The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses
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Review Comparative Study
Grading scales used in the management of aneurysmal subarachnoid hemorrhage: a critical review.
The use of grading scales to predict clinical outcomes following aneurysmal subarachnoid hemorrhage (aSAH) is commonplace. In recent times management of aSAH patients has developed such that surgical intervention is taking place earlier in the course of the illness. Given the complex and multifactoral clinical picture of these patients, there is an increased impetus to examine and reevaluate the relative merits and predictive characteristics of grading scales. ⋯ Reports on newly developed instruments often lacked the replication data necessary to effectively compare measures currently in use. The timing of measurements and the use of serial measures emerged as important factors in the prediction of clinical outcomes. Assessments taken close to the time of surgical intervention were found to have superior predictive abilities.
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Clearing the cervical spine in adult trauma patients must be done cautiously and methodically. Practitioners must be able to recognize abnormalities not only in the patient's neurological examination but also on the radiographic views obtained. A missed cervical spine injury can be a significant and catastrophic error. Nurse practitioners in the emergency department, as well as those working on an inpatient trauma service, should be confident in their ability to manage the cervical spine in the adult trauma patient population.
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Randomized Controlled Trial Clinical Trial
Double-blind, randomized, controlled trial of local anesthetic use for iliac crest donor site pain.
Autogenous iliac crest bone grafts are often used for persons undergoing anterior cervical fusion (ACF). Study findings have shown that pain at the iliac crest donor site can often be more severe than that at the primary operation site. A method used to eliminate pain after bone harvesting involves infiltration of a local anesthetic directly into the site. ⋯ The bupivacaine group's mean morphine intake for the first 24 hours after surgery was found to be lower (32 mg; placebo 44 mg), whereas participants younger than 49 years who received bupivacaine were found, on average, to have stayed in the hospital one day less (3.6 days) than placebo group participants (4.5 days). Younger participants receiving bupivacaine required less morphine and had, on average, a reduced length of stay. The clinical implication of using local anesthetic for the relief of donor site pain suggests that it is a safe and efficacious technique.
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Randomized Controlled Trial Clinical Trial
The impact of aneurysmal subarachnoid hemorrhage on functional outcome.
Despite advances in the management of aneurysmal subarachnoid hemorrhage (SAH), a significant percentage of survivors are left with persistent cognitive, behavioral, and emotional changes that affect their day-to-day lives. This article describes outcome at 3 months after aneurysmal SAH in 61 patients, using the Extended Glasgow Outcome Scale (GOSE) and the Functional Status Examination (FSE). The GOSE provides a measure of overall functional outcome but does not address the specifics of functional limitations. ⋯ The findings of this study demonstrate that SAH survivors have considerable limitations in functional status in almost all areas of daily living at 3 months following SAH. The limitations were attributed to a variety of physical, cognitive, and emotional factors, and they were reported to be moderately to severely bothersome in almost half of the individuals. The findings highlight the need for appropriate rehabilitation, education, and support for SAH survivors and their families to enhance coping and improve quality of life, given the substantial and persistent impact of SAH.
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Review Case Reports
Respiratory failure in the neurological patient: the diagnosis of neurogenic pulmonary edema.
Neurogenic pulmonary edema (NPE) is a potential complication of a central nervous system (CNS) insult such as intracranial hemorrhage, uncontrolled generalized seizures, head trauma, tumors, and neurosurgical procedures. The proposed etiology is massive sympathetic discharge following a CNS event. The pathogenesis is not completely understood. ⋯ There is evidence for both theories, and NPE is probably the result of a combination of the two. The treatment is mainly supportive with the use of mechanical ventilation and alpha-adrenergic blocking agents while managing increased intracranial pressure. A thorough understanding of the pathophysiological mechanisms behind the development of NPE aids in the management of these patients to prevent further complications.