Скачать или смотреть Examining a Patient with Loss of Consciousness or Patient in Coma

Examining a Patient with Loss of Consciousness (LOC) requires a structured, rapid, and thorough approach to identify life-threatening conditions and guide immediate management. Here's a practical breakdown:

🚨 Initial Priorities: ABCDE Approach
Step Action
Airway Ensure patency; suction secretions; consider intubation if compromised
Breathing Assess respiratory rate, oxygen saturation, and effort
Circulation Check pulse, blood pressure, perfusion; start IV access
Disability Evaluate neurological status (Glasgow Coma Scale, pupil response)
Exposure Look for trauma, rashes, needle marks, medical alert tags
🧠 Focused Neurological Examination
Glasgow Coma Scale (GCS): Assess eye opening, verbal response, and motor response

Pupil size and reactivity: Detect brainstem dysfunction or drug effects

Motor responses: Look for posturing (decorticate or decerebrate), asymmetry

Breathing pattern: Cheyne-Stokes, Kussmaul, or ataxic breathing may localize lesions

Reflexes: Corneal, gag, cough, and plantar reflexes help assess brainstem integrity

🔍 Key Questions to Answer
What is the level of consciousness?

Are there focal neurological signs?

What is the likely site and cause of the problem?

🧪 Essential Investigations
Blood glucose: Rule out hypoglycemia

Electrolytes, renal/liver function tests

Toxicology screen

CT/MRI brain: Detect stroke, hemorrhage, trauma

EEG: If seizures are suspected

Lumbar puncture: If CNS infection is suspected and safe to perform

🧑‍⚕️ History Gathering
From family, witnesses, or paramedics:

Onset and duration of LOC

Preceding symptoms (e.g., chest pain, palpitations, aura)

Medical history (e.g., epilepsy, diabetes, substance use)

Medications or recent travel

#C