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Query: UMLS:C0085631 (agitation)
 12,064 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The acute toxicity of dried Nerium oleander leaves to Najdi sheep is described in 12 sheep assigned as untreated controls, N. oleander-treated once at 1 and 0.25 g/kg body weight and N. oleander-treated daily at 0.06 g/kg body weight by drench. Single oral doses of 1 or 0.25 g of dried N. oleander leaves/kg body weight caused restlessness, chewing movements of the jaws, dyspnea, ruminal bloat, incoordination of movements, limb paresis, recumbency and death 4-24 hr after dosing. Lesions were widespread congestion or hemorrhage, pulmonary cyanosis and emphysema, hepatorenal fatty change and catarrhal abomasitis and enteritis. The daily oral doses of 0.06 g dried N. oleander leaves/kg body weight caused less severe signs and death occurred between days 3 and 14. In these animals, the main lesions were hepatonephropathy and gelatinization of the renal pelvis and mesentry and were accompanied by significant increases in serum AST and LDH activities, in bilirubin, cholesterol and urea concentrations and significant decreases in total protein and albumin levels, anemia and leucopenia.
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PMID:Acute toxicity of various oral doses of dried Nerium oleander leaves in sheep. 1178 96

The uses, pharmacology, clinical efficacy, dosage and administration, adverse effects, and drug interactions of hawthorn are discussed. Hawthorn (Crataegus oxyacantha) is a fruit-bearing shrub with a long history as a medicinal substance. Uses have included the treatment of digestive ailments, dyspnea, kidney stones, and cardiovascular disorders. Today, hawthorn is used primarily for various cardiovascular conditions. The cardiovascular effects are believed to be the result of positive inotropic activity, ability to increase the integrity of the blood vessel wall and improve coronary blood flow, and positive effects on oxygen utilization. Flavonoids are postulated to account for these effects. Hawthorn has shown promise in the treatment of New York Heart Association (NYHA) functional class II congestive heart failure (CHF) in both uncontrolled and controlled clinical trials. There are also suggestions of a beneficial effect on blood lipids. Trials to establish an antiarrhythmic effect in humans have not been conducted. The recommended daily dose of hawthorn is 160-900 mg of a native water-ethanol extract of the leaves or flowers (equivalent to 30-169 mg of epicatechin or 3.5-19.8 mg of flavonoids) administered in two or three doses. At therapeutic dosages, hawthorn may cause a mild rash, headache, sweating, dizziness, palpitations, sleepiness, agitation, and gastrointestinal symptoms. Hawthorn may interact with vasodilating medications and may potentiate or inhibit the actions of drugs used for heart failure, hypertension, angina, and arrhythmias. The limited data about hawthorn suggest that it may be useful in the treatment of NYHA functional class II CHF.
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PMID:Hawthorn: pharmacology and therapeutic uses. 1188 7

There are very few case reports on allergic reactions to lychee in the literature - so far only in adults. We report on a 12-year-old girl who developed swelling of lips, pruritus, generalized urticaria and dyspnea 30 min after eating a raw lychee. A second event occurred after eating a piece of cake covered with a fruit cocktail. All other foods were well tolerated. In infancy the girl had suffered from atopic dermatitis, which disappeared in childhood; for the previous 2 yr she had presented with seasonal allergic rhinoconjunctivitis. Upon oral provocation, she developed restlessness, flush, generalized urticaria and inspiratory stridor 50 min after eating half a lychee. The diagnostic work up showed a clear positive skin prick test to raw lychee and specific immunoglobulin E (IgE) in serum to latex but not to lychee. In the cellular antigen stimulation test (CAST) carried out with lychee extracts in several concentrations, the same positive results could be found confirming an allergic reaction. Cross-reactivity of lychee to latex was shown by inhibition experiments using the UniCAP 100-system. In conclusion, it seems worthwhile considering the rare allergy to lychee in the case of unclear food-allergic reactions and lychee should be added to the list of foods cross-reacting with latex.
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PMID:Anaphylactic reaction to lychee in a 12-year-old girl: cross-reactivity to latex? 1200 May 1

Dyspnea is a subjective sensation of breathlessness. This distressing symptom is experienced by many patients with lung cancer and often is accompanied by physiologic signs and symptoms, such as tachypnea, tachycardia, pallor, and cyanosis. Dyspnea-induced hypoxia may occur and cause confusion, cognitive impairment, and restlessness. Prompt and accurate nursing assessment of dyspnea can assist in identifying appropriate treatment interventions. Supplemental oxygenation and medications, along with treatment of the underlying cause of the dyspnea, may promote patient comfort. Nurses need to be skilled in assessing dyspnea experienced by patients with lung cancer and knowledgeable in implementing effective symptom management techniques.
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PMID:Nursing assessment and management of dyspneic patients with lung cancer. 1279 41

Patients treated with platinum compounds are subject to hypersensitivity reactions. Our study has highlighted the reactions related to oxaliplatin (OHP) infusion. One hundred and twenty-four patients affected by advanced colorectal cancer were treated with different schedules containing OHP, at the Institute of Haematology and Medical Oncology 'L. and A. Seragnoli' of Bologna and at the Medical Oncology Division of Livorno Hospital. Seventeen patients (13%) showed hypersensitivity reactions after a few minutes from the start of the OHP infusion. Usually, these reactions were seen after 2-17 exposures to OHP (Mean+/-s.e.: 9.4+/-1.07). No patient experienced allergic reactions at his/her first OHP infusion. Eight patients developed a mild reaction consisting of flushing and swelling of the face and hands, itching, sweating and lachrymation. The remaining nine patients showed a moderate-severe reaction with dyspnoea, wheezing, laryngospasm, psycho-motor agitation, tachycardia, precordial pain, diffuse erythema, itching and sweating. Six patients out of 17 were re-exposed to the drug with premedication of steroids and all except one developed the hypersensitivity reaction again. The cumulative dose, the time of exposure to OHP and the clinical features are variable and unpredictable. The risk of developing hypersensitivity reactions in patients treated with a short infusion of OHP cannot be underestimated.
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PMID:Hypersensitivity reactions related to oxaliplatin (OHP). 1288 15

To describe an institutional procedure for ventilator withdrawal and to analyze patient responses to terminal extubation, the medical records of 21 patients who underwent withdrawal of mechanical ventilation according to the process followed by an interdisciplinary palliative care team were retrospectively reviewed. The cohort was a convenience sample of sequentially treated patients in a 1048-bed urban university-affiliated medical center. Sixteen of the 21 patients were on medical or surgical floors and five patients were in critical care units. Patients were assessed for discomfort, such as dyspnea, agitation, or anxiety. Sedative and analgesic medications were administered based on clinical parameters. Palliative care clinician observations of patient reports, tachypnea,use of accessory muscles, and signs of discomfort such as agitation or anxiety were recorded for the first 4 hours after extubation. Medication use and length of survival were recorded. Fifty-seven percent were symptomatic during the extubation process and required administration of either a benzodiazepine or opioid medication. The median survival of the 18 patients who died post-extubation was 0.83 hours (interquartile range 0.5-43.8). Bolus doses of opioid or benzodiazepine medications were effective for management of symptoms in about two-thirds of patients. One-third of patients required continuous infusions. Eighteen patients died following extubation in the medical center, and three of these patients were transferred to an inpatient hospice unit. Three patients (14%) survived to discharge from the hospital. The procedure followed provides a foundation for collaboration between palliative care and critical care services to ensure continuity of care across clinical settings/units.
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PMID:Ventilator withdrawal: procedures and outcomes. Report of a collaboration between a critical care division and a palliative care service. 1457 56

General anaesthesia using ketamine has been shown to be safe. It is generally used in our private hospitals where there is lack of qualified personnel and sophisticated anaesthetic machines. A retrospective review of 295 cases of laparoscopy was performed over 28 months at the fertility Unit of Life Specialist Hospital Nnewi, Anambra State, Nigeria. Ketamine general anaesthesia was used for all the patients after premedication with 0.6 mg of atropine. Seventy-six and 102 patients who had additional premedication of 10 mg diazepam and 50 mg promethazine, respectively, were compared. The duration of this procedure ranged between 7 and 18 minutes, with a mean of 12 minutes. The dose of ketamine used was 100 mg mean (range 50-180 mg); 12.6% of the patients had some form of reaction. Diazepam reduced talkativeness during recovery but increased the recovery time significantly, from an average of 45 minutes to 3 hours. Promethazine significantly reduced vomiting and restlessness and did not significantly prolong the recovery time (from an average of 45 minutes to 70 minutes). Two patients who had only atropine as premedication had an idiosyncratic reaction of breathlessness and tonic-clonic-like movements. They responded to intravenous diazepam. Ketamine produces a safe, effective and simple general anaesthesia and is recommended for use in day-case laparoscopy, where standard anaesthetic machines and trained personnel are lacking. Use of promethazine premeditation is advocated for improved outcome.
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PMID:The use of simple ketamine anaesthesia for day-case diagnostic laparoscopy. 1461 71

The lungs are surrounded by the pleural membranes. The visceral pleura directly covers the lung and is separated from the parietal pleura by a layer of surfactant, which reduces friction during respiratory movement. A potential space exists between these two layers, and they may become separated by fluid or air. A lung can collapse to the size of a fist under pressure from either. Standard treatment in the field for an open chest wound is an occlusive dressing. The first thing that can be used to occlude the wound is a gloved hand. After placing the dressing, evaluate the breath sounds and determine if they have improved. The dressing should be taped down on three sides, leaving one side open to relieve the pressure during exhalation (one-way valve). "Burping" the dressing involves lifting one side to make sure any pressure buildup is relieved, as occasionally the dressing can become adhered to the skin, which may lead to a tension pneumothorax. If, after ensuring the occlusive dressing is properly in place, the respiratory rate increases, distress level worsens, oxygen saturations fall and breath sounds decrease, then needle decompression is required. A neurovascular bundle is located underneath each rib, and it is important to avoid damage to that bundle by performing a decompression over the top of a rib. If the patient is intubated before the development of a tension pneumothorax, carefully evaluate the breath sounds (especially if the left-side sounds are diminished) to determine if the ET tube needs to be withdrawn a centimeter. The rescuer performing ventilation will usually recognize a tension pneumothorax by the difficulty in bagging the patient. Remember, when you perform a needle thoracentesis, you are creating an open chest wound. Early signs and symptoms of a tension pneumothorax include diminished or absent breath sounds, severe dyspnea, narrowing pulse pressure, tachycardia and restlessness. Neck veins may be distended, but this can be a normal finding in a supine patient. The classic sign is a deviated trachea; the trachea shifts toward the "good" lung as the buildup of pressure collapses the "bad" lung. This is a late sign and suggests the tension pneumothorax has been developing for some time. One sign that does not normally accompany a plain pneumothorax is hypotension. In this case, the persistent low BP, combined with cool, mottled skin and a delayed capillary refill time, led providers to suspect that a hemothorax was developing as well. With endotracheal intubation and pleural decompression, the positive-pressure ventilations allowed the affected right lung to inflate more fully, utilize more of the available alveolar space and "bag out" some of the blood pooling at the base. The patient's vital signs and saturation improved. He needed surgical treatment and removal of the blood in the pleural space before ventilation and oxygenation could normalize.
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PMID:An open question. 1475 Feb 94

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. Cramps, pathological crying or laughter, spasms, and spasticity can all be treated by medication. When speech can no longer be understood, adaptive strategies such as sign language, mime, posture and communication apparatus varying from a note pad to advanced computer systems can be used. Sialorrhoea, caused by difficulty swallowing with its accompanying danger of aspiration can be halted by the use of medication, by radiotherapy and by the injection into the salivary glands of botulin A toxin. Weight loss, also a result of dysphagia, can be avoided by eating frequent small meals or if necessary performing a percutaneous endoscopic or radiological gastroscopy. Excess mucus in the respiratory tract can be treated with anticholinergics. Difficulty in coughing up thick and sticky mucus cannot always be adequately helped. Respiratory weakness is treatable by external respiratory supportive therapy using a nasal mask, as well as invasive respiratory support via a trachcostoma and by treating the symptoms of respiratory weakness. 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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PMID:[The symptomatic treatment of amyotrophic lateral sclerosis]. 1519 69

Weaning a patient from mechanical ventilation is occasionally a difficult process complicated by the patient's emotional state. Anxiety, agitation, depression and other emotional disturbances can start a vicious circle between fear of losing breath and dyspnea that impairs the process of withdrawing ventilatory support. A biocybernetic loop model is suggested that integrates psychological variables (e.g., capacity of self-control, self-confidence, sense of self-efficacy) as important factors for a successful weaning. The paradigm of biofeedback is regarded as a suited approach to strengthen these psychological factors. It means the externalization of physiological functions especially of those from the autonomous nervous system so that a patient becomes aware of them. In the case of the ventilated patient, it is assumed that the transformation of the respiratory activities into perceptible (acoustic and visual) signals supports the patient's self-controlling behaviour during the weaning process. He gets positive reinforcement for his efforts to influence his breathing intentionally and, by continuous and immediate information, he regains self-confidence to control his somatic functions effectively. The application of biofeedback is mainly described in single case studies. They all report a decrease in the respiratory rate and an increase in the tidal volume. The need for a controlled study is suggested that would answer the question of whether biofeedback is an appropriate psychological tool to facilitate the weaning process in mechanically ventilated patients.
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PMID:Biofeedback as a supportive method in weaning long-term ventilated critically ill patients. 1519 41


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