Palliative Care in ALS课件.ppt

Palliative Care in ALS Deborah Gelinas, M.D. April, 2012;Amyotrophic Lateral Sclerosis;Diagnosis El Escorial;Age Specific Incidence of ALS;Genetics : 10% of all ALS is Familial;Vulnerability Genes in Sporadic ALS;Survival Curve of Patients with ALS;Hospice and Palliative Care;Palliative Care;Models of Palliative Care;First Step in Palliation: Delivering the Diagnosis;First Step in Palliation: Delivering the Diagnosis;AAN Guidelines for Care of Patients with Amyotrophic Lateral Sclerosis;Figure 1. Algorithm for sialorrhea management.;Figure 2. Algorithm for nutrition management. 1Rule out contraindications. 2Prolonged mealtime, ending meal prematurely because of fatigue, accelerated weight loss due to poor caloric intake, family concern about feeding difficulties. *Forced vital capacity...;Figure 3. Algorithm for respiratory management. 1Forced vital capacity (FVC) or vital capacity (VC) can be used.;Are Hospice Criteria Adequate for ALS?;Are Hospice Criteria Adequate for ALS?;How Do Patients With ALS Die?;Terminal Suffering;Symptoms during the last 24 hours;Palliative Effect of Nutrition, Ventilation and Medication in the Terminal Phase;“The final month of life in patients with ALS” Ganzini. Neurology: 2002;纳价坊蓬绑垫磁酉怒绰华伎诞彩诛蝎膘冬些错泉移逞吴授绿蹄廊怠盲躬也Palliative Care in ALS课件Palliative Care in ALS课件;Spinocerebellar Ataxias;Autosomal Dominant Ataxias;Associated Professionals;Medical Management;Symptoms;Is It Weakness?;Neuromuscular Pathway;Differential Diagnosis of Weakness;Pattern of Weakness Localization;Testing in Neuromuscular Disease: Where to Begin?;Myopathic or Neuropathic?; Muscle Biopsy  Myopathic Neuropathic fiber size variation fiber type grouping central nuclei angular atrophic fibers split fibers inflammatory cells; EMG/NCSMyopathic: Neuropathic:Fibs, PSW’s Fibs, PSW’sSmall Amplitude Large AmplitudeEarly Recruitment Decreased Re