Articles: brain-injuries.
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Critical care medicine · Mar 1998
Influence of body temperature, with or without sedation, on energy expenditure in severe head-injured patients.
To quantify the effect of body temperature and sepsis on energy expenditure in head-injured patients. ⋯ Sedation had a major effect on energy expenditure. In sedated patients, body temperature was the main determinant of energy expenditure; the anesthetic agent used had little influence on the level of energy expenditure. Sepsis increased energy expenditure independently of fever, probably through hormonal changes.
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To address the accuracy of a bedside jugular bulb oxygen saturation (SjO2) catheter monitor (Baxter-Edwards, Santa Ana, CA) versus in vitro co-oximetry measurements in the intensive care unit (ICU). ⋯ Continuous ICU SjO2 monitoring correlates significantly with in vitro values, but less so than previously described during intracranial surgery. Although sensitivity of the bedside monitor to detect confirmed desaturations remains an issue, the high specificity indicates that it is less of a concern that patients may be misdiagnosed as having desaturations resulting in unnecessary interventions. Nonetheless, suspected jugular bulb desaturation should be verified before taking therapeutic actions.
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Brain injury : [BI] · Mar 1998
Prevalence of traumatic brain injury in psychiatric and non-psychiatric subjects.
Traumatic brain injury (TBI) and its sequelae may impact the expression and treatment of psychiatric disorders. The prevalence of TBI in psychiatric patients is unknown and investigations in the general population are limited. This study examined the prevalence of TBI with loss of consciousness in mental health setting patients (n = 231), general hospital and university staff and students (n = 534) and non-psychiatric medical clinical patients (n = 59). ⋯ The percentage of medical patients and staff and students reporting TBI was similar to previous research. The greater percentage of psychiatric patients reporting TBI indicates the need to assess TBI in this population. The role of TBI in the emergence, expression and treatment outcome of psychiatric disorders and the risk factors that leave psychiatric patients vulnerable to TBI should be further examined.
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The authors discuss objective medical labor and forensic medical expert valuation of the severity of corporal injuries and performance abilities of subjects in various periods after slight concussion or confusion of the brain. Files of a neurotraumatology department over 11 years (10072 case histories) and 3769 conclusions, made by the Regional Bureau of Forensic Medical Expert Evaluation on the health status of subjects exposed to slight concussion and(or) confusion of the brain, are analyzed. ⋯ The authors detected faults in the examination and description of the mechanism of injury and neurological status and its changes, which impede expert evaluation. They emphasize the need in a universal scientifically-based approach to this problem, which is to be solved by united efforts of medical, legal, and social workers.