The most obvious sign that our brains function asymmetrically is the near-universal preference for the right hand, which goes back at least as far as the historical record takes us, and has long been a powerful source of symbolism, with the dexterous right associated with positive values and the sinister left with negative ones . This has often led to stigmatization of left-handed individuals, sometimes forcing them to switch hand use, occasionally with grievous consequences. Superstitions about left and right were compounded by the discovery, in the 1860s, that speech was based predominantly in the left hemisphere of the brain . Since language itself is uniquely human, this reinforced the idea that brain asymmetry more generally is a distinctive mark of being human . Because the left hemisphere also controls the dominant right hand, it came to be widely regarded as the dominant or major hemisphere, and the right as nondominant or minor. Nevertheless, further evidence that the right hemisphere was the more specialized for perception and emotion also led to speculation, some of it far-fetched, about the complementary roles of the two sides of the brain in maintaining psychological equilibrium .
Interest flagged for a while, but was revived a century later, in the 1960s, with the study of patients who had undergone split-brain surgery, in which the main commissures connecting the two hemispheres were cut as a means of controlling intractable epilepsy. Testing of each disconnected hemisphere again revealed the left to be specialized for language and the right for emotional and nonverbal functions ,. This work won Roger W. Sperry the Nobel Prize for Physiology and Medicine in 1981, but again led to speculation, most of it exaggerated or ill-founded, about the complementary functions of the two sides of the brain.
Venous oxygen saturation (SvO2) is a measure of the oxygen content of the blood returning to the right side of the heart after perfusing the entire body. When the oxygen supply is insufficient to meet the metabolic demands of the tissues, an abnormal SvO2 ensues and reflects an inadequacy in the systemic oxygenation. SvO2 is, therefore, dependent on oxygen delivery and oxygen extraction.
As with the placement of PAC, informed consent is obtained before the procedure, and the technique is carried out under sterile conditions. The equipment and devices needed are obtained, and the patient is placed in an anatomically advantageous position (Trendelenberg position for subclavian/internal jugular vein access). Pre and peri-procedural ultrasound is used to define anatomy, to reduce the time for venous access and the risk of complications. The CVC is introduced into one of the central veins (decided based on the patient condition and comfort of the practitioner), and the tip is positioned to lie in the lower superior vena cava or outside the right atrium. The catheter placement is confirmed by one of the following methods: chest radiography, fluoroscopy, ultrasound, or transesophageal echocardiography. A venous blood sample is drawn for ScvO2 measurement.
ScvO2 or SmvO2 can be measured by drawing blood from the distal line of CVC or PAC for blood gas analysis. It can also be measured continuously using a fibreoptic catheter that uses reflection spectrophotometry. The saturation value is displayed on an oximetry monitor and updated every 2 seconds. Thus, this provides up-to-date real-time measurement of the venous oxygen saturation, and fluctuations can be closely monitored in critically ill patients. While the continuous venous oximetry is more expensive, repeated blood draws for blood gas analysis in unstable patients leads to blood loss and adds up to the cost. A pilot study comparing the two in sepsis concluded that intermittent measurement was not inferior to continuous monitoring when delivered with the first 6 hours of treatment. These factors should be considered when deciding the method of venous oximetry.
In normal patients, the ScvO2 is 2 to 3% lower than SmvO2 because the lower body extracts less oxygen than the upper body. In non-shock conditions, there is a good correlation between ScvO2 and SmvO2. However, in shock, there are changes in regional blood flow and oxygen extraction. There is a decrease in mesenteric and renal blood supply (with an increase in O2 extraction) and redistribution of blood flow to the GI tract and the brain in the later stages of shock. Thus, the absolute numerical values of ScvO2 and SmvO2 are not comparable. However, the trends in change parallel one another, and therefore the trend of ScvO2 is often used as a substitute for SmvO2. Additionally, it is important to note that factors such as sedation, recent intubation, and position of the tip of the central catheter (closer to the right atrium, more comparable to SmvO2) must be taken into consideration when interpreting the ScvO2 values. In critical illnesses, ScvO2 is estimated to be higher than SmvO2 by 7% +/- 4%.
1. Arrhythmias when the catheter is introduced into the cardiac chambers due to wall irritation. 2. Knotting of the catheter inside the cardiac chambers identified on chest radiography. 3. Misplacement due to the looping of the catheter in the right atrium or ventricle. 4. Valve rupture or endocardial injury.5. Pulmonary artery perforation, a grave complication that occurs due to balloon overinflation or perforation of the catheter tip. It presents as hemoptysis and requires urgent management. 6. Pulmonary infarction occurs if the catheter is left wedged for a prolonged duration of time or migration of the tip to distal branches. 7. Thromboembolism (less common now because of the use of heparin bonded catheters). 8. Air embolism is caused by open infusion ports and entry of air into the venous circulation. 9. Catheter-related bloodstream infections.
In sum, we developed three new measures (the Acceptability of Implementation Measure, Implementation Appropriateness Measure, and Feasibility of Intervention Measure) that are considered to be important implementation outcomes in their own right as well as leading indicators of other implementation outcomes, such as adoption. Our development procedures resulted in 12 items (four for each construct) that are both valid and reliable measures of these implementation outcomes. Predictive validity will be assessed in a forthcoming prospective follow-up study. We will also subject these measures to a formal evaluation of pragmatic properties, testing features beyond their brief nature and sensitivity to change. These measures have great potential for widespread use across implementation studies regardless of intervention focus, target disease/problem, and setting because of their general wording, boosting their ability to generate cumulative knowledge. Moreover, the measure development process employed in this set of studies presents a replicable and relatively efficient method.
Wider implications of the findings: Tramadol and Celecoxib are effective in reducing pain in outpatient hysteroscopy. Celecoxib may be better tolerated as no side effects were reported in the study, however further research on a larger sample size is required before drawing firm conclusions about lack of side effects.
Most paediatric cases are identified when children start school and they are challenged with writing and numbers. In addition to the four primary symptoms, many children also have constructional apraxia, an inability to copy simple drawings. Frequently, there is also impairment in reading (dyslexia). Children with good intellectual function as well as those with brain damage may be affected.
The amount of force required to result in a traumatic spinal cord is the same amount of force applied to the entire body including the brain. The head is a large body part supported by the smaller sized neck so a trauma to the spinal cord can reverberate as the neck is not strong enough to support the head under such dramatic circumstances. SCI from a bullet wound can produce a shock wave through the spinal cord and up inside the brain.
Brain injury as a result of SCI may go undiagnosed because of loss of consciousness, lack of ability to move the body or subtleness of the injury. Symptoms of brain injury may be overlooked because of the SCI experience, severe illness, anesthesia, depression, anxiety, fear, and paralysis. Many times, change in brain function is noted by family members either in the rehabilitation setting or when the individual is discharged to home where they have difficulty in performing thinking activities that they used to do with ease. Behavioral issues can appear outside of the controlled environment of a hospital.
Traumatic Brain Injury (TBI) is the result of trauma to the brain. This can be caused by a bump, blow, or jolt that is severe enough to damage the brain. A penetrating head injury where something breaks the skull is considered a TBI. As the central nervous system (CNS) includes both the brain and spinal cord, these same trauma sources can also be found in traumatic spinal cord injury.
Brain Herniation occurs when pressure or swelling inside the brain forces the brain tissue to be pushed to an area where the skull does not resist. The only spot for this to happen is an opening at the back base of the skull, about the size of a quarter, where the brain stem connects to the spinal cord. If the skull is fractured (broken), the brain can expand through the broken area. The brain tissue is squeezed or damaged as it is pushed through the protection of the skull.
Hemorrhage is uncontrolled bleeding on the surface of the brain (subarachnoid hemorrhage) or inside the brain (intracerebral hemorrhage). A hemorrhage in the brain or spinal cord can develop from trauma or medical issues. Hemorrhage is active bleeding. 2b1af7f3a8