Loss of consciousness: an overview (2023)

The unconscious victim and "sexual aggression that facilitates through drugs",

Alcohol and other drugs play an important role in many sexual aggression.Half of all sexual aggression concerns drug or alcohol intake.⁶¹In many cases, it is not clear whether a medication was taken voluntarily or whether the victim has been attacked.

Folk media have created public awareness of drugsRappalding threshold(Table 58.6).⁶²Although dated rape medications are of great importance, extensive forensic tests in the United States show that only a minority of sexual assault concerns the suspect that increases the drink of a victim with a tablet, a capsule, dust, dust or drugs.liquid spirit.⁶³A urine drug screen in the routine hospital is not sufficient to evaluate a victim of sexual aggression.Forensic laboratories generally offer an evaluation for several medication in a specific test for the victim of sexual aggression.Of all the substances that were facilitated by medication during sexual aggression, the type of calming or hypnotic medicine or a combination of both can be used to facilitate sexual aggression. People with high amounts of alcohol and caffeine (e.g. fourLoko [2017 Phusion Projects, Chicago IL]).^63,64In the past decades, laboratory tests Fluntratepam and GHB have included sexual aggression, which was provided by drugs in about 3 to 5% of cases.^Sixty-fiveFluntratepam is a benzodiazepine that is not available in the United States but is available in Mexico.It can be proven up to 3 weeks after taking the urine.^Sixty-fiveIn the United States, GHB is a depression of the central nervous system that is prohibited nationwide and is only available for narcolepsia with the exception of Appendix 3, but users can easily be made by recipe such as the Xyrem medication (Pharmaceuticals PLC Jazz, Dublin, Ireland).Butanodiol and γ-butiractone.

It is often the last memory of the victim to use drugs or alcohol and then take another place going and to lack the intermediate memory.Some remember short activities that may indicate a kind of sexual acts.Victims may lack memory, but they want to "check" "sex. A medical examination should be carried out an integral part of these people. Without a history of the victim, Vulva and all holes (oral, vaginal and anal). In drugs that are used to facilitate sexual aggression, cannot be found in the laboratory tests of the routine hospital, and it may be impossible to distinguish the self -government of secret intake.

summary

ScharfLoss of consciousnessA fascinating scenario for theoretical and clinical research throws their patients with loss of consciousness to predict the clinical result.

Unconscious neuromuscular control

The late rehabilitation phase finally advances to the disorders or reactive exercises that are intended to improve the sensoriomotor, unconscious or forward -looking control of the limb.¹⁴The acquisition of conscious neuromuscular control for all muscles involved is an important prerequisite before these types of exercises are started.The final goal of these exercises is to improve global joint stability in the entire upper limb because it represents a continuous kinetic chain unit.⁶⁹This type of exercise depends on the activation of complex neurophysiological sensori monoto control paths, which have produced and centrally regulated by cortical and cerebellar centers.¹⁴The fault exercises require fast activation or the KO control of several muscle groups that have to work optimally synchronously in order to create the stability of global dynamic joints.¹⁰⁴These exercises are reserved for the final phases of propioception rehabilitation^14,69Because they embody the highest functional training before a patient returns to a complete activity without restrictions.

The fault exercises of the upper extremities can be carried out by closed and open kinetic chain strategies that use several training equipment and devices available in stores.⁶⁹The usual exercise equipment used in the clinic can include a weighted ball, Swiss ball, Bosu ball and handicraft devices (e.g. Flexar, body blade, gyroscope).¹⁰⁵The use of this device induces reactive muscle activations and focuses on several functional movement patterns.The aim of improving the functional muscle resistance.⁶⁹

The clinical selection of the closed or open chain must only depend on the patient's specific rehabilitation program.Therefore, closed and open chain training strategies can contribute to functional improvements depending on the functional goals of the patient.⁶⁹An example of the interference exercise of the closed chain of the upper extremity is a wall of Switzerland or Switzerland, which in a script or anti -foil surrounds the wall and adding disorders that are directed by the therapist in several directions (therapistAbb. 99.9).Block of a patient's view could make these exercises even more difficult.Closed chain exercises can progress even more by putting the patient in such a way that he works more against the influence of gravity and progress on the ground.The proprioceptive exercises of the closed chain can also contain a foam cushion or a Bosu ball, which starts from double arm support positions (positions made of double arm (Abb. 99.10).¹⁰⁶

Syncope

Loss of consciousnessIt can occur due to diffuse cerebral hypoxia or ischemia.The clinical properties of a syncopal event can be similar to those of a seizure and certain seizures.Therefore, the possibility of syncopal episodes should be taken into account if a patient occurs with the late start of an obvious seizure disorder.Recent studies show that neurocardiogenic syncope continues to be incorrectly diagnosed as epilepsy.⁷⁵And that such patients are often overwhelmed and treated inappropriately, which risks a fatal result.

During a syncopal episode, it is generally said that the EEG shows a diffuse slow behind.The restoration occurs in reverse order.In fact, EEG changes are more variable;In some cases there is no weakening of electromebral activity, while in other cases it develops electromebral calm with a low or no earlier change in the frequency of background rhythms.^76,77The temporary relationship requires EEG changes to loss of consciousness is also variable.⁷⁶Depending on part of the cause of the syncope.⁷⁸

unconsciousness

Compared to the other final points of anesthesia, research on the biological basis of anesthesia is induced, the lack of consciousness induced it develops effective deep monitors of anesthesia.These efforts reflect a growing interest and progress in the "science of consciousness" in general.^49,50In addition, anesthetics are used as research instruments to solve the neuronal foundations of consciousness.

Loss of consciousness(or hypnosis) is a characteristic seal for the beginning of anesthesia.What is generally knownUnconstructions under anesthesiaIt could be described more precisely asMissing feedback,A disease that could also cover states of self -confidence without environmental awareness (as in sleep) or environmental awareness without remembering (for example, conscious amnesia in combination with neuromuscular paralysis during anesthesia induction).^32,51

Numerous theories were advanced to explain the unconsciousness induced by anesthesia.In general, they can be divided into those that control the changes in the circuits of the brain stick that controls the excitement^52,53Against changes "from top to bottom" in the talamocortical circuits that integrate information.⁵⁴In fact, this distinction formed the basis for a recent proposal that theebenof conscience reflects processes from bottom to top, while thecontentsThe certain reflects processes from top to bottom, a term with intuitive attractiveness.⁵⁵

One of the most influential theories was the "integrated information theory of consciousness (IITC)" by Tononi,⁵⁶This emphasizes the need for a simultaneous differentiation between the brain states and its integration into a coherent whole.⁵⁷Drugs or diseases that suppress consciousness could work through any process.Other information base approaches use symbolic analysis,⁵⁸Entropy transmission,⁵⁹Chaostheorie,⁶⁰and more.The extensive connectivity of the brain rortue and its hierarchical organization is particularly suitable for enabling a high degree of information integration into the human brain.Some brain areas have a "Club -Rico" gereration (ie high -connected nodes are preferably connected with other highly connected nodes), which has been proposed that it is optimal for the integration of information.^61,62These centers are promising goals for the hypnotic effect of general anesthesia.

The anesthetics could work by interfering with the operational synchronicity and coherence of corticotalamic networks⁶³and loss of the induced reaction capacity by Midazolam.⁶⁴This breakdown of cortical connectivity instead of the pharmacological active ingredient of the environment could be the loss of loss of consciousness.^Sixty-fiveUnconstruction would not be characterized by absence, but by the fragmentation of cortical processing.

Loss of consciousness

In the interimLoss of consciousnessIt is rarely in the infarction of the MCA territory.It takes only 8.4% of the ischemic strokes at the beginning.¹³⁰The delayed loss of consciousness occurs more frequently and often occurs 36 hours to 4 days after the hemisphs, which vary from the entire MCA area only into the frontotemporal region.¹³¹The decrease in consciousness is usually part of a large oneAbb. 24-11).

149 Is it an athlete with a first brain breakdown with a higher risk of a second?

And.LOC with a brain opening is described with the risk of six times higher future brain intake compared to the brain and without LOC, "Second Impact" syndrome with the death of a second injury to an athlete who had suffered an initial shock of brainfrom which the athlete had not completely recovered.

Meehan Wp III, Bachur RG: Sport - -related brain shock,Pediatrics1123: 114–123, 2009.

Nervous system

Clinical characteristics

Clinical characteristics

Loss of consciousnessIt is not always immediate;A clear time of several minutes can intervene between the lesion and the beginning of the neurological deterioration.The Glasgow coma scale quantifies the degree of reaction after head injuries (Tabla 2.2).The scores of 8 or less correlate well with serious injuries.

Acute cerebral swelling and intracranial bleeding cause clinical properties.The increase in intracranial pressure is always available and can lead to hernia if they are not controlled.Focal neurological deficits indicate intracerebral bleeding.

The mortality rates in children with serious head injuries are usually between 10% and 15% and have not changed significantly in the past ten years.Low mortality rates are sometimes associated with higher percentages of the survivors in chronic vegetative conditions.The duration of the Coma is the best guide to long -term morbidity.Permanent neurological deterioration is an expected result if Coma continues for a month or more.