Articles: brain-injuries.
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Study of a number of routine nursing care activities has suggested a relationship between activities and intracranial pressure (ICP). The purpose of this study was to focus on the relationship between nursing care activities and variations in ICP. A case study method was used to study ICP in five brain-injured patients with a Glasgow Coma Scale (GCS) score of 4 or more. ⋯ During the bathing procedures only two baths elicited an ICP greater than 20 mm Hg. All other bathing procedures elicited minimal increases in ICP. These findings further support the need for nurses to be aware of the patient's ICP prior to turning and suctioning.
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Transcranial Doppler sonography (TCD) has gained increasing relevance since its introduction by Aaslid in 1982. Basal cerebral arteries are insonated with a 2-MHz ultrasound beam. The backscattered ultrasound is analyzed by Fast-Fourier transformation and permits continuous and noninvasive determination of flow velocities (v) and pulsatility index (PI). ⋯ TCD is a fascinating monitoring device with many advantages. It can be useful for many patients and physicians, if its limitations and the clinical situation are kept in mind. Further studies have to define the role of TCD in neuroanaesthesia.
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The neuropathological changes produced by a captive bolt pistol are described. The primary wound track in the brain was similar to that inflicted by a weapon such as a .22 calibre rifle. However neural and vascular damage at a distance from the primary wound canal was much less severe and widespread after penetration of the low velocity captive bolt projectile due to the formation of a smaller temporary wound cavity by radial forces imparted to the parenchyma. These findings suggest that the use of a captive bolt pistol for euthanasia should be immediately followed by further actions to ensure that an animal is rendered permanently unconscious.
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Sufentanil is an intravenous opioid often used as a component of anesthesia during neurosurgical procedures. However, the effects of sufentanil on intracranial pressure in patients with diminished intracranial compliance are not well established, and remain controversial. ⋯ The results of the current study indicate that caution should be exercised in the administration of sufentanil bolus to patients with abnormal intracranial elastance, particularly if ICP is significantly increased.