Axone (Dartmouth, N.S.)
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Axone (Dartmouth, N.S.) · Sep 1992
The cardiopulmonary complications of aneurysmal subarachnoid hemorrhage: current trends in management.
It is well established that excessive sympathetic activity, resulting in the development of cardiopulmonary complications, commonly occurs in patients who have suffered aneurysmal subarachnoid haemorrhage. Cardiac dysfunction and neurogenic pulmonary edema are life threatening conditions that have serious implications with regard to patient outcome. The purpose of this article is to familiarize the neuroscience practitioner with the effects of subarachnoid haemorrhage on the heart and lungs and to provide an update in terms of current medical and nursing management trends. ⋯ A brief review of the anatomy and physiology of the sympathetic division of the autonomic nervous system will be presented. In addition, the theories that have been proposed to explain the underlying pathogenesis will be introduced. Medical and nursing management strategies will also be addressed.
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Today much of our knowledge about a patient's level of consciousness is given to us by his or her score on the Glasgow Coma Scale (GCS). Since its development at the University of Glasgow in 1974, it has been widely adopted, become an integral component of the hourly "neuro assessment", and is typically incorporated into the graphic assessment portion of the patient's medical record. Once the information has been documented, the pure data itself is lost as the documented form takes on an interpretative meaning or a reality that is different from the clinical state experienced by the patient. ⋯ These are important as they are not visible in the scale itself; however, their effects are evident in the coma score obtained. These forces include the design of the GCS and the manner in which the tool is taught and used. The purpose of this paper is to discuss these factors and to delineate how they create a reality that may not accurately depict the patient's level of consciousness.