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3 results

  • Chapter 24 - Post-Arrest Neurologic Resuscitation

  • 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 346-356

  • Summary

    The management of unresponsive post-cardiac arrest patients has been an area of much controversy and research. Interventions during the arrest, particularly no-pause cardiopulmonary resuscitation and the advent of the automated external defibrillator have placed patients in a better position to respond to post-resuscitative measures. The initiation of post-arrest therapeutic hypothermia protocols, now referred to as targeted temperature management (TTM), has resulted in significant improvement in the number of neurologically intact survivors. Post-arrest care is centered on TTM, but includes a series of protocolized steps that define the measures to be taken to optimize outcome in these patients. Post-arrest care is the fifth and final link in the American Heart Association’s out-of-hospital chain of survival.

  • Electrophysiological Investigations in Orthostatic Myoclonus: Preliminary Findings

  • Aysegul Gunduz, Melih Tutuncu, Burcu Zeydan, Hulya Apaydin, Gunes Kiziltan, Sibel Ertan, Meral E. Kiziltan
  • Journal:
    Canadian Journal of Neurological Sciences / Volume 45 / Issue 1 / January 2018
    Published online by Cambridge University Press:
    07 November 2017, pp. 100-103
    • Article
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  • We report the clinical and electrophysiological findings in seven patients with orthostatic myoclonus (OM) associated with gait initiation failure and falls. OM is one of the causes of unsteadiness of stance and gait, and it may develop as a symptom of neurodegenerative disorders. Both positive myoclonic bursts and negative myoclonus may be seen in electrophysiological recordings, and electrophysiological analysis suggests a subcortical origin for OM.

  • SECTION VIII - BRAIN DEATH

    • By Sid M. Shah, Assistant Clinical Professor Michigan State University; Faculty member of Sparrow/MSU Emergency Medicine Residency Program Lansing, Michigan, Kevin M. Kelly, Associate Professor of Neurology Drexel University College of Medicine
  • Edited by Sid M. Shah, Michigan State University, Kevin M. Kelly, Drexel University, Philadelphia
  • Book:
    Principles and Practice of Emergency Neurology
    Published online:
    06 August 2009
    Print publication:
    18 February 2003, pp -

  • Summary

    The brain death criteria include assessment of the following: normothermia; cause of brain death; unresponsiveness; absence of brainstem reflexes; and apnea. The presence of withdrawal reflexes, typically seen in the lower extremities, do not preclude the diagnosis of brain death given that withdrawal reflexes can be spinally mediated. The absence of brainstem reflexes includes pupillary responses, eye movements, and lower brainstem reflexes such as response to tracheal stimulation. Apnea testing is performed to demonstrate lack of respiratory effort, even in the presence of elevated pCO2 levels. When no respiratory effort is made during the apnea test and the other criteria have been met, the patient may be pronounced dead. The diagnosis of brain death is not without controversy. For instance, thermoregulation is regarded as a brainstem function; therefore, some argue that those patients who maintain their body temperature cannot be declared brain dead.