident. ⋯ The PRISM scoring system accurately distinguished ED patients who would survive neurologically intact from those who would die or suffer neurologic impairment. There was not a specific PRISM score or probability of outcome that could distinguish PICU patients who would survive neurologically intact from those who would die or suffer severe neurologic impairment. The PRISM scoring system appeared to be more accurate in distinguishing intact survival from death or neurologic impairment in ED patients than in PICU patients.
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Controlled, continuous intrathecal infusion of baclofen injection relieves severe spasticity for a wide range of patients. This therapy has become a standard treatment option in spasticity management programs. ⋯ Experience from clinical trials and commercial use of this treatment provides a guide for others who are initiating this therapy at their facility. Further prospective research is needed to accurately determine best clinical practice guidelines for cost effective use of this therapy.
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Acta Neurochir. Suppl. · Jan 1998
Comparative StudyClinical evaluation of the Codman microsensor intracranial pressure monitoring system.
The use of the Camino fibre-optic subdural device for measuring Intracranial Pressure (ICP) in patients, has been shown to correlate well with recordings from the "gold standard" intraventricular fluid filled catheter [1]. Following this work, its use has become standard in the clinical monitoring of patients. More recently, laboratory studies have demonstrated accuracy, acceptable drift and high fidelity for the new Codman Microsensor ICP Transducer, a miniature strain gauge mounted on a flexible nylon catheter [3]. Its performance in patients, however, has yet to be fully assessed, in comparative studies. ⋯ These differences could in the majority of cases (excepting the negative drift) be explained by a constant offset of the Codman transducer, as described previously [6]. Further examination of this device is required.
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Second impact syndrome (SIS) occurs when an athlete who has sustained an initial head injury, most often a concussion, sustains a second head injury before symptoms associated with the first have fully cleared. While most commonly reported in football, the SIS can occur during any sport that can produce head blows. Any athlete still complaining of post-concussion symptoms after a head injury must not be allowed to return to play.
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Comparative Study Clinical Trial
Thiopental in CSF and serum correlates with prolonged loss of cortical activity.
Barbiturate coma is initiated in brain-injured patients whenever elevated intracranial pressure remains unresponsive to other therapeutical strategies. However, barbiturates alter cortical activity resulting in difficulties in clinical evaluation. ⋯ Prolonged unresponsiveness to exteroceptive stimuli correlates with persisting thiopental in CSF and serum. Thus, quantitative analysis of thiopental in serum becomes indispensable in predicting the length of drug-induced neurological impairment and in avoiding misinterpretation of the neurological status.