Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We compared analgesia and sedation provided by one of four different opioids in combination with midazolam during gastrointestinal endoscopy. Patients were given 1-3 mg midazolam and meperidine 50-100 mg, fentanyl 50-100 micrograms, sufentanil 5-10 micrograms, or alfentanil 150-300 micrograms, plus additional opioid and/or midazolam if needed. No untoward effects (i.e., O2 saturation < 85%, nausea, vomiting, severe bradycardia) occurred. Sedation and analgesia were comparable in the upper gastrointestinal groups. The number of patients with amnesia for the examination was highest in the meperidine group. Recovery time generally was shorter with alfentanil and sufentanil. Recovery time of the lower gastrointestinal patients was significantly longer in the meperidine group than in the other groups; analgesia scores for sufentanil were significantly lower than for meperidine. Sedation scores for these patients were highest in the meperidine group. The number of patients given meperidine who were amnesic was significantly greater than for the other opioids. Meperidine was better than the other opioids with regard to patient comfort and amnesia during colonoscopy.
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PMID:Sedation and analgesia for gastrointestinal endoscopy. 809 40

To assess signs that might be used in the decision whether or not to admit a patient with minor head injury, the records of 713 female and 1163 male patients were reviewed. Skull radiographs were not obtained routinely; all patients were able to walk and talk when they reached medical contact. Nine patients developed an intracranial complication. The risk of developing such a complication was 16.7 per cent when the patient was agitated, 3.4 per cent in the presence of impaired consciousness and 2.1 per cent when positive neurological signs were observed at the time of examination. Based on the medical history, amnesia for > 5 min and vomiting were associated with a risk of 3.3 and 1.2 per cent respectively; the risk increased considerably in the presence of both. It is recommended that all patients presenting themselves with one or more of the above symptoms or signs, or with alcohol intoxication, after a minor head injury be admitted for observation. If these guidelines had been used, all patients with an intracranial complication would have been detected, and 44.5 per cent of the bed-days used would have been saved.
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PMID:Prognostic signs in the evaluation of patients with minor head injury. 840 98

Patient comfort during percutaneous radiofrequency electrocoagulation for trigeminal neuralgia provides better working conditions for the surgeon and makes the patient more willing to return if a second procedure is necessary. This study evaluates five different regimens for analgesia and sedation including the standard of fentanyl and droperidol (Group A) and four other regimens, each containing midazolam. In a sixth group, droperidol was assessed for its antiemetic effects. Patients were medicated as follows: Group B, low-dose midazolam (3.0 mg average); Group C, low-dose midazolam (2.5 mg average) and oral diazepam (7.5 mg average) just before the procedure; Group D, high-dose midazolam (5.5 mg average); and Group E, high-dose midazolam (5.1 mg average) and oral diazepam. Medications were titrated to induce mild sedation in Groups A, B, and C and heavier sedation in Groups D and E. All patients received fentanyl and small doses of intravenous methohexital just before the cannula penetrated the foramen ovale and before radiofrequency electrocoagulation. At least 2 weeks later, patients reported their level of discomfort during the procedure and their recollection of the procedure on a 0 to 10 scale. In another group of 96 patients, 1.25 mg of droperidol was given in addition to the medications described for Groups D and E. There was a statistically significant improvement in comfort in Groups C, D, and E and added amnesia in Groups D and E. Vomiting occurred in none of the patients medicated with droperidol and in 5 of 143 patients who did not receive droperidol.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Analgesia and sedation during percutaneous radiofrequency electrocoagulation for trigeminal neuralgia. 845 65

Head injury is a frequent cause of morbidity and mortality in pediatric trauma. Guidelines for obtaining computed tomographic (CT) scans in the child with mild head injury are poorly defined. This study investigated the utility of head CT scanning in the pediatric patient presenting with normal neurologic examination. All patients undergoing head CT scanning for trauma in the emergency department (ED) at a tertiary care pediatric trauma center during 1992 were identified (508). Charts were reviewed for historical and physical examination findings, CT results, and need for neurosurgical intervention. Patients were excluded if they had an abnormal neurologic examination (179), known depressed skull fracture (11), bleeding diathesis (3), age older than 18 years (1), or developmental delay (1). Included were 313 patients (median 5.5 years) who presented with clinical variables including sleepiness (38%), vomiting (34%), headache (30%), loss of consciousness (LOC) (25%), irritability (22%), amnesia (20%), and seizures (8%). An abnormal head CT was noted in 88 cases (28%); 79 (25%) were traumatic abnormalities involving the skull and/or contents. Thirteen patients (4%) had intracranial injuries (ICI); all had either a linear (10), basilar (2), or depressed (1) skull fracture noted on CT. Four patients required neurosurgery, three for epidural hematoma, and one for a complicated orbital fracture (without ICI). No clinical variables (seizure, LOC, vomiting, headache, confusion, irritability, sleepiness, amnesia) were associated with ICI (P > 0.05). In pediatric head trauma patients, with normal neurologic examinations in the ED, ICI occurs < 5% of the time and neurosurgery is needed in 1% of the cases. Commonly used clinical variables are not associated with ICI in these children.
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PMID:The utility of head computed tomographic scanning in pediatric patients with normal neurologic examination in the emergency department. 880 36

The study group on Head Injury of the Italian Society for Neurosurgery suggests the following guidelines for minor head injured patients management. Patients either oriented to time, space and person (GCS 15) or confused (GCS 14) are included among the group of minor head injury. Criteria of exclusion are the presence of focal neurological deficits, open injury and a GCS < or = 13. Six categories of risk factors (coagulopathies, alcoholism, drug abuse, epilepsy, previous neurosurgical treatments and disabled elderly patients) relevant to the clinical course are identified. Three group of patients are distinguished. Patients in the Group 0 (GCS 15, without loss of consciousness, amnesia, diffuse headache, vomiting) could be sent home from Emergency Department after at least 6 hours period of observation with an information sheet. Patients in the Group 1 (GCS 15, with loss of consciousness and/or amnesia and/or diffuse headache and/or vomiting) require clinical observation (> or = 6 hours) and neuroradiological assessment. According to hospital availability, either skull-X rays or CT scan is obtained. In the presence of a skull fracture a CT scan is mandatory. In the presence of intracranial lesions, neurosurgical consultation is requested. In the absence of skull fractures or intracranial lesions the patient is admitted for observation (> or = 24 hours). Patients in the Group 0 and in the Group 1 with a risk factor (R) are admitted to the hospital (> or = 24 hours) and submitted to a CT scan. In patients with coagulopathies or in treatment with anticoagulants a CT scan should be repeated before discharge even in the absence of intracranial lesion on the first CT. In patients in the Group 2 (GCS 14) a CT scan is obtained in all cases independent of the presence of a risk factor.
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PMID:Guidelines for minor head injured patients' management in adult age. The Study Group on Head Injury of the Italian Society for Neurosurgery. 891 56

A number of symptoms cause physical or mental distress and suffering in the terminal and dying patient. In this prospective study of 117 patients (96% with a cancer diagnosis) in a Danish hospice all symptoms causing distress were assessed daily in three degrees of severity. The ten most frequently recorded symptoms were: fatigue, pain, weakness, dyspnoea, immobility/paresis, anorexia, general malaise, nausea/vomiting, oedema and amnesia. Fatigue was registered on 60.9% of the admission days, pain on 27.3%, dyspnoea on 19.2% and nausea/vomiting on 8.5%. The prevalence of pain, dyspnoea, nausea/vomiting, thirst and anxiety did not increase during the last seven days of life. Unconsciousness occurred in 23% of the patients during the last 24 hours and in 5% on the day before.
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PMID:[Distress symptoms in hospice patients]. 941 5

The clinical course of patients admitted following minor head injuries (Glasgow Coma Score [GCS] 13-15) has been studied less extensively than in severely head injured patients. Admission criteria, methods and indications for radiological evaluation are controversial. To study this further, a retrospective review of 633 patients admitted following such injuries to King Khalid University Hospital between 1986 and 1993 was undertaken. Their ages ranged from one month to 80 years (average 17 years). The mechanisms of injury were mainly falls in 339 (53.5%) cases and road traffic accidents in 234 (37%). None of the cases resulted from a non-accidental injury. Radiological evaluation was by skull radiography in 616 (97.3%) cases followed by CT scan in 131 (20.7%). These studies revealed a skull fracture in 78 (12.7%) cases. Six of these 78 patients with skull fracture required a neurosurgical procedure during the first week post injury. These represented 0.97% of the cases who had skull radiographs. A base of skull fracture was an ominous sign, since 3 of the 5 cases with such fractures required ventilation of which one resulted in the only mortality of this series, the fourth developed meningitis. Of the cases studied, 3 (0.5%) developed growing skull fractures all had the initial injury during their first year of life. Other complications were as follows: 25 (3.9%) early post-traumatic seizures, 10 (1.6%) chronic subdural haematomas, 9 (1.4%) extradural haematomas, 2 (0.3%) post-traumatic hydrocephalus and one (0.2%) cerebral abscess. We conclude that patients who have an abnormal GCS, a neurological deficit, post-traumatic seizure, signs or suspicion of basal or depressed skull fracture should be admitted for observation because of the risk of deterioration. Patients with a history of loss of consciousness or amnesia without any of the previous may be discharged to be observed at home by a competent observer, otherwise, will need admission for observation. Radiological evaluation once indicated must be by CT scan. There is no benefit from immediate skull radiography in the initial evaluation of minor head injuries. The indications for CT are an abnormal GCS, presence of neurological deficit, signs of basilar or depressed fracture and persistent or progressive headache or vomiting. Infants with minor injuries should be followed up at least once after two to three months for possible growing fractures.
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PMID:Management of minor head injuries: admission criteria, radiological evaluation and treatment of complications. 952 9

A 75-year-old male was hit by a car, when riding a bicycle. The diagnosis of acute epidural hematoma was made based on computed tomography (CT) findings of lentiform hematoma in the left temporal region. On admission he had only moderate occipitalgia and amnesia of the accident, so conservative therapy was administered. Thirty-three hours later, he suddenly developed severe headache, vomiting, and anisocoria just after a positional change. CT revealed typical acute subdural hematoma (ASDH), which was confirmed by emergent decompressive craniectomy. He was vegetative postoperatively and died of pneumonia one month later. Emergent surgical exploration is recommended for this type of ASDH even if the symptoms are mild due to aged atrophic brain.
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PMID:Abrupt exacerbation of acute subdural hematoma mimicking benign acute epidural hematoma on computed tomography--case report. 1009 58

A 35-year-old hyperthyroid woman who developed nausea, vomiting, tachycardia, nystagmus and mental disturbance, was referred to our hospital with a suspected diagnosis of thyroid storm. However, the thyroid gland was only slightly palpable, bruits were not audible, and exophthalmos was not present. Serum levels of thyroid hormone were increased, but TSH receptor antibodies were negative. Echography and color flow doppler ultrasonography revealed a slightly enlarged thyroid gland and a slightly increased blood flow, both of which were much less milder than those expected for severe hyperthyroid Graves' disease. Under the diagnosis of hyperthyroidism due to gestational thyrotoxicosis associated with Wernicke encephalopathy, vitamin B1 was administered on the first day of admission. Her consciousness became nearly normal on the second day except for slight amnesia. Her right abducent nerve palsy rapidly improved, but horizontal and vertical nystagmus, diminished deep tendon reflexes and gait ataxia improved only gradually. MRI findings of the brain were compatible with acute Wernicke encephalopathy. We concluded that history taking and physical findings are important to make a differential diagnosis of gestational thyrotoxicosis with acute Wernicke encephalopathy from Graves' thyroid storm, and that Wernicke encephalopathy should be treated as soon as possible to improve the prognosis.
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PMID:Gestational thyrotoxicosis with acute Wernicke encephalopathy: a case report. 1072 54

The objective of this study was to determine whether analgesia-sedation improved patient acceptance of day-case herniorrhaphy and to evaluate the extent of patient morbidity. A total of 98 patients (mean age 34 years, range 17-75 years) were studied before and after herniorrhaphy to determine their response to the procedure. All patients were unpremedicated and underwent herniorrhaphy using a Bassini repair technique with a standard local anaesthetic block. Sedation was obtained with titrated intravenous midazolam(Hypnovel, Roche Products Ltd.) without narcotic analgesia. Patients were evaluated with a simple questionnaire after surgery. The maximum dose of midazolam used was 5 mg (median dose 3.5 mg). Monitoring of vital signs with pulse oximetry during the operative period was routine though oxygen therapy was not required. All patients were able to walk without assistance and were discharged under responsible supervision. Operative morbidity was low (5%). Adverse reactions to the procedure such as nausea, vomiting and headache were not seen. In conclusion, conscious sedation allows amnesia to be achieved with low morbidity in the majority of patients undergoing local anaesthetic procedures. This should result in increased patient acceptance.
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PMID:Analgesia-sedation for day-case inguinal hernia repair. A review of patient acceptance and morbidity. 1094 57


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