Neurocritical care
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Randomized Controlled Trial
Predictors and clinical implications of shivering during therapeutic normothermia.
Shivering during induced normothermia (IN) remains a therapeutic limitation. We investigated potential risk factors and clinical implications of shivering during IN. ⋯ Men, hyponatremia, and hypomagnesaemia may predispose febrile patients treated with IN to shivering. Shivering dramatically increases the amount of heat transfer required to maintain normothermia, and may be associated with adverse effects on level of consciousness.
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Comparative Study
Therapeutic hypothermia after cardiac arrest: performance characteristics and safety of surface cooling with or without endovascular cooling.
Various methods are available to induce and maintain therapeutic hypothermia after cardiac arrest, but little data is available comparing device-mediated cooling to simple surface methods in this setting. ⋯ Use of an endovascular cooling catheter as part of a treatment protocol for hypothermia after cardiac arrest provides better control during maintenance of hypothermia, preventing temperature overshoot. Active cooling rates may be enhanced by the use of a larger cooling catheter.
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Status epilepticus (SE) is a medical emergency requiring prompt treatment to try to limit mortality and improve outcome. So far, newer antiepileptic drugs (AED) have not assumed a noticeable role in the treatment of SE. This may be in part due to the lack of IV forms for the newer AEDs. The IV form of Levetiracetam (IV-LEV) has recently become available and has a potential role in the treatment of SE. ⋯ IV-LEV may have a potential role in the treatment of non-convulsive status epileptics.
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Case Reports
Aminophylline for the treatment of symptomatic bradycardia and asystole secondary to cervical spine injury.
Bradycardia is a common complication of cervical spine damage in the weeks following injury, occurring in up to 100% of patients in some studies. Cardiac arrest and asystole have been reported in as many as 15% of these patients and cardiac events are the main cause of death within the first year. We describe the case of a 25-year-old African-American male involved in a motor vehicle collision who suffered C6-C7 subluxation. ⋯ There is limited evidence for the use of methylxanthines in the treatment of bradycardia associated with spinal cord injury. In patients with recurrent asystolic events or symptomatic bradycardia the use of these agents should be considered.
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A 38-year-old man with severe head trauma complicated by paroxysmal severe intracranial pressure elevation associated with tachypnea, tachycardia, diaphoresis, and extensor posturing was diagnosed as suffering from paroxysmal autonomic instability with dystonia (PAID). These events were unresponsive to standard medical therapy, which included morphine, fentanyl, labetalol, lorazepam, metoprolol, and clonidine. ⋯ Dexmedetomidine may be a novel pharmacologic agent to aid in abrogating PAID.