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8 results

  • Chapter 27 - Brain Death

  • from Section 3 - Specific Neurological Disorders in Emergency Medicine
  • Edited by Thomas P. Campbell, Allegheny Health Network, Pittsburgh, Kevin M. Kelly, Allegheny Health Network, Pittsburgh
  • Book:
    Handbook of Emergency Neurology
    Published online:
    10 January 2024
    Print publication:
    17 August 2023, pp 392-394

  • Summary

    The term “brain death” implies permanent absence of cerebral and brainstem functions. US law equates brain death with cardiopulmonary death, but specific criteria need to be met for diagnosis of brain death or death by neurologic criteria (DBNC). There are established prerequisite criteria to consider a patient for brain death that include: (1) a cause of CNS catastrophe deemed irreversible; (2) no confounding metabolic abnormality; (3) no drug intoxication or CNS depressants; (4) a normothermic state; and (5) a normotensive state. If these criteria are met, then the patient can be formally considered for DBNC.

  • Single Rescuer Ventilation Using a Bag Valve Mask with Removable External Handle: A Randomized Crossover Trial

  • Paul Reed, Baruch Zobrist, Monica Casmaer, Steven G. Schauer, Nurani Kester, Michael D. April
  • Journal:
    Prehospital and Disaster Medicine / Volume 32 / Issue 6 / December 2017
    Published online by Cambridge University Press:
    15 August 2017, pp. 625-630
    Print publication:
    December 2017
  • Introduction

    Ventilation with a bag valve mask (BVM) is a challenging but critical skill for airway management in the prehospital setting.

    Hypothesis

    Tidal volumes received during single rescuer ventilation with a modified BVM with supplemental external handle will be higher than those delivered using a standard BVM among health care volunteers in a manikin model.

    Methods

    This study was a randomized crossover trial of adult health care providers performing ventilation on a manikin. Investigators randomized participants to perform single rescuer ventilation, first using either a BVM modified by addition of a supplemental external handle or a standard unmodified BVM (Spur II BVM device; Ambu; Ballerup, Denmark). Participants performed mask placement and delivery of 10 breaths per minute for three minutes, as guided by a metronome. After a three-minute rest period, they performed ventilation using the alternative device. The primary outcome measure was mean received tidal volume as measured by the manikin (IngMar RespiTrainer model; IngMar Medical; Pittsburgh, Pennsylvania USA). Secondary outcomes included subject device preference.

    Results

    Of 70 recruited participants, all completed the study. The difference in mean received tidal volume between ventilations performed using the modified BVM with external handle versus standard BVM was 20 ml (95% CI, -16 to 56 ml; P=.28). There were no significant differences in mean received tidal volume based on the order of study arm allocation. The proportion of participants preferring the modified BVM over the standard BVM was 47.1% (95% CI, 35.7 to 58.6%).

    Conclusions

    The modified BVM with added external handle did not result in greater mean received tidal volume compared to standard BVM during single rescuer ventilation in a manikin model.

    ReedP, ZobristB, CasmaerM, SchauerSG, KesterN, AprilMD. Single Rescuer Ventilation Using a Bag Valve Mask with Removable External Handle: A Randomized Crossover Trial. Prehosp Disaster Med. 2017;32(6):625–630.

  • A case of severe obstructive sleep apnoea in Madelung's disease treated by lateral pharyngoplasty

  • V Pinto, P G Morselli, D Tassone, O Piccin
  • Journal:
    The Journal of Laryngology & Otology / Volume 131 / Issue 9 / September 2017
    Published online by Cambridge University Press:
    23 May 2017, pp. 834-837
    Print publication:
    September 2017
  • Background:

    Madelung's disease is a rare disorder characterised by the presence of multiple, symmetric, non-capsulated fat masses in the face, neck and other areas of upper extremities. In some cases, severe clinical complications such as upper airway compression can occur.

    Case report:

    A 56-year-old man affected by Madelung's disease complained of snoring and severe daytime sleepiness. Polysomnography revealed severe obstructive sleep apnoea. An attempt to treat sleep apnoea by continuous positive airway pressure failed because of poor compliance. Functional expansion pharyngoplasty was carried out as an initial treatment. Marked improvement of neck movements and normalisation of somnographic parameters were observed at six months’ follow up.

    Conclusion:

    Patients with Madelung's disease should be examined carefully for potential obstructive sleep apnoea. Although continuous positive airway pressure remains the treatment of choice, specific surgery can be used in those patients who cannot tolerate continuous positive airway pressure therapy.

  • Association between Sleep Disordered Breathing and Nighttime Driving Performance in Mild Cognitive Impairment

  • Nathan Cross, Zoe Terpening, Shantel L. Duffy, Simon J.G. Lewis, Ron Grunstein, Keith Wong, Sharon L. Naismith
  • Journal:
    Journal of the International Neuropsychological Society / Volume 23 / Issue 6 / July 2017
    Published online by Cambridge University Press:
    24 April 2017, pp. 502-510

  • Objectives: The effect of sleep disordered breathing (SDB) on driving performance in older adults has not been extensively investigated, especially in those with mild cognitive impairment (MCI). The aim of this study was to examine the relationship between severity measures of SDB and a simulated driving task in older adults with and without MCI. Methods: Nineteen older adults (age ≥50) meeting criteria for MCI and 23 age-matched cognitively intact controls underwent neuropsychological assessment and a driving simulator task in the evening before a diagnostic sleep study. Results: There were no differences in driving simulator performance or SDB severity between the two groups. In patients with MCI, a higher oxygen desaturation index (ODI) was associated with an increased number of crashes on the simulator task, as well as other driving parameters such as steering and speed deviation. Poorer driving performance was also associated with poorer executive functioning (set-shifting) but the relationship between ODI and crashes was independent of executive ability. Conclusions: While driving ability did not differ between older adults with and without MCI, oxygen saturation dips in MCI were related to worse driving performance. These results suggest that decreased brain integrity may render those with SDB particularly vulnerable to driving accidents. In older adults, both cognition and SDB need to be considered concurrently in relation to driving ability. (JINS, 2017, 23, 502–510)

  • Chapter 26 - Neurological disease and neurological catastrophes

  • from Section 4 - The pregnant patient with coexisting disease
  • Edited by Marc van de Velde, Helen Scholefield, Lauren A. Plante
  • Book:
    Maternal Critical Care
    Published online:
    05 July 2013
    Print publication:
    04 July 2013, pp 285-300

  • Summary

    The problems in the pregnant woman are universal: physiological changes during pregnancy lead to a reduction in time from onset of apnea to oxygen desaturation and to an increased likelihood of regurgitation from a full stomach. An antenatal visit allows the airway to be evaluated and discussion to be held with the parturient about the use of invasive monitors, such as invasive arterial blood pressure monitoring and the use of continuous positive airway pressure devices during and after labor and delivery. A recent development in the management of the airway in the obese patient is the use of the so-called ramped position. Perhaps the main factor responsible for a higher incidence of difficulties in airway management is that general anesthesia is generally reserved for extreme obstetric emergencies. The use of supraglottic airways in the management of the obstetric airway is undergoing evaluation.

  • 29 - Animal subjects research Part II: Ethics of animal experimentation

  • from 4 - Research and publication
  • Edited by Gail A. Van Norman, University of Washington, Stephen Jackson, Stanley H. Rosenbaum, Susan K. Palmer
  • Book:
    Clinical Ethics in Anesthesiology
    Published online:
    05 March 2012
    Print publication:
    28 October 2010, pp 174-179

  • Summary

    Advances in medical technology and transplantation lead to the re-defining of death to include death by virtue of brain death. The determination of whole brain death requires the demonstration of three things: an irreversible comatose state; the loss of brainstem reflexes; and brainstem inactivity leading to apnea. Protocols for the clinical determination of brain death vary among institutions but must generally be made by more than one doctor in one of several relevant specialties. Neurophysiologic determinations of cerebral circulatory arrest include four-vessel cerebral angiography as well as various scintigraphic perfusion studies. In all countries where brain death is recognized legally, the diagnosis rests with physical examination, at times supported by further medical testing. Philosophical arguments for the integrity of brain death as a definition of death rest in historic religious and social concepts of what constitutes life, or with ideas that loss of personhood may be equivalent to death.

  • Learning in children and sleep disordered breathing: Findings of the Tucson Children's Assessment of Sleep Apnea (TuCASA) Prospective Cohort Study

  • KRIS L. KAEMINGK, ALICE E. PASVOGEL, JAMES L. GOODWIN, SHELAGH A. MULVANEY, FERNANDA MARTINEZ, PAUL L. ENRIGHT, GERALD M. ROSEN, WAYNE J. MORGAN, RALPH F. FREGOSI, STUART F. QUAN
  • Journal:
    Journal of the International Neuropsychological Society / Volume 9 / Issue 7 / November 2003
    Published online by Cambridge University Press:
    12 February 2004, pp. 1016-1026

  • We examined the relationship between nocturnal respiratory disturbance and learning and compared learning in children with and without nocturnal respiratory disturbance. Subjects were 149 participants in a prospective cohort study examining sleep in children ages 6–12: The Tucson Children's Assessment of Sleep Apnea study (TuCASA). Sleep was assessed via home polysomnography. Intelligence, learning and memory, and academic achievement were assessed. Parents rated attention. Group comparisons were used to test the hypothesis that the group with an apnea/hypopnea index (AHI) of 5 or more (n = 77) would have weaker performance than the group with AHI less than 5 (n = 72). The group with AHI of 5 or more had weaker learning and memory though differences between groups decreased when arousals were taken into account. There was a greater percentage of Stage 1 sleep in the AHI 5 or more group, and Stage 1 percentage was negatively related to learning and memory in the sample (n = 149). There were negative relationships between AHI and immediate recall, Full Scale IQ, Performance IQ, and math achievement. Hypoxemia was associated with lower Performance IQ. Thus, findings suggest that nocturnal respiratory disturbance is associated with decreased learning in otherwise healthy children, that sleep fragmentation adversely impacts learning and memory, and that hypoxemia adversely influences nonverbal skills. (JINS, 2003, 9, 1016–1026.)