Podcasts about Glasgow Coma Scale

Welcome back! In this episode, we're diving deep into something we all think we know, the Glasgow Coma Scale. The GCS has been a fundamental part of assessing patients with altered consciousness for over 50 years. You'll find it in trauma scores, neurology exams and practically every prehospital and ED handover. But here's the thing, is it as reliable and useful as we think? In this episode, we'll explore the origins of the scale, what it was designed for and how it's been used (and maybe misused...) since. We take a look at how reproducible it really is, particularly when different clinicians score the same patient. Spoiler alert: it's not always as consistent as you might hope! We'll also unpack the individual components; eyes, voice, motor and ask if they all carry equal weight, or are some more prognostically useful than others? Because a GCS of 4 isn't always the same GCS of 4, depending on how you get there… We'll be looking at real-world implications, how we make decisions around airway management, imaging, and referral, all based on that one number. So whether you're in prehospital care, the ED, or intensive care - stick with us as we try to answer the question: is the GCS still doing what we need it to, or is it time to move on? Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon, Rob & James

When the odds say you shouldn't be alive, sometimes you wake up and make a podcast application anyway. In this episode, Hannah Maria takes us through her miraculous survival story after a devastating collision with a semi-truck left her with the lowest possible score on the Glasgow Coma Scale. From a shattered pelvis to a brain that decided to take an 11-day nap, her injuries read like a medical textbook's greatest hits. But what happens when you wake up thinking you're pregnant, only to discover you've been crafting Instagram reels in your sleep? Between memory gaps, broken bones, and an inexplicable urge to apply to Sickboy while still in the ICU, Hannah Maria's story is a testament to resilience, universal healthcare, and the strange ways our minds work when piecing life back together. In the wrap-up, the fellas dive into the surprising differences between getting knocked out and falling into a coma, proving that sometimes the best naps are the ones you don't remember taking.Want to see some of the jaw dropping photos from Hanna Maria's experience? Be sure to catch the full video version of this episode on YouTube.Follow Sickboy on Instagram, TikTok and Discord.

When the odds say you shouldn't be alive, sometimes you wake up and make a podcast application anyway. In this episode, Hannah Maria takes us through her miraculous survival story after a devastating collision with a semi-truck left her with the lowest possible score on the Glasgow Coma Scale. From a shattered pelvis to a brain that decided to take an 11-day nap, her injuries read like a medical textbook's greatest hits. But what happens when you wake up thinking you're pregnant, only to discover you've been crafting Instagram reels in your sleep? Between memory gaps, broken bones, and an inexplicable urge to apply to Sickboy while still in the ICU, Hannah Maria's story is a testament to resilience, universal healthcare, and the strange ways our minds work when piecing life back together. In the wrap-up, the fellas dive into the surprising differences between getting knocked out and falling into a coma, proving that sometimes the best naps are the ones you don't remember taking.Want to see some of the jaw dropping photos from Hanna Maria's experience? Be sure to catch the full video version of this episode on YouTube.Follow Sickboy on Instagram, TikTok and Discord.

In this episode of the Medical Nursing Podcast we're chatting all about managing ethylene glycol toxicity. These patients commonly present as emergencies and require very intensive nursing care - the disease carries a poor prognosis, and it's often fatal.  However, with rapid intervention and intensive treatment and nursing, recovery can be possible. Today, we're talking all about what happens when a patient ingests EG, and how we can treat and nurse these patients accordingly - along with the practical skills we can use to support them. ---

Vi snackar om julmusik, Kiss som avatarer, Lasse W och Jocke B, konsertturism, överdrivna pressmeddelanden, Eldkvarns giriga "avslutningsturné", Solen på Cirkus och våra aningen märkliga Spotify Wrapped. Dessutom har Ricky Holmquist inspirerats till att lyssna på Hannes Aitman, blivit nostalgisk till Matchbox Twenty och fortsatt digga Dalmatin medan  Mikael Mjörnberg blivit besviken på Günther och fortsatt pumpa postrock. I segmentet "listan" pekar Ricky Holmquist ut tre riktigt mäktiga outron från svenska artister. Musiken som diskuteras i avsnittet hittar ni här: https://open.spotify.com/playlist/1PZytvYkF3GyGvMS9JdZtH?si=bd21b47f3cdc477f Vinjettfoto: Martin Wilson (https://www.facebook.com/fotografmartinwilson) Vinjettmusik: Systemet (https://open.spotify.com/artist/72k91zc6DR3LSq87r4fnVO?si=dcfb98a9377e428a)

Contributor: Travis Barlock MD Educational Pearls: When might you need to apply a painful stimulus in a medical setting? The main reason is to assess the patient's level of consciousness, such as when they are waking up from anesthesia or have potentially suffered a brain injury. It can be part of the Glasgow Coma Scale (GCS) if patients are not responding to auditory stimuli. Possible levels of consciousness include Alert, Lethargic, Obtunded, and Comatose (ALOC) What are the approved ways to apply a painful stimulus to assess central nervous system function? Trapezius squeeze. Grab the trapezius muscle and twist (contraindicated in clavicle fractures). Supraorbital rim pressure. Find the notch in the supraorbital rim of the patient and push hard with your thumb (contraindicated in facial fractures). Mandibular pressure (not mentioned). Press hard at the angle of the jaw on the mandibular nerve (contraindicated in mandible fractures). Sternal rub. Push down with your knuckles into the patient's sternum and rub vigorously (contraindicated in chest injury/surgery). Each technique should be done for between 15 and 30 seconds. If skin damage is observed in one location, move to a different location. This is especially true of the sternal rub. Important note: Peripheral techniques such as nail tip pressure should only be used to evaluate spinal nerve reflexes and not as a method of assessing the level of consciousness. References Lower J. Using pain to assess neurologic response. Nursing. 2003 Jun;33(6):56-7. doi: 10.1097/00152193-200306000-00047. PMID: 12799591. Middleton PM. Practical use of the Glasgow Coma Scale; a comprehensive narrative review of GCS methodology. Australas Emerg Nurs J. 2012 Aug;15(3):170-83. doi: 10.1016/j.aenj.2012.06.002. Epub 2012 Aug 3. PMID: 22947690. Mistovich JJ, Krost W, Limmer DD. Beyond the basics: patient assessment. Emerg Med Serv. 2006 Jul;35(7):72-7; quiz 78-9. PMID: 16878751. Naalla R, Chitirala P, Chittaluru P, Atreyapurapu V. Sternal rub causing presternal abrasion in a patient with capsuloganglionic haemorrhage. BMJ Case Rep. 2014 Apr 7;2014:bcr2014204028. doi: 10.1136/bcr-2014-204028. PMID: 24711478; PMCID: PMC3987201. Summarized by Jeffrey Olson, MS2 | Edited by Jorge Chalit, OMSII

The Australian mother of 3 and successful business owner is launching a book and nonprofit to assemble the world's greatest minds and visionaries. Sarah “Sharky” Harkness likes to say she “was forced to the bottom of hell and found God … over and over and over and over again.”​ The 38-year-old mom of three young children and visionary entrepreneur has survived 26 surgeries over a 3-year space.  She also come as close to death as one can (Glasgow Coma Scale of 3), suffered a stroke and spent almost 2 years in the hospital during Covid while fighting complications from life-threatening Autonomic dysreflexia – an overreaction of the involuntary nervous system to stimulation.​ The Sydney-based Australian has survived the experiences and is now thriving – releasing a new book and new nonprofit while running a successful revenue optimization agency called Cattle Dog Digital.​ “I have always known that we are given a choice in our lives, and I have made the same one over and over again: To get in and just get it done,” Harkness said. “I would not wish what I went through on anyone, and it's been absolute hell every time. … But I learned what alchemy you can create out of suffering.” The book will be called “Guided by Giants: A story of survival to thriving.”It will debut in September and will discuss Harkness' battle in the hospital, which included three brain shunts and several other interventions to save her life. In addition, it will reveal the inspiration behind the recently launched Project Lotus, the nonprofit that “aims to empower individuals and communities to break free from the constraints of scarcity and achieve greater abundance in every aspect of their lives.”​ “Our mission is to bring together the brightest minds from various communities and leverage our collective expertise in RevOps, AI, and abundance theory to make a positive impact on millions of people's lives,” Harkness said. “We aim to create a platform that provides personalized guidance on how to optimize resources, finances, and investments to achieve greater abundance or impact, and to foster collaboration and knowledge sharing among individuals who are passionate about helping others.”​ Harkness has a deep background serving the SaaS and cloud computing industry while working a decade for Salesforce, Marketo and Gitlab before starting Cattle Dog Digital with her husband Luke in 2015.  While at Salesforce, her nickname became “Sharky” – a combination of the first letter of her first name and first four letters of her surname. She said the “Sharky” description is a perfect fit for her personality as sharks “look for whatever opportunity they can to survive that is available within the adversity.”​ Even near death, especially on May 8, 2022, Harkness said “my will was so strong that it wouldn't let me die.” That experience and others have been the inspiration for Project Lotus as a lotus flower is associated with rebirth and renewal through suffering. ​ “It grows from muddy waters and rises above the surface to bloom into a beautiful flower,” Harkness said. “This symbolism could be fitting for a project focused on using technology and collaboration to create a positive outcome that prioritizes integrity and cultivation-based protocols.”​ Sarah has three children and having a son with some challenges with natural empathy meant she uses her experiences to help teach him how to connect with others. ​​ “Failure or succumbing to the emotion of my suffering,” she said, “is not an option. Mindset is a choice and I hope to share my story to enable others to activate the choice and will in them." Harkness believes that within us all is the possibility of transformation. ​ “I am so full of life now and so incredibly grateful,” Harkness said. “I have been humbled and brought to my knees in ways most humans will never experience. Now it's time to share my story with the world to inspire and activate others.”  For more information, visit www.sharkyceo.com

Approach to Pediatric Trauma Welcome to PICU Doc On Call, A Podcast Dedicated to Current and Aspiring Intensivists.I'm Pradip Kamat coming to you from Children's Healthcare of Atlanta/Emory University School of Medicine and I'm Rahul Damania, from Cleveland Clinic Children's Hospital. We are two Pediatric ICU physicians passionate about all things MED-ED in the PICU. PICU Doc on Call focuses on interesting PICU cases & management in the acute care pediatric setting so let's get into our episode.Welcome to our Episode today of a 7 yo M who presents to the PICU after a severe Motor Vehicle Accident.Here is the case presented by RahulA 7-year-old male child is admitted to the PICU after sustaining severe trauma. The patient was brought to the emergency department after a motor vehicle accident that involved an 18-wheeler truck & the family's car; in this severe accident the 7 yo was noted to be restrained however upon impact was ejected from the vehicle. He was unconscious and had multiple injuries, including a laceration on the head and bruising on the chest. The EMS was activated and the patient presented to the ED for acute stabilization. Upon examination, the patient was found to have a Glasgow Coma Scale score of 8, indicating a serious head injury. He had multiple bruises and abrasions on the chest and arms, and his pulse was rapid and weak. The patient was resuscitated with colloid and blood products, intubated, and transferred to the pediatric intensive care unit for further management.Notably, a CT scan of the head showed a skull fracture and a subdural hematoma. A chest X-ray showed multiple rib fractures and bilateral pulmonary opacities with no evidence of pneumothorax. The patient was also found to have a grade 2 liver laceration and a splenic injury. Pelvic x-ray and cardiac FAST exam were unrevealing.To summarize key elements from this case, this patient has:A traumatic brain injuryPulmonary contusions and is at risk for PARDSLiver and spleen injuryAnemiaPertinent negative includes: No pelvic injuries or injuries to great vessels in the chestRahul, let's approach the PICU medical management of this case based on a culmination of various guidelines published in the Pediatric Critical Care literature. Namely, let's use this case to dive deep into guidelines for:Traumatic brain injury (TBI)****Transfusion and Anemia Expertise Initiative (****TAXI)pediatric blunt liver and spleen injury management, are also known as the ATOMAC protocol, as well as general PICU management of acute trauma.As we take the management of this pediatric trauma patient in a systems-based fashion let's first go into the Management of Pediatric Traumatic Brain Injuries, can you start us off with some key management considerations?Based on the March 2019 TBI guidelines published in Pediatric Critical Care Medicine in 2019 (PCCM20(3S):p S1-S82, March 2019)This patient should have an ICP monitor or even an EVD placed for CSF diversion in consultation with the NS and trauma team. A CPP of at least >50 in our 7 yo patient and ICP < 20 mm Hg has been shown to improve outcomes and reduce mortality.Just as a quick review, CPP stands for cerebral perfusion pressure, which is the pressure that maintains blood flow to the brain. The formula for CPP is:CPP = MAP (mean arterial pressure) - ICP (intracranial pressure)Monitoring does not affect outcomes directly; rather the information from monitoring can be used to direct treatment decisions. Treatment informed by data from monitoring may result in better outcomes than treatment informed solely by data from clinical assessment. In short, it is important to have qualitative and quantitative data to optimize your decision-making.As we talked about ICP control is so crucial for

Join the #1 community of nursing students on the planet with 12,000+ students studying now inside of the NCLEX Virtual Trainer review on sale now at http://www.ReMarNurse.com   Your NCLEX RN & LPN Study Tools:  ► Get NCLEX Virtual Trainer: http://www.ReMarNurse.com/NCLEXVT ► Get the Question Bank: http://www.ReMarNurse.com/NCLEXQBank ► Get Quick Facts for NCLEX: http://bit.ly/QuickFactsNCLEX Get MORE from Regina MSN, RN: ► WATCH MORE: http://bit.ly/PassNCLEXPlayList/ ► GET THE PODCAST: https://remarnurse.podbean.com/ ► WATCH LESSONS: http://bit.ly/ReMarNCLEXLectures/ ► FOLLOW ReMar on Instagram: https://www.instagram.com/ReMarNurse/ ► LIKE ReMar on Facebook: https://www.facebook.com/ReMarReview/   ReMar Review features weekly NCLEX review questions and lectures from Regina M. Callion MSN, RN.  ReMar is the #1 content-based NCLEX review and has helped thousands of repeat-testers pass NCLEX with a 99.2% student success rate!   ReMar focuses on 100% core nursing content and as a result, has the best review to help nursing students pass boards - fast!

Intraventricular hemorrhage (IVH) is a devastating neurosurgical condition associated with high rates of morbidity and mortality. It can occur as the result of several pathologies and typically presents with mental status changes, neurologic deficits, seizures, headaches, and decreased Glasgow Coma Scale score. These patients are often treated with placement of an external ventricular drain, which helps decrease the clot burden; however, they commonly clot off leading to multiple exchanges. Dr. Ryan Hess, neurosurgeon form Buffalo General Hospital presents a case review in which drainage, irrigation, and fibrinolytic (DRIFT) therapy using IRRAflow® (IRRAS) irrigating catheter was used to treat a patient with severe IVH secondary to aneurysmal subarachnoid hemorrhage. Read more here: https://www.cureus.com/articles/57776...

Dr. Don Marion and Dr. Anne Bunner discuss whether a drug known for treating Alzheimer's, which may have some neuroprotective effects, could improve short-term neurological function in patients with moderate TBI. Publication: Mokhtari, M., Nayeb-Aghaei, H., Kouchek, M., Miri, M.M., Goharani, R., Amoozandeh, A., Akhavan Salamat, S., Sistanizad, M. (2017). Effect of Memantine on Serum Levels of Neuron-Specific Enolase and on the Glasgow Coma Scale in Patients With Moderate Traumatic Brain Injury. Journal of Clinical Pharmacology. Epub ahead of print. doi: 10.1002/jcph.980 PubMed link: www.ncbi.nlm.nih.gov/pubmed/28724200 CUBIST is a podcast for health care providers produced by the Traumatic Brain Injury Center of Excellence. We discuss the latest research on traumatic brain injury (TBI) most relevant to patient care. For more about TBI, including clinical tools, go to www.health.mil/TBICoE or email us at dha.ncr.j-9.mbx.tbicoe-info@mail.mil. The views, opinions, and/or findings in this podcast are those of the host and subject matter experts. They should not be construed as an official Department of Defense position, policy, or decision unless designated by other official documentation. Our theme song is “Upbeat-Corporate' by WhiteCat, available and was used according to the Creative Commons Attribution-Noncommercial 4.0 license.

En kvinne i 40-årene følte seg kvalm og uvel i økende grad et par dager før hun ringte den lokale AMK-sentralen. Selv om hun var våken og til stede da ambulansen kom, forverret tilstanden seg raskt, og det ble blant annet bemerket at hun tømte hele oksygenreservoaret for hvert åndedrag. Blodtrykket var ikke lenger målbart, hun mistet bevisstheten og skåret 6–7 poeng på Glasgow Coma Scale. Kvinnens alvorlige tilstand – og det senere utfallet – er såpass spesielt at det ikke finnes tilsvarende i eksisterende litteratur, ifølge forfatterne. Vi snakker med spesialist i hjertesykdommer og i akutt- og mottaksmedisin, Jørn Einar Rasmussen. Han er seksjonsoverlege ved Drammen sykehus og sjeflege i Hæren.Artikkelen «En kvinne i 40-årene med brystsmerter og livstruende bradykardi» er skrevet av Jørn Einar Rasmussen og Anders Wold Bjerring. Den kan leses i Tidsskriftet nr. 5/2022, og på tidsskriftet.no: https://tidsskriftet.no/2022/03/noe-laere-av/en-kvinne-i-40-arene-med-brystsmerter-og-livstruende-bradykardi Tilbakemeldinger kan sendes til stetoskopet@tidsskriftet.no. Stetoskopet produseres av Caroline Ulvin Johansson, Are Brean og Julie Didriksen ved Tidsskrift for Den norske legeforening. Ansvarlig redaktør er Are Brean. Jingle og lydteknikk: Håkon Braaten / Moderne media Coverillustrasjon: Stephen Lee

Den kommande biofilmen med Foo Fighters, streaminguppsvinget efter Super Bowl, artister som släpper musik utanför streamingtjänsterna, partiledarnas favoritmusik och väldigt mycket mer avhandlas i veckans avsnitt. Dessutom har Ricky Holmquist lyssnat på Sahara Hotnights och ett medley av Bruce medan Mikael Mjörnberg hyllar Günther och har fortsatt sitt strövtåg genom postrocken. I vårt hiss och diss-segment "hög och mög" sågar vi Kiss och hyllar musiker som inte gör politiska statement. Musiken som diskuteras i avsnittet hittar ni här: https://open.spotify.com/playlist/2bShPu35MGhwmIknmD27MQ?si=030103968e4e4cfe Vinjettfoto: Martin Wilson (https://www.facebook.com/fotografmartinwilson) Vinjettmusik: Systemet (https://www.facebook.com/systemetmusic)

Good morning and welcome to your Monday dose of Your Daily Meds.Bonus Review: Consider a Rhesus (Rh) positive foetus being carried by a Rh negative mother in her first pregnancy. Would that foetus be affected by the mother’s antibodies against foetal red blood cells? Answer: In short, probably not.Given this is her first pregnancy, the mother will probably not have any Rhesus antibodies (Anti-D antibodies). She could have developed these antibodies if she had been exposed to Rh positive blood in the past, such as in a previous pregnancy with an Rh positive foetus or an Rh positive blood transfusion.So, by considering the use of Anti-D passive immunisation in the event of a sensitising event in a pregnant woman of this status; and avoiding Rh positive transfusions in women of child-bearing age, we can reduce the risk of blowing up foetal red blood cells…Case:A 34-year-old male is brought into the Emergency Department via ambulance after a high-speed motor vehicle accident.On assessment:There is no eye openingIncomprehensible sounds are notedHe pulls his hand away when you firmly squeeze his nailbed with a pen.Which of the following correctly describes this man’s GCS score?GCS 7 – E 1; V 2; M 4GCS 7 – E 1; V 2; M 4GCS 7 – E 1; V 2; M 4GCS 7 – E 1; V 2; M 4GCS 7 – E 1; V 2; M 4Have a think.Scroll for the chat.Paediatrics:Which of the following is not considered in the calculation of an Apgar Score for a neonate?Heart rateRespiratory effortMuscle toneTemperatureReflex responseHave a think.More scroll for more chat.What the GCS?:The Glasgow Coma Scale is used as a neurological scoring system and assesses the patient’s best eye response, best vocal response and best motor response.It is scored out of 15, with the eye component scored out of 4, the verbal component out of 5 and the motor component out of 6.In this case, there is no eye opening (E 1), there are incomprehensible sounds verbalised (V 2), and the patient withdraws from painful stimulus (M 4). This results in a total GCS of 7.A GCS of 8 or less is often used as a marker for the need for intubation in the setting of an unprotected airway.Remember, the minimum GCS is 3, not 0.Toasters have a GCS of 3. As do logs.The GCS marking criteria are shown below for reference:APGARing:The Apgar Score comprises the assessment of neonatal heart rate, respiratory effort, muscle tone, colour and reflex response; with each criterion scored from 0-2 with a maximum score of 10. Not Temperature.Consider the table below:The score is based on the degree of cardiorespiratory and neurological depression present in the neonate and is measured at 1 and 5 (and sometimes 10) minutes after birth. A normal Apgar score is between 7 to 10. Apgar score of 4 to 6 indicate moderate depression; and 0 to 3 indicates severe depression. Bonus: Ok so what is the difference between a Hormone and a Vitamin?Answer in tomorrow’s dose.Closing:Thank you for taking your Meds and we will see you tomorrow for your MANE dose. As always, please contact us with any questions, concerns, tips or suggestions. Have a great day!Luke.Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. Just credit us where credit is due. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit yourdailymeds.substack.com

Guillermo Martínez Minutti comparte una playlist de lo más selecto del Rock contemporáneo alrededor del mundo con bandas como: Proud peasant, Krokofant, Glasgow Coma Scale y Ars de Er. Si te gusta el rock ¡Esta playlist es para ti!

Mit Musik von: Glasgow Coma Scale, Gudrun Gut und Mabe Fratti, Keshavara, Faust, Thala

With Music by: Glasgow Coma Scale, Gudrun Gut und Mabe Fratti, Keshavara, Faust, Thala

Traumatic Brain Injury Lawsuits & Glascow Come Scale Scores FInd out if you have a TBI https://866attylaw.com/new-york-city-brain-injury-lawyer/traumatic-brain-injury-symptoms/Frekhtman & Associates specialize in serious and catastrophic injury litigation and are recognized as some of the best personal injury lawyers in the New York City area.▶▶ ANY QUESTION? TEXT ME:

Welcome to another bombastic bout of the BOOF! This is the second half of my 2019 Rugby World Cup saga. I'm sure you can enjoy it as a stand-alone episode, but it picks up directly where we left off last time, so if you haven't already, I'd thoroughly recommend getting stuck into Part 1 before you proceed.  Expect hearty digressions on The Reverend Richard Price, the national anthem, the metaphysics of sports matches, imagined vs. real violence, joggers, the Cayman Islands, transvestitism, delirium tremens, the Glasgow Coma Scale, the morbidity of automation and pissing in public. I hope you enjoy.   Subscribe to the podcast and follow our socials to keep up-to-date with new episodes and upcoming guests, and go behind the scenes of BITB. Instagram: https://instagram.com/barter_in_the_booth Facebook: https://facebook.com/bitb.podcast Twitter: https://twitter.com/barter_booth Youtube: https://www.youtube.com/channel/UCyO2DvOW7tjSlLxhs-BpYOQ Email: bitb.pod@gmail.com

Join Raluca (ICU Nurse) and Chris (ICU Consultant) in looking after Mary, a (hypothetical) patient who has been in ICU for a week following a cardiac arrest. We are looking at reducing sedation and assessing Mary's neurology. Join us in discussion: Sedation? What is this and what medications we may use? Pain relief: what and why? How to assess neurology: GCS, RASS and CAM-ICU Delirium and its management. We mention research around GCS: Glasgow Coma Scale: Teasdale, G. and Jennett, B. (1974) 'Assessment of coma and impaired consciousness', The Lancet, 2 (7872), pp.81-84. Green, S.M. (2011) ‘Cheerio, Laddie! Bidding Farewell to the Glasgow Coma Scale', Annals of Emergency Services, 58(5), pp. 427-430. Reith FC, Synnot A, van den Brande R, Gruen RL, Maas AI (2017) ‘Factors Influencing the Reliability of the Glasgow Coma Scale: A Systematic Review.', Neurosurgery, 1;80(6), pp: 829-839. doi: 10.1093/neuros/nyw178. Ramazani, J. and Hosseinei, M. (2019) ‘Comparison of Full Outline of Unresponsiveness Score and Glasgow Coma Scale in Medical Intensive Care Unit', Annals of Cardiac Anaesthesia, 22(2), pp. 143-148, Wolf, C., Wijdicks, E., Bamlet, W., McLelland, R. (2007) ‘Further validation of the FOUR score coma scale by intensive care nurses' in Mayo Clinic Proceedings, 82(4) pp.435-438 Main debate: how useful do you find these assessment tools? Drop us a message… Don't miss our three takeaway messages and please send us yours! Enjoy the episode! Raluca Vagner- Intensive Care Nurse @RalucaVagner Chris Gough- Intensive Care Consultant @GoughC --- Send in a voice message: https://anchor.fm/hla-listen/message

On Episode 4 of the Stroke Alert Podcast, host Dr. Negar Asdaghi highlights two featured articles from the May 2021 issue of Stroke: “Association of Serum IL-6 With Functional Outcome After Intracerebral Hemorrhage” and “SARS-CoV-2 and Stroke Characteristics: A Report from the Multinational COVID-19 Stroke Study Group.” This episode also features a conversation with Dr. Alvaro Garcia-Tornel Garcia-Camba to discuss his article “Ischemic Core Overestimation on Computed Tomography Perfusion.” Dr. Negar Asdaghi: 1) Can a pro inflammatory marker predict the hematoma size and clinical outcomes in patients with intracerebral hemorrhage? 2) What are the characteristics of stroke patients infected with coronavirus? 3) Is ischemic core reliably represented by the current established cerebral blood flow thresholds on CT perfusion imaging? Or are we underestimating the importance of perfusion overestimating the ischemic core? We will discuss these topics in today's podcast. You're listening to Stroke Alert Podcast. Stay with us. Dr. Negar Asdaghi:                                     From the Editorial Board of Stroke, welcome to the Stroke Alert Podcast. My name is Negar Asdaghi. I'm an Associate Professor of Neurology at the University of Miami Miller School of Medicine and your host for the monthly Stroke Alert Podcast. For the May 2021 issue of Stroke, we have an exciting program today, as we cover topics from the predictive role of inflammatory markers in intracerebral hemorrhage to characteristics of stroke patients infected with SARS-CoV-2 virus. Later in the podcast, I have the privilege of interviewing Dr. Alvaro Garcia-Tornel Garcia-Camba from Autonomous University of Barcelona on the topic of ischemic core overestimation by CT perfusion imaging. I hope you enjoy our podcast. Dr. Negar Asdaghi:                                     Intracerebral hemorrhage is an aggressive form of stroke with high morbidity and mortality rates. Increased systemic inflammation may be correlated with more severe neurological presentation, larger hematoma volume, and worse clinical outcome in these patients. Elevated levels of interleukin 6, or IL-6, have been found in the experimental models of ICH and may represent a therapeutic target to reduce the inflammatory response in ICH if similar findings were replicated in clinical studies of patients with ICH. Dr. Negar Asdaghi:                                     In the May issue of the journal, in the study titled “Association of Serum IL-6 With Functional Outcome After Intracerebral Hemorrhage,” Dr. Kevin Sheth from Department of Neurosurgery at Yale University and colleagues performed a pre-specified exploratory analysis of the patients enrolled in the FAST trial, testing the association of admission levels of serum IL-6 with baseline neuroimaging and functional outcome at 90 days. Dr. Negar Asdaghi:                                     But just a reminder for our listeners that FAST trial was a multicenter randomized trial of the recombinant factor VIIa administered in two doses versus placebo in patients with spontaneous nontraumatic intracerebral hemorrhage presenting within three hours of symptom onset. Dr. Negar Asdaghi:                                     So, in the current analysis, amongst 841 patients enrolled in the trial, 66% were included who had both baseline IL-6 measurements and the follow-up modified Rankin Scale on day 90. Patients were stratified into four quartiles based on their admission IL-6 serum levels from low/normal in quartile one to very high levels in quartile four. And their baseline characteristics, neuroimaging and outcomes were then compared. Dr. Negar Asdaghi:                                     So, what they found is that patients with a poor outcome, defined as modified Rankin Scale of four or higher at 90 days, had a higher median admission IL-6 level than those with a favorable outcome. In their multivariate analysis, for each one nanogram per liter increase in IL-6 level, there was a 30% increase in the odds of a poor functional outcome after adjustment for various factors, such as age, intracerebral hemorrhage volume, baseline Glasgow Coma Scale, presence of intraventricular hemorrhage, hematoma expansion, ICH location, and recombinant factor VIIa treatment allocation. Dr. Negar Asdaghi:                                     So, a higher IL-6 level at baseline was also found to be independently associated with higher baseline hematoma volume and was a predictor of perihematomal edema, an association that was stronger in patients with lobar rather than subcortical  ICH. Dr. Negar Asdaghi:                                     Now, whether there is a causal relationship between IL-6 and outcomes in ICH, and importantly, whether the growing number of anti-IL-6 therapies have a role in the reduction of inflammation and improvement of clinical outcome in this population, are important subjects to consider and study in the future. So please stay tuned. Dr. Negar Asdaghi:                                     We now move on to our next paper, examining the characteristics of stroke in COVID-positive patients. In the study titled “SARS-CoV-2 and Stroke Characteristics: A Report from the Multinational COVID-19 Stroke Study Group,” Dr. Ramin Zand from Geisinger Neuroscience Institute and colleagues from across the globe examine the characteristics of COVID-infected patients with neuroimaging-confirmed stroke from 71 centers across 17 countries. Patients were included in the study if presented to the hospital with stroke-related chief complaints and asymptomatic COVID infection, or had a stroke while being hospitalized for COVID, or patients with stroke-related admission who had confirmed prior diagnosis of COVID infection. Dr. Negar Asdaghi:                                     A total at 432 stroke patients were included in the study. 75% of those had acute ischemic stroke, 21% with intracerebral hemorrhage, and the remainder had cerebral venous sinus thrombosis. The authors found that, in general, stroke characteristics and subtypes were different in COVID-infected patients as compared to non-COVID stroke patients based on the prior population-based studies for both ischemic and hemorrhagic stroke. Notably, amongst COVID-infected patients with acute ischemic stroke, a third had only asymptomatic COVID. They had an overall male predominance with a young median age, and that a quarter of ischemic stroke patients were younger than 55 years of age, and a similar percentage had no known identifiable vascular risk factors. Among those with available vascular imaging, close to 50% had evidence of a large vessel occlusion on vascular imaging. In considering the etiology of stroke as defined by the TOAST classification, only 10% of COVID-positive stroke population had small vessel disease in contrast to typically 30% of the general ischemic stroke population. Dr. Negar Asdaghi:                                     Now, when considering the hemorrhagic stroke, despite smaller number of patients included in the study, similar differences in general classification of hemorrhagic stroke patients was noted. Specifically, 25% of hemorrhagic strokes had evidence of subarachnoid hemorrhage, over two thirds of which was non-aneurysmal, a much higher percentage than that reported amongst non-COVID infected patients. A third of hemorrhagic strokes in this population is related to cerebral venous sinus thrombosis, an observation that is in keeping with the general notion that COVID infection can create a hypercoagulable state. Dr. Negar Asdaghi:                                      In summary, this study adds to the growing literature regarding the complex interplay between COVID infection and vascular disease, and the importance of understanding how this virus may play a role in clinical presentation of stroke. Dr. Negar Asdaghi:                                      Various imaging modalities, including diffusion-weighted imaging, MR perfusion, and CT perfusion, are used to define the extent of ischemic core in patients presenting with acute ischemic stroke. In contrast to restrictions and delays associated with acquisition of an MRI study in the acute setting, CT perfusion is readily accessible with relatively fast acquisition times and is easily incorporated in the stroke-alert workflow. As a treating stroke neurologist, you make the decision not to proceed with endovascular therapy in an otherwise eligible patient due to presence of a large volume of ischemic core, as measured by CT perfusion, only to find out that perfusion overestimated the ischemic core. How often do we encounter this scenario? And what are the factors associated with ischemic core overestimation as determined by CT perfusion? Joining me now is Dr. Alvaro Garcia-Tornel Garcia-Camba from Autonomous University of Barcelona, who's the first author of the study titled “Ischemic Core Overestimation as Measured by CT Perfusion: Collateral Status, Time and Its Interaction.” Good afternoon, Alvaro. Thank you for joining us from Barcelona. Dr. Alvaro Garcia-Tornel Garcia-Camba: Good afternoon, Negar. It is a pleasure to be interviewed in a Stroke Alert Podcast to talk about our work with you. Dr. Negar Asdaghi:                                      Great, Alvaro. Endovascular treatment is routinely offered to patients with a target intracranial occlusion, or between 6 to 24 hours from symptom onset, or those without a known time of onset if they're determined to have a small ischemic core. Can you walk us through the evolution of stroke endovascular therapies from time-based to imaging-based decision-making, please? Dr. Alvaro Garcia-Tornel Garcia-Camba: Yeah, well, I remember when I started my neurology training, that was nearly 10 years ago, that the most important biomarkers that we took into account in decision making was time and stroke severity. For decades, time had been the tool to select patients for thrombolysis. It was no different for patients that were considered for endovascular treatment at the beginning. And we did a variety of scales and scores for acute stroke infarct assessment on non-contrast CT and MRI, like ASPECTs score and the routine use of non-invasive angiographics tests for the selection of patients with large vessel occlusion and the new generation stent-retrievers, and in basic framework for patient selection started to grow, and this led to positive progress for endovascular treatment trials back in 2015. Perfusing imaging developed in parallel with SWIFT-PRIME and EXTEND-IA being the early window trials that used perfusion imaging to select patients for endovascular treatment, with the aim to estimate the ischemic core, the already infarcted tissue, and penumbra, the ischemic tissue that is still viable if reperfusion is achieved, on computed tomography perfusion as an effort to mimic the accuracy of diffusion imaging MRI core estimation. Multiple studies for the development of thresholds applied to computed tomography perfusion role data to estimate core and penumbra using diffusion imaging as the gold standard. And the mismatch concept was the finite and it was successfully applied in the extended window that was above six hours in DEFUSE 3 trial. Dr. Alvaro Garcia-Tornel Garcia-Camba: And DAWN trial, the other late window endovascular treatment trial, used a slightly different approach using the core clinical measurements, taking into account clinical severity and age rather than the penumbral tissue to select patients for endovascular treatments. Both the studies had positive results and a number needed to treat comparable to early imaging trials. And we have learned in the past years that time is one of the most important prognostic factors in patients with an acute stroke. But the clock runs at different speeds depending on the specific patient that we evaluate. Tissue analysis on imaging is the way to calibrate this state. Dr. Negar Asdaghi:                                      Thank you, Alvaro, for this nice review of the literature. Can you please tell us about the concept of ischemic core overestimation, specifically by CT perfusion? What was known in the literature before, and what prompted you to look into this in more detail in the current study? Dr. Alvaro Garcia-Tornel Garcia-Camba: Well, we consider ischemic core overestimation is present when the estimated score by computed tomography perfusion imaging is actually larger than the real core, which is the not salvageable tissue at the time of imaging. Most of the studies that have focused on computed tomography perfusion accuracy considered both types of error, that the estimated score is larger or smaller than actual real core normal using diffusion imaging as the ground truth. We wanted to focus on overestimation because of two reasons. The first one is because it might deny endovascular treatment for patients in which reperfusion might lead to better outcomes. And because the ground truth is that the core should increase its size over time, not decrease. The study that prompted me to further investigate on this concept was an article that was published back in 2017, that is ghost infarct core concept that it was published by the unit that I work in nowadays. Dr. Alvaro Garcia-Tornel Garcia-Camba: And this is the two main factors succeeded with overestimation. In this case was slightly different because they consider core overestimation to be when the estimated core was 10 milliliters larger than the follow-up infarct where reperfusion that was achieving more than 50% of reperfusion after endovascular treatment for more than mTICI 2B or earlier imaging in time. We consider the main limitation of this specific study was the small size because it only included 70 patients. And that the software used for computed tomography perfusion analysis was not as validated at this time as RAPID is, the one that is used in our actual study. Dr. Negar Asdaghi:                                      Right. Now, very important concept to keep in mind, especially because RAPID is now used worldwide everywhere in many institutions. And as you mentioned, we make therapeutic decisions based on volumetric assumptions of ischemic core that's given to us by RAPID. Alvaro, we're excited to hear about your study. Can you please tell us about your patient population, and how you define ischemic core and CT perfusion, and what measures were used to determine the final ischemic volume in your study? Dr. Alvaro Garcia-Tornel Garcia-Camba: Well, we included 407 patients from a single center retrospective database that was from 2014 to 2019. They had to have an anterior circulation intracranial large vessel occlusion, including in portions of M1, M2 of middle cerebral artery or terminal intracranial carotid artery occlusion. And they had to have baseline computed tomography perfusion, and they must have achieved reperfusion after endovascular treatment that we have defined as mTICI 2B at the end of the procedure, with a follow-up non-contrast CT at 24-48 hours, in order to measure the final infarct volume. Dr. Alvaro Garcia-Tornel Garcia-Camba: Patients with unwitnessed stroke onset were included, and the estimated core and hypoperfusion intensity ratio that it's a perfusion imaging output that it strongly correlates with collateral flow were determined using RAPID automated software with default thresholds. That is a relative reduction of cerebral flow below 15%* as compared to contralateral hemisphere for estimated core and the ratio of tissue with a Tmax delay above 10 seconds in areas with a Tmax delay above six seconds for hypoperfusion intensity ratio. Dr. Alvaro Garcia-Tornel Garcia-Camba: The final infarct that was the ground truth for comparison was calculated as the mean from two observers' measurements using a semiautomatic method for non-contrast CT and patients with a parenchymal hemorrhage type 2 hemorrhagic transformation on follow-up imaging were excluded from the analysis. Ischemic core overestimation was considered when estimated core was larger than final infarct volume. Dr. Negar Asdaghi:                                      Perfect. Can you please tell us about the main findings of the study? Dr. Alvaro Garcia-Tornel Garcia-Camba: We found out that ischemic core overestimation is a phenomenon that is more prevalent in patients with earlier window time and that the influence of poor collateral status are measuring using hypoperfusion intensity ratio with a cutoff point of 0.4. Previously as stated to discriminate between good and [inaudible 00:16:02] collaterals was stronger in patients with earlier window time. Patients with poor collateral status in the first four hours window had twice the odds of ischemic core restoration, as compared to patients that presented above four hours from symptom onset. Dr. Negar Asdaghi:                                      Very interesting, Alvaro. CT perfusion overestimated the volume of ischemic core in 20% of your study population. What was the median volume of core overestimation, and what were the factors associated with this overestimation in your multivariate analysis? Dr. Alvaro Garcia-Tornel Garcia-Camba: 83 patients presented with ischemic core overestimation. The median volumetric overestimation was 12 milliliters with an interquartile range of 56 milliliters. Apart from hypoperfusion intensity ratio and time from onset to imaging, terminal internal carotid occlusion location and complete reperfusion that was more than 90% of the people with modified TICI 2C–3 were independently associated with ischemic core overestimation on multivariate analysis. Within the [inaudible 00:17:12] and independent association with time from imaging to reperfusion, a variable that had been previously reported to influence the accuracy of core overestimation on computed tomography perfusion, and we believe that differences in baseline characteristics between the studies and the low variability in imaging reperfusion time in the core will explain why it was not statistically significant. Dr. Negar Asdaghi:                                      Very important findings, Alvaro. Just reminding clinicians to pay attention to factors such as location of the occlusion and, as you mentioned, the hypoperfusion intensity ratio, in addition to the volume of the tissue with relative cerebral blood flow of less than 30% to define the ischemic core. So, definitely many important learning factors for all of us here. Alvaro, I want to finish by just a question that in routine clinical practice, CT perfusion is not commonly performed in those under six hours. And yet ischemic core overestimation seems to be a phenomenon most notably found in earlier presenters. So, what is the clinical implication of the ischemic core overestimation by CTP in late presenters? Dr. Alvaro Garcia-Tornel Garcia-Camba: Well, the rate of ischemic core overestimation was low in patients presenting above four hours from symptom onset. And I do not personally believe that clinically relevant overestimation is present in late presenters with witnesses at the stroke onset. Nonetheless, a high proportion of this population with late presentation do not actually have a clear symptom onset times. And it was witnessed in this group of patients, they [inaudible 00:18:46] not to perform in the vascular treatment for a large score on CTP only should be carefully taken given the results of our study. As taken solely in accountable volumetric estimation of core on computed tomography perfusion might lead to deny treatment to patient that could benefit from it. Dr. Negar Asdaghi:                                      Very important, Alvaro. Again for our listeners, keep that ischemic core overestimation in mind when relying on CT perfusion in waker-upers and those with ischemic stroke of unknown time of onset. So, Alvaro, please tell us what's the most important takeaway message from your study, and what does the future hold for you in terms of your research? Dr. Alvaro Garcia-Tornel Garcia-Camba: Well, it's a global message. I believe that contemporary perfusion imaging construct is based on fixed thresholds to estimate ischemic core. Those thresholds rely on [inaudible 00:19:37] patients with relatively small cores and early imaging. These models might have overfitted to those specific population characteristics. Different studies, including ours, have pointed that the accuracy of computed tomography perfusion core estimation is dependent on many variables. Some of them are known at the time of imaging, like degree of the perfusion after endovascular treatment or time from imaging to reperfusion. In order to improve our prediction accuracy for both core and prognosis estimation, further research should be focused on a multi-parametric approach that takes into account both clinical and imaging parameters, not only imaging parameters. Dr. Negar Asdaghi:                                      Dr. Alvaro Garcia-Tornel Garcia-Camba, thank you for joining our podcast, and we look forward to covering more of your work in the future. And this concludes our podcast for the May 2021 issue of Stroke. Please be sure to check out the May table of contents for the full list of publications, including original contributions on clinical and basic and translational sciences, brief reports, editorials, comments and opinions, and much more. And remember that every breakthrough in science started somewhere from an idea that was then cultivated with care, determination, perseverance, and collaboration. A simple idea that someone might've heard somewhere in passing or on a podcast. So, keep working on your ideas, and until our next podcast, stay alert with Stroke Alert. *Dr. Alvaro Garcia-Tornel Garcia-Camba confirmed following the interview that “15%” should be “30%.”

The glasgow coma scale is used all the time to assess the level of consciousness of a patient (especially for those with acute head injury). We give a patient a score out of 15 depending on their motor response, their verbal response and the eye response. There are 6 possible points for motor, 5 for voice and 4 for eyes. The higher the score, the better the level of consciousness in the patient. There is a version we can use for pre verbal kids under 2. Follow us on Instagram @yourekiddingrightdoctors Facebook: https://www.facebook.com/yourekiddingrightpod-107273607638323/ Our email is yourekiddingrightpod@gmail.com Make sure you hit SUBSCRIBE/FOLLOW so you don’t miss out on any pearls of wisdom and RATE if you can to help other people find us! (This isn’t individual medical advice, please use your own clinical judgement and local guidelines when caring for your patients)

Baba mala 26 a prdla jej tepna v mozgu. Ale nie všetko treba tlačiť hneď na CT. Igor Vinci, RTG asistent, o trnavskom bentley medzi CT. Od hlavy po päty za 4 sekundy! A okrem toho Glasgow Coma Scale, rozkašovaný pankreas aj infarkt obličky. NEXT? PODOZRIVÝ Z VRAŽDY SPOLUŽIAČKY  https://open.spotify.com/episode/6Krr1lm9ivOrEL2eAP75gs  KAREL GOTT  https://ceskamincovna.sk/sk/search/?text=karel+gott  PCR TEST  https://www.medirex.sk/  Produkcia @doktormafilipa by @zapoofficial  https://www.zabavavpodcastoch.sk/     

Thank you Steven Doyle, OMS III for developing this topic. Thank you Valentina Bonnefil, OMS III and Gio Montesano, OMS III for participating in this podcast as well. This is a difficult area to make generalizations about and the data was presented in a manner to help students recognize trends in assessing risk for TBI related psychiatric conditions. Glasgow Coma Scale, types of postures, and a few other high yield facts on disparate topics seemed to show up through the podcast.

In this episode Hayleigh and Shelby discuss everything from naughty patients to organ donation to how rank a patient on the Glasgow Coma Scale (spoiler alert: it involves touching the eye which makes Hayleigh uncomfortable). Join us as we break down the third episode of Grey's Anatomy as the interns start to get (slightly) better at their jobs. Visit our Instagram or facebook page for more information on organ donation. --- Send in a voice message: https://anchor.fm/pickme-chooseme-podcastme/message

Simon Carley, Associate Editor of EMJ, talks through his highlights of the March 2020 edition of the Emergency Medicine Journal. Read the primary survey here - https://emj.bmj.com/content/37/3/117. Predicting abusive head trauma in children https://emj.bmj.com/content/37/3/118 Validation of the PredAHT-2 prediction tool for abusive head trauma https://emj.bmj.com/content/37/3/119 Association of clinically important traumatic brain injury and Glasgow Coma Scale scores in children with head injury https://emj.bmj.com/content/37/3/127 Biological mechanisms and individual variation in fibrinolysis after major trauma https://emj.bmj.com/content/37/3/135 Prehospital critical care is associated with increased survival in adult trauma patients in Scotland https://emj.bmj.com/content/37/3/141 Cranial burr holes in the emergency department: to drill or not to drill? https://emj.bmj.com/content/37/3/151 Cranial burr holes in the emergency department: to drill or not to drill? https://emj.bmj.com/content/37/3/154 Lessons from a pilot for uncontrolled donation after circulatory death in the ED in the UK https://emj.bmj.com/content/37/3/155 Non-invasive techniques for stimulating urine production in non-toilet trained children: a systematic review https://emj.bmj.com/content/37/3/162 Read the full March issue here - emj.bmj.com/content/37/3

A handy mnemonic for the Glasgow Coma Scale, get excited, or as excited as you can about comas.

After having a discussion at work about the reliability of the Glasgow Coma Scale and it's reliability and applicability, I decided to do some research to answer my questions. Most of the questions were related to how we use it, why we use it, and are we doing it right? I discovered some very interesting answers.

Dr. Don Marion and Dr. Anne Bunner discuss whether a drug known for treating Alzheimer’s, which may have some neuroprotective effects, could improve short-term neurological function in patients with moderate TBI. Publication: Mokhtari, M., Nayeb-Aghaei, H., Kouchek, M., Miri, M.M., Goharani, R., Amoozandeh, A., Akhavan Salamat, S., Sistanizad, M. (2017). Effect of Memantine on Serum Levels of Neuron-Specific Enolase and on the Glasgow Coma Scale in Patients With Moderate Traumatic Brain Injury. Journal of Clinical Pharmacology. Epub ahead of print. doi: 10.1002/jcph.980 PubMed link: www.ncbi.nlm.nih.gov/pubmed/28724200 CUBIST is a podcast for health care providers produced by the Defense and Veterans Brain Injury Center. We discuss the latest research on traumatic brain injury (TBI) most relevant to patient care. For more about TBI, including clinical tools, go to dvbic.dcoe.mil or email us at dha.DVBICinfo@mail.mil The views, opinions and/or findings contained in this podcast are those of the host and subject matter experts. They should not be construed as an official Department of Defense position, policy or decision unless so designated by other official documentation. All music in this podcast was used according to Creative Commons licensing. Our theme song is "Dog Wind" by Skill_Borrower, and our credit music is "Esaelp Em Xim" by Pitx, both from CCmixter.org. All music in this podcast was used according to Creative Commons licensing.

Tingkat kesadaran seseorang dengan tiga indikator yaitu mata, kemampuan bicara serta gerakan tubuh

'Patients with GCS scores of 8 or less require prompt intubation', that's what ATLS tells us. The mantra of GCS 8, intubate has pervaded teaching for those involved in the management of patients with a reduced GCS (Glasgow Coma Scale). But on reflection it would seem slightly odd that the gain or loss of a single point on the Glasgow Coma Scale could simply account for a change in the decision as to whether a patient would benefit from intubation and ventilation. So should the patient with a GCS of 9 be best managed without a definitive airway, but when that slips to 8 we should reach for the portex®? In this podcast we take a deeper look at the GCS, we have a think about the role that it was designed to perform and consider how it should best be applied to acutely ill patients when considering protecting their airway. The podcast is based upon the blog from the TEAM Course blog(Training in Emergency Airway Management), make sure to go and have a look at the post and other resources available on that site. Enjoy! Simon, Rob & James References GCS 8 intubate; TEAMcourse Advanced trauma life support (ATLS®): the ninth edition. J Trauma Acute Care Surg.2013;74(5):1363-6.Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2(7872):81-4. Teasdale G, Maas A, Lecky F, Manley G, Stocchetti N, Murray G.The Glasgow Coma Scale at 40 years: standing the test of time.Lancet Neurol. 2014;13(8):844-54. Duncan R, Thakore S. Decreased Glasgow Coma Scale score does not mandate endotracheal intubation in the emergency department. J Emerg Med. 2009;37(4):451-5. Green SM. Cheerio, laddie! Bidding farewell to the Glasgow Coma Scale.Ann Emerg Med. 2011;58(5):427-30. Healey C, Osler TM, Rogers FB, et al. Improving the Glasgow Coma Scale score: motor score alone is a better predictor.J Trauma. 2003;54(4):671-8. Isbister GK, Downes F, Sibbritt D, Dawson AH, Whyte IM. Aspiration pneumonitis in an overdose population: frequency, predictors, and outcomes.Crit Care Med. 2004;32(1):88-93. Adnet F, Baud F. Relation between Glasgow Coma Scale and aspiration pneumonia.Lancet. 1996;348(9020):123-4. Kulig K, Rumack BH, Rosen P. Gag reflex in assessing level of consciousness.Lancet. 1982;1(8271):565. Rotheray KR, Cheung PS, Cheung CS, et al. What is the relationship between the Glasgow coma scale and airway protective reflexes in the Chinese population?.Resuscitation. 2012;83(1):86-9. Moulton C, Pennycook A, Makower R. Relation between Glasgow coma scale and the gag reflex.BMJ. 1991;303(6812):1240-1.

This session reviews the basics of the Glasgow Coma Score.         The opinions expressed are those of the host and do not represent opinions or views of the host's employers. The information contained in the podcasts does not constitute medical or legal advice.

Glasgow Coma Scale brukes for å vurdere bevissthetsnivå, vanligvis ved hodeskader og rus. Sigve og Nils Christian snakker om skalaen, hvordan den brukes, og Nils Christian spiller scener fra bygdefest. Fortell oss gjerne hva du synes om podkasten vår. Enten via Instagram eller gi oss en rating i Itunes.

Dr. Don Marion and Dr. Anne Bunner discuss whether a drug known for treating Alzheimer’s, which may have some neuroprotective effects, could improve short-term neurological function in patients with moderate TBI. Publication: Mokhtari, M., Nayeb-Aghaei, H., Kouchek, M., Miri, M.M., Goharani, R., Amoozandeh, A., Akhavan Salamat, S., Sistanizad, M. (2017). Effect of Memantine on Serum Levels of Neuron-Specific Enolase and on the Glasgow Coma Scale in Patients With Moderate Traumatic Brain Injury. Journal of Clinical Pharmacology. Epub ahead of print. doi: 10.1002/jcph.980 PubMed link: https://www.ncbi.nlm.nih.gov/pubmed/28724200 CUBIST is a podcast for health care providers produced by the Defense and Veterans Brain Injury Center. We discuss the latest research on traumatic brain injury (TBI) most relevant to patient care. For more about TBI, including clinical tools, go to dvbic.dcoe.mil or email us at info@dvbic.org. The views, opinions and/or findings contained in this podcast are those of the host and subject matter experts. They should not be construed as an official Department of Defense position, policy or decision unless so designated by other official documentation. All music in this podcast was used according to Creative Commons licensing. Our theme song is "Dog Wind" by Skill_Borrower, and our credit music is "Esaelp Em Xim" by Pitx, both from CCmixter.org.

  In today’s podcast, Richard L. Duquette discusses the symptoms and tools in Proving Mild Traumatic Brain Injuries Part 1. Tune in to help you decide how to proceed with your case!   Mild Traumatic Brain Injury   In a crash, a bicyclist can get different types of injuries from small wounds to traumatic ones. A serious injury, such as a mild traumatic brain injury (MBTI), can increase the value of the settlement by $100,000 or more.   MBTIs can affect a person permanently. For this, a 3-part series will be available to tackle the (1) symptoms and tools, (2) lifestyle effects, and (3) evidentiary issues.   What are the symptoms of MBTI?   Know the symptoms of MBTI. The injured bicyclist can lose consciousness for less than 30 minutes in its mild stage, more than 30 minutes in its moderate stage, and 6 hours or more in its severe stage. Although a person suffering MBTI can return to his usual activities, the symptoms would still exist to hamper him. As discussed in today’s episode, examples of such symptoms are: slower cognitive processes, confusion, diminished vocabulary, mood swings, and many more. How does a bicyclist get an MBTI?   Head injuries are common in bicycling accidents. They are sometimes caused by multiple impacts after being thrown and when hitting the ground.   To help provide the best solution, hence, it is important for the victim to know how he got the injury. Concussions involving temporary loss of consciousness can occur even when wearing a helmet. A broken helmet, bruises, cuts, and other such damages can show how the injury happened.   Diagnostic Tools   Hospital treatments are primarily focused on treating visible injuries. For this, MBTIs often are not detected in an emergency.   Field diagnosis usually depends on what the first responders see. Signs of potential brain traumatic injuries often seem to show up at a later time.   To hear about the symptoms and tools in Proving Mild Traumatic Brain Injuries Part 1, download and listen to the entire episode.   If you are short on time, here are the highlights of Proving Mild Traumatic Brain Injuries Part 1:   What is MTBI? (2:30) How do MBTIs occur? (4:09) Diagnostic tools? (5:15) Glasgow Coma Scale? (6:20) Imaging tools? (7:56) Final thoughts on MTBI? (13:35)   Connect with Richard L. Duquette at the following links:   Richard's Website Email Richard Call Richard: 760-730-0500 Connect with Richard on Facebook Follow Richard on Twitter   © 2016 Law Firm of Richard L. Duquette  

FOAMcast is bringing you pearls from conferences we attend including SMACC.  (and next June 13-16, we'll bring you pearls from smaccDUB in Dublin, Ireland) Today we discuss some pearls on shift work, analgesia (even without drugs), the perils of the Glasgow Coma Scale and more!

Sir Graham Teasdale reflects on the Glasgow COMA scale for brain injury, 40 years after it was published in The Lancet.

Objective: Unplanned readmission of hospitalized patients to an ICU is associated with an increased mortality and hospital length of stay. The ability to identify patients at risk, who would benefit from prolonged ICU treatment, is limited. The aim of this study is to validate a previously published numerical index named the Stability and Workload Index for Transfer in a heterogeneous group of ICU patients. Design: In this retrospective data analysis, the Stability and Workload Index for Transfer score was calculated for all patients, and the ability of the score to predict readmission was compared with the original publication. Setting: Four ICUs, one intermediate care unit, and one postanesthesia care unit of the department of anesthesia and intensive care of a university hospital. Patients: All consecutive patients treated in one of the units. Interventions: None. Measurements and Main Results: Unplanned ICU readmissions or unexpected death within 7 days of ICU discharge. The data of 7,175 patients were included in the analysis. Five hundred ninety-six patients were readmitted or died within 7 days of discharge. The patients who are readmitted to the ICU are significantly older and have significantly higher scores that define the severity of disease at the time of admission and discharge of their first ICU stay. The source of admission for the initial ICU stay did not differ (p = 0.055), and the last Glasgow Coma Scale and the last Pao(2)/Fio(2) ratio before discharge from the ICU were higher in patients who did not need a readmission to the ICU. The performance of the Stability and Workload Index for Transfer score is poor with an area under the receiver operator curve of 0.581 (95% CI, 0.556-0.605; p < 0.001). Conclusions: Based on the data from our patients, the proposed Stability and Workload Index for Transfer score by Gajic et al is not ideal in aiding the clinician in the decision, if a patient can be discharged safely from the ICU and further research is necessary to define the patients at risk for readmission.

Das Ziel der vorliegenden Studie war es zu untersuchen, inwiefern die Einführung des pauschalierten Entgeltsystem in Deutschland (G-DRG-System) die Erlösstruktur eines Krankenhauses der Maximalversorgung im Vergleich zu dem bisherigen Abrechnungssystem nach Bundespflegesatzverordnung verändern kann. Anhand der Daten sollte abgeleitet werden, ob ein 24-stündig einsatzbereites Team und die Bereitstellung eines chirurgischen Schockraumes sowie die Versorgung von polytraumatisierten und kritisch kranken Patienten finanzierbar ist. In einer prospektiven Längsschnittstudie wurden anhand des Traumaregisters der Chirurgischen Klinik, Klinikum Innenstadt der Ludwig-Maximilians-Universität München, 411 Patienten, die innerhalb von zwei Jahren über den Schockraum aufgenommen wurden erfasst. Erhoben wurden neben persönlichen Daten, die Anzahl der Tage des Gesamtaufenthaltes, des Aufenthaltes auf Intensiv- und Normalstation, die Anzahl der Beatmungsstunden, der Verletzungsmechanismus, Glasgow Coma Scale, systolischer Blutdruck, Atemfrequenz sowie alle Diagnosen und durchgeführten Prozeduren. Zur Beurteilung der Verletzungsschwere erfolgte die Ermittlung des ISS-Wertes. Die Diagnosen und Prozeduren wurden nach ICD-10-GM 2005 bzw. OPS 301 SGB V verschlüsselt. Die Erlöse nach Tagessätzen konnten aus den Rechnungen, die an die Krankenkassen gestellt worden waren, entnommen werden. Die Handbücher der Australian Refined-Diagnosis Related Groups Version 4.1 Band 1-3 galten als Vorlage für die Kodierung für das australische DRG-System. Anhand der in diesen Bänden vorgegebenen Entscheidungsbäume wurde jedem einzelnen Patienten eine DRG zugeordnet. Die Gruppierung für das deutsche DRG-System für das Jahr 2003 und 2005 erfolgte mittels einer Grouper-Software. Nach entsprechender Kodierung erfolgten Ermittlung und Vergleich der Erlöse für speziell ausgewählte Patientengruppen und DRGs, nach Tagessätzen, Australian Refined-Diagnosis Related Groups und German Diagnosis Related Groups der Version von 2003 und 2005. Bei der Betrachtung des Gesamtpatientenkollektivs konnte mit dem G-DRG-System von 2003 ein Mindererlös von 3 % und mit dem G-DRG System von 2005 ein Mehrerlös von 16 % gegenüber den tatsächlichen Einnahmen nach Tagespflegesätzen erzielt werden. Die Berechnung der Erlöse nach dem australischen System ergab einen Mehrerlös von 36 % gegenüber den Tagespflegesätzen. Vergleicht man die Erlösberechnung zwischen den Jahren 2003 und 2005 im deutschen DRG-System, so wurden für 2005 zusätzliche Einnahmen von 20 % ermittelt. Die Ergebnisse dieser Untersuchung zeigen auf, dass mit dem G-DRG-System für das Jahr 2005 für polytraumatisierte Patienten im Vergleich zu den Tagessätzen ein Mehrerlös von 44,2 % erzielt wurde. Der Mehrerlös für 2003 lag bei 0,6 % und der Mehrerlös nach dem australischen System bei 22,3 % im Vergleich zu den Tagessätzen. Trotz der in der vorliegenden Arbeit festgestellten Erlöszunahme für polytraumatisierte Patienten im G-DRG-System 2005, können alle Kosten, welche für die Versorgung eines Polytraumas anfallen, mit dem pauschalierten Entgeltsystem nicht abgedeckt werden. Dies belegen Studien, welche einen direkten Kosten-Erlös-Vergleich durchgeführt haben. In einer aktuellen Arbeit aus München von Billing et al.2 wird bestätigt, dass mit dem DRG-System von 2005 erhebliche Einbußen bei der Versorgung von Schwerstkranken auftreten. In Anbetracht dieser aktuellen Studienlage zu den kalkulierten Kosten der Versorgung von Schwerstverletzten zeigt sich eine Diskrepanz zum derzeitigen Entgeltsystem. Wegen der Komplexität der Fälle erscheint es fast unmöglich, derzeit einen adäquaten Pauschalbetrag für einen polytraumatisierten Patienten festzulegen. Zur Versorgung schwerstkranker und polytraumatisierter Patienten wären, wie von Haas et al.9 angestrebt, spezialisierte Traumazentren in Zukunft denkbar, wo durch die Kostenbündelung eine adäquate Erlösstruktur erzielt werden könnte.