Cases reported "Psychomotor Agitation"

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1/33. Sevoflurane mask anesthesia for urgent tracheostomy in an uncooperative trauma patient with a difficult airway.

    PURPOSE: Proper care of the trauma patient often includes tracheal intubation to insure adequate ventilation and oxygenation, protect the airway from aspiration, and facilitate surgery. airway management can be particularly complex when there are facial bone fractures, head injury and cervical spine instability. CLINICAL FEATURES: A 29-yr-old intoxicated woman suffered a motor vehicle accident. Injuries consisted of multiple abrasions to her head, forehead, and face, right temporal lobe hemorrhage, and complex mandibular fractures with displacement. mouth opening was <10 mm. blood pressure was 106/71 mm Hg, pulse 109, respirations 18, temperature 37.3 degrees C, SpO2 100%. Chest and pelvic radiographs were normal and the there was increased anterior angulation of C4-C5 on the cervical spine film. Drug screen was positive for cocaine and alcohol. The initial plan was to perform awake tracheostomy with local anesthesia. However, the patient was uncooperative despite sedation and infiltration of local anesthesia. Sevoflurane, 1%, inspired in oxygen 100%, was administered via face mask. The concentration of sevoflurane was gradually increased to 4%, and loss of consciousness occurred within one minute. The patient breathed spontaneously and required gentle chin lift and jaw thrust. A cuffed tracheostomy tube was surgically inserted without complication. Blood gas showed pH 7.40, PCO2 35 mm Hg, PO2 396 mm Hg, hematocrit 33.6%. Diagnostic peritoneal lavage was negative. Pulmonary aspiration did not occur. Oxygenation and ventilation were maintained throughout the procedure. CONCLUSION: Continuous mask ventilation with sevoflurane is an appropriate technique when confronted with an uncooperative trauma patient with a difficult airway.
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ranking = 1
keywords = injury, trauma
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2/33. thrombosis associated with physical restraints.

    OBJECTIVE: Physical restraint is controversial, but still frequently used in psychiatric units. We describe two cases of thromboembolic phenomena, one with a fatal outcome, in association with physical restraint. METHOD: The world literature on physical restraint and thrombosis was reviewed by undertaking a search of electronic databases. RESULTS: To our knowledge, we are the first to report thrombosis associated with physical restraint. CONCLUSION: immobilization and trauma to the legs while restraining a patient are adequate explanations for the occurrence of thrombosis. Special attention should be paid to thrombosis when employing restraints in psychiatric wards. Further systematic research into physical restraints in psychiatry is clearly needed.
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ranking = 0.0041686863014516
keywords = trauma
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3/33. The use of bupropion in the treatment of restlessness after a traumatic brain injury.

    The occurrence of restlessness after a traumatic brain injury (TBI) is common. Severe restlessness can be a barrier in the multidisciplinary treatment of patients with TBI. The following case describes a patient with restlessness after a head-on motor vehicle accident. The patient was tachycardic, diaphoretic, demonstrating decerebrate posturing and a Rancho Los Amigos Stage II--III. Significant left lower leg restlessness was severe enough to cause bruising and ulceration. A multidisciplinary look was taken at the effects of using different neurotransmitter modulators in the treatment of restlessness after a TBI. Current biology treatment options include the use of medications that either modulate dopamine or noradrenaline alone. bupropion effects both the dopaminergic and noradrenergic pathways. In the following case, the patient's restlessness was resistant to almost every medication employed. The only medication that proved to be effective in significantly reducing the patient's restlessness was bupropion. The evidence for the use of bupropion in the treatment of restlessness after a TBI has never been discussed previously, aside from anecdotal accounts. It is hoped that this case will prove insight into another treatment option for patients who have severe restlessness.
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ranking = 3047.1554560185
keywords = traumatic brain injury, brain injury, traumatic brain, brain, injury, trauma
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4/33. Use of antecedent control to improve the outcome of rehabilitation for a client with frontal lobe injury and intolerance for auditory and tactile stimuli.

    KM, a single 23-year-old male, sustained a severe traumatic brain injury in a motor vehicle accident. Aggressive and uncooperative behaviour, resulting from the client's cognitive deficits and hypersensitivity to stimuli, made him unmanageable in a subacute rehabilitation setting. Minimizing sources of agitation reduced the client's outbursts and facilitated the completion of functional tasks, such as bathing and dressing. Modifying his environment also increased the client's participation in social and leisure activities. These changes improved the outcome of the client's rehabilitation.
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ranking = 613.33104273247
keywords = traumatic brain injury, brain injury, traumatic brain, brain, injury, trauma
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5/33. Agitation assessment in severe traumatic brain injury: methodological and clinical issues.

    The aim of this single case study was to evaluate the applicability of a graphic and statistical time-series analyses in the observation of an agitation disturbance in a 16-year-old patient who had sustained a severe traumatic brain injury. The agitation was measured using the Agitated Behaviour Scale. The experimental model was of the A-B type: phase A corresponded to the period of vegetative state, and phase B to the period following the reawakening from coma. The data were submitted to visual and statistical analysis by the split-middle trend line method, function of autocorrelation, and C statistic. The results show the different nature and frequency of the agitated behaviour during the vegetative state and after reawakening from coma. The application of a statistical analysis to establish whether the behavioural disturbance is random or a response to the environment allows the adoption of specific and potentially more efficacious treatments.
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ranking = 3047.1554560185
keywords = traumatic brain injury, brain injury, traumatic brain, brain, injury, trauma
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6/33. risperidone treatment of motor restlessness following anoxic brain injury.

    PRIMARY OBJECTIVE: This paper examined the use of an atypical neuroleptic medication, risperidone, in reducing the excessive motor activity of an adolescent with an anoxic brain injury following cardiac arrest from a lightning strike. lower extremity restlessness caused the patient to develop skin breakdown and interfered with healing of existing burns. research design: Single-blind, placebo-controlled single-subject experimental design. EXPERIMENTAL INTERVENTION: Escalating doses of risperidone up to 1 mg and in combination with methylphenidate (10 mg) and amantidine (100 mg). MAIN OUTCOMES AND RESULTS: The patient demonstrated a reduction in restlessness in response to the use of risperidone, which permitted wound healing. The addition of methlphenidate to risperidone led to a slight increase in attention to task. CONCLUSIONS: The use of the atypical neuroleptic medication, risperidone, may be considered as part of the armamentarium available to physicians treating restlessness in severe brain injuries.
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ranking = 1051.9346312726
keywords = brain injury, brain, injury
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7/33. Early recognition of neuroleptic malignant syndrome during traumatic brain injury rehabilitation.

    neuroleptic malignant syndrome is a rare disorder that manifests with hyperthermia, muscle rigidity and autonomic instability. Presented is a case series of individuals with traumatic brain injury and agitation who, when treated with neuroleptics, developed neuroleptic malignant syndrome. Although the incidence of this syndrome is rare, it is associated with significant morbidity and mortality. The onset of symptoms inconsistent with the patient's current level of recovery should alert the clinician to consider other possible diagnosis and failure to distinguish the features of neuroleptic malignant syndrome from post-traumatic agitation will delay appropriate intervention for this potentially life-threatening disorder.
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ranking = 3047.1596247048
keywords = traumatic brain injury, brain injury, traumatic brain, brain, injury, trauma
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8/33. Beneficial behavioural effects of lamotrigine in traumatic brain injury.

    Anti-convulsant medications have been employed to treat behavioural disorders resulting from traumatic brain injury (TBI). However, there is a paucity of literature investigating the use of lamotrigine to treat aggression and agitation in patients with TBI. In a single case study design, the present study examined the effectiveness of lamotrigine to treat aggressive and agitated behaviour in a 40-year-old male who sustained a severe TBI. A substantial decrease in problematic behaviours and a significant improvement in neurobehavioural functioning were observed after lamotrigine treatment. This case study provides some support for the use of lamotrigine to treat aggression and agitation in patients with a TBI. Further research is needed to examine the relationship between lamotrigine and functional outcome after TBI.
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ranking = 3047.1554560185
keywords = traumatic brain injury, brain injury, traumatic brain, brain, injury, trauma
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9/33. propofol withdrawal syndrome in an adult patient with thermal injury.

    A 48-year-old man with a history of ethanol abuse and bipolar disease fell asleep while smoking in an intoxicated state. The patient received a 30% total body surface area burn involving his face and upper torso that resulted in an inhalation injury. Several attempts at weaning from mechanical ventilation failed due to his extreme agitation, which was unresponsive to benzodiazepines, opiates, and antipsychotic agents. propofol therapy was begun in combination with valproic acid, fluoxetine, and risperidone to assist in the treatment of his severe agitation associated with the bipolar disease, inhibiting ventilatory weaning. Repeated attempts to discontinue propofol were associated with withdrawal symptoms such as severe agitation, tremors, tachycardia, tachypnea, and hyperpyrexia. His symptoms resolved only after each time the propofol infusion was restarted. The patient received propofol for 95 days for management of his agitation before dying from refractory septic shock and multiple organ failure.
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ranking = 4.8749394109565
keywords = injury
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10/33. Functional analysis and intervention to reduce self-injurious and agitated behavior when removing protective equipment for brief time periods.

    The authors conducted studies that were designed to maintain low levels of hand-to-head self-injury when protective equipment was removed (i.e., rigid arm sleeves and a protective helmet) for brief time periods with an individual with profound intellectual disabilities. A series of assessments was first conducted of a topographically similar form of behavior to self-injury when the person was wearing protective equipment (i.e., hitting helmet with rigid arm sleeves). Results of these assessments indicated that head hitting (with equipment) was not sensitive to social consequences (Study 1) but that it was reduced substantially when the individual had access to items that produced vibration or vibration and sound (Study 2). A treatment protocol that included items that produced vibration and vibration with sound produced substantial reductions in attempts at self-injury and agitation when protective equipment was removed for brief time periods (Study 3).
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ranking = 2.9249636465739
keywords = injury
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