Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Mar 2004
Comment Case Reports[Amyotrophic lateral sclerosis: mechanical ventilation--or not right?].
In two patients (men aged 64 and 62 years, respectively) with amyotrophic lateral sclerosis (ALS) tracheostomy ventilation was initiated following (imminent) acute respiratory failure; in one patient this was done because advance directives were lacking, while in the other non-invasive ventilation (NIPPV) was no longer an option. A third ALS patient, a woman aged 36 years, already had chronic respiratory failure when she presented at the local centre for home mechanical ventilation. As a result, the placement of a percutaneous endoscopic gastrostomy (PEG) was impossible. ⋯ Following the placement of a PEG he started NIPPV electively. In patients with ALS, domiciliary ventilation should be discussed early in the course of the disease. Advance directives with regard to domiciliary ventilation are important, not only to avoid undesired (invasive) ventilation, but also with respect to the placement of a PEG and the appropriate use of oxygen and morphine.
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Ned Tijdschr Geneeskd · Mar 2004
Review[The symptomatic treatment of amyotrophic lateral sclerosis].
Patients with amyotrophic lateral sclerosis (ALS) have symptoms of progressive muscle weakness, of disturbed speech and swallowing, and in the terminal phase those of respiratory weakness. Treatment options, in particular those for excessive weight loss and respiratory weakness, should be introduced to the patients and their families when the patient is emotionally capable and before dysarthria severely hampers communication. Special equipment for keeping the patient as mobile as possible should be made available much earlier than in the case of other diseases of the muscles as in ALS progression is much faster. ⋯ The latter form of treatment is palliative and forms part of terminal care. During the terminal phase restlessness, anxiety, pain, and dyspnoea require the most attention. Treatment requires careful multidisciplinary cooperation.
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Ned Tijdschr Geneeskd · Mar 2004
Review[Physical diagnosis--the Glasgow coma scale for the measurement of disturbances of consciousness].
The Glasgow coma scale (GCS) may be used for the evaluation of disturbances of consciousness. The GCS is a reliable and reproducible test that can easily be carried out at the patient's bedside. The GCS can be used to assess the severity of a head injury and to determine the prognosis of the patient. The prerequisites for a reliable determination of the GCS-score are training of inexperienced personnel, re-assessment by a physician with experience in neurology, correction for external factors and reporting in accordance with a protocol.