A systematic approach to the unconscious patient

Cooksley, Tim; Rose, S G; Holland, Mark

doi:10.7861/clinmedicine.18-1-88

Cited by 31 publications

(25 citation statements)

References 20 publications

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“…There were no significant findings in the MRI, EEG, or CSF examinations. Table 1 shows the differential diagnoses of consciousness impairment that physicians find difficult to diagnose in the acute phase 1 . We also analyzed anti‐GQ1b antibody levels for diagnosing BBE in this patient 2 .…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and prediction of prognosis for Bickerstaff’s brainstem encephalitis using auditory brainstem response: a case report

Kurihara

Igarashi

Kobai

et al. 2020

Acute Medicine & Surgery

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Background It is difficult to diagnose Bickerstaff’s brainstem encephalitis (BBE) in the acute phase, and emergency physicians could diagnose BBE as an unknown cause of consciousness disturbance. Case presentation A 75‐year‐old woman presented with dizziness and weakness in both arms 1 week after an upper respiratory infection. She experienced gradual worsening of consciousness, had dilated pupils and no light reflex. She was suspected of brainstem dysfunction at the upper part of the brainstem; however, there were not significant findings on magnetic resonance imaging, cerebrospinal fluid, or electroencephalography. The auditory brainstem response demonstrated a low voltage, but there was no prolonged latency. At a later date, she was diagnosed with BBE based on serum immunoglobulin G anti‐GQ1b antibody. She was discharged home without any neurological sequelae. Conclusion It is necessary to analyze serum immunoglobulin G anti‐GQ1b antibodies to diagnose BBE. Auditory brainstem response would be helpful in detecting lesions and predicting functional recovery.

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Section: Discussionmentioning

confidence: 99%

Diagnosis and prediction of prognosis for Bickerstaff’s brainstem encephalitis using auditory brainstem response: a case report

Kurihara

Igarashi

Kobai

et al. 2020

Acute Medicine & Surgery

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“…In the emergency medicine, POC BG testing can be of enormous importance, where the cause of coma can be immediately diagnosed and treated by the emergency medical team on field [ 71 ].…”

Section: Point-of-care Diagnostics In Haematology and Biochemistrymentioning

confidence: 99%

Diagnostic Modalities in Critical Care: Point-of-Care Approach

et al. 2021

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The concept of intensive care units (ICU) has existed for almost 70 years, with outstanding development progress in the last decades. Multidisciplinary care of critically ill patients has become an integral part of every modern health care system, ensuing improved care and reduced mortality. Early recognition of severe medical and surgical illnesses, advanced prehospital care and organized immediate care in trauma centres led to a rise of ICU patients. Due to the underlying disease and its need for complex mechanical support for monitoring and treatment, it is often necessary to facilitate bed-side diagnostics. Immediate diagnostics are essential for a successful treatment of life threatening conditions, early recognition of complications and good quality of care. Management of ICU patients is incomprehensible without continuous and sophisticated monitoring, bedside ultrasonography, diverse radiologic diagnostics, blood gas analysis, coagulation and blood management, laboratory and other point-of-care (POC) diagnostic modalities. Moreover, in the time of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, particular attention is given to the POC diagnostic techniques due to additional concerns related to the risk of infection transmission, patient and healthcare workers safety and potential adverse events due to patient relocation. This review summarizes the most actual information on possible diagnostic modalities in critical care, with a special focus on the importance of point-of-care approach in the laboratory monitoring and imaging procedures.

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“…2 Besides, a brain injury should still be suspected even in cases when there is an apparent absence of signs of trauma, especially among the elderly population and patients receiving anticoagulation medications. 3 Among the various conditions within the emergency department, coma has been considered a relatively rare condition in such settings, nonetheless, these patients usually require rapid interventions to prevent the development of any complications that may end up with death in critically ill patients. The attending physicians start with the baseline support of life for the affected patients, followed by rapid assessment and evaluation of the etiology, pathophysiology, adequate physical examination and imaging and laboratory investigations whenever needed to determine the most appropriate management plan.…”

Section: Introductionmentioning

confidence: 99%

Urgent considerations for assessment of coma in the emergency department

Aldarwish

Alolowi

Alsadiqi³

et al. 2021

Int J Community Med Public Health

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Not speaking, closed eyes, absent response to tactile, verbal or noxious stimuli are characteristic of comatose patients. Many causes of coma have been identified and reported in the literature. However, other causes might require extensive assessment and evaluation approaches. The attending physicians start with the baseline support of life for the affected patients, followed by rapid assessment and evaluation of the etiology and pathophysiology and adequate physical examination. In addition, it requires imaging and laboratory investigations whenever needed to determine the most appropriate management plan. In this literature review, we have conducted a brief discussion about the urgent considerations for the assessment of coma in the emergency department. Many causes can attribute to the development of coma. Therefore, adequate assessment and evaluation is a key component in the management of the affected patients in the emergency department. Moreover, the management approach might differ based on the underlying etiology. Nevertheless, caring for breathing, circulation, management of the airways, and stabilization are the main steps that should be done for each comatose patient. Physical examination is also critical in such situations, where imaging or conducting laboratory tests might not be suitable for some patients. Finally, the treatment plan should be directed based on the underlying etiology of coma.

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A systematic approach to the unconscious patient

Cited by 31 publications

References 20 publications

Diagnosis and prediction of prognosis for Bickerstaff’s brainstem encephalitis using auditory brainstem response: a case report

Diagnosis and prediction of prognosis for Bickerstaff’s brainstem encephalitis using auditory brainstem response: a case report

Diagnostic Modalities in Critical Care: Point-of-Care Approach

Urgent considerations for assessment of coma in the emergency department

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