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    Investigations in An Unconscious Patient

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    cyphochilus
    The document provides guidance on investigations to request for an unconscious patient. It recommends obtaining the patient's history, performing imaging like CT/MRI to check for structural causes of unconsciousness, measuring blood glucose and electrolyte levels, assessing blood gases and pH, performing drug screening and liver function tests, and considering a lumbar puncture if increased intracranial pressure can be ruled out. The goal is to identify potential functional or structural causes like trauma, infection, metabolic disturbances, lack of substrates, or drug overdose.

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    Investigations in An Unconscious Patient

    Uploaded by

    cyphochilus
    3K views16 pages
    The document provides guidance on investigations to request for an unconscious patient. It recommends obtaining the patient's history, performing imaging like CT/MRI to check for structural causes of unconsciousness, measuring blood glucose and electrolyte levels, assessing blood gases and pH, performing drug screening and liver function tests, and considering a lumbar puncture if increased intracranial pressure can be ruled out. The goal is to identify potential functional or structural causes like trauma, infection, metabolic disturbances, lack of substrates, or drug overdose.

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    Investigations in an Unconscious Patient

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    The document provides guidance on investigations to request for an unconscious patient. It recommends obtaining the patient's history, performing imaging like CT/MRI to check for structural causes of unconsciousness, measuring blood glucose and electrolyte levels, assessing blood gases and pH, performing drug screening and liver function tests, and considering a lumbar puncture if increased intracranial pressure can be ruled out. The goal is to identify potential functional or structural causes like trauma, infection, metabolic disturbances, lack of substrates, or drug overdose.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    3K views16 pages

    Investigations in An Unconscious Patient

    Uploaded by

    cyphochilus
    The document provides guidance on investigations to request for an unconscious patient. It recommends obtaining the patient's history, performing imaging like CT/MRI to check for structural causes of unconsciousness, measuring blood glucose and electrolyte levels, assessing blood gases and pH, performing drug screening and liver function tests, and considering a lumbar puncture if increased intracranial pressure can be ruled out. The goal is to identify potential functional or structural causes like trauma, infection, metabolic disturbances, lack of substrates, or drug overdose.

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    You are on page 1of 16

    DESCRIBE INVESTIGATIONS

    YOU WILL REQUEST FOR IN


    AN UNCONSCIOUS PATIENT
    INTRODUCTION
    What is unconsciousness?
    Requirements for one to be
    awake.
    Difference between coma and
    sleep.
    Abnormal drowsiness
    Stupor
    IMPORTANCE OF HISTORY
    Give an idea as to the
    investigations to be carried out
    Taken from a witness or by
    stander
    Ascertain if onset was sudden or
    gradual
    Abnormal behavior prior to onset
    Brief lucid interval?
    CAUSES OF
    UNCONSCIOUSNESS
    Functional: lack of substrate
    depression of
    function
    Abnormal function
    Structural: diffuse
    focal: supra or sub
    tentoriol
    INVESTIGATIONS
    Imaging: X-RAY
    MRI
    CT-scan
    Blood glucose
    Electrolytes
    LFTs
    Blood gases & pH
    Drug screen
    Lumbar puncture
    X-RAY
    Skull fractures . Depressed?
    Calcified pineal gland: midline
    shift
    CXR: cardiomegaly, tb
    X-ray of bruised limbs &
    suspected fractures
    NB: In head trauma cases a c
    spine x-ray should always be
    sought.
    CT & MRI
    CT- scan is useful in the case
    where SOL are suspected
    Imaging of the skull where
    images of higher definition than
    x-ray are required
    MRI may be used to view bleeds.
    Hypo dense?Hyperdense?
    BLOOD SUGAR
    Must be done on every coma
    patient
    Normal fasting: 3.9-6.1mm0l/L
    Hypoglycemia is the most
    common cause of coma in
    diabetics
    Hyperglycemia causes
    hyperosmolar state osmotic
    diuresis with loss of sodium and
    potassium ions.
    May cause coma independent of
    pH
    Normal blood pH 7.35-7.45
    Hypergycaemia,riased pH,kussmaul
    breathing, and ketotic breath point
    to diabetic ketoacidosis
    Lactic acidosis may complicate
    diabetic coma when tissue s
    become hypoxic. Lactic acidosis
    may itself cause coma.
    1% of children with diabetic
    ketoacidosis develop brain edema&
    can cause coma. 25% mortality
    BLOOD GASES
    Important if there is brain
    damage causing central pontine
    hyperventilation.
    Changes in respiratory pattern
    provide important and relatively
    objective evidence of
    deterioration.
    Normal blood gas levels:pO2 75-
    100mmHg
    pCO2
    ELECTROLYTES
    Monitoring of potassium is
    important in management of
    diabetic patients.
    Total body potassium may be low
    but plasma levels normal: ECF
    volume is decreased due to polyuria
    potassium moves from
    cells to ECF when H+
    conc. is high
    lack of insulin induced k+
    entry into cells
    In severe acidosis NA+ is markedly
    depleted.
    LFTs&DRUG SCREEN
    Lfts deranged in hepatic coma,
    drug overdose
    Elevated aminotransferase levels
    Associated clinical findings e.g.
    jaundice
    *paracetamol OD may not cause
    coma but other drugs taken at
    that time may.
    *alcohol level may be misleading
    and other causes should be
    LUMBAR PUNCTURE
    Ensure intracranial pressure is
    not raised
    Levels of lymphocytes elevated
    in tb meningitis(100-300)
    normal(0-2) polymorphs 0-100,
    colorless
    In bacterial meningitis
    polymorphs are 200-2000,
    yellowish or turbid
    Neoplastic
    meningitis(infiltration)5-1000
    BLOOD Ix
    Hemoglobin can be used to asses
    bs control 4-6 wks prior to the
    test.
    Raised WBC,*mantoux test
    INR:hepatic coma,spotaneous
    bleed
    OTHER Ix

    Myxedema coma: Thyroid function


    tests.
    *loss of brain function as a result of
    long standing low levels of thyroid
    hormones.

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