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Approach to Unconscious Patient

*Requirements:Blood, nutrients, circulationBRAINMethod of expressionIf any of these factors are impaired, unconsciousness may follow.. Consciousness. AlcoholEpilepsyInsulinOverdoseUremia (and other metabolic causes). TraumaInfectionPsychiatricStroke, syncope. Possible Causes. ABCImme

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Approach to Unconscious Patient

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    1. By: Reefan Al-Yami Supervisor: Dr. Mohamed Abdurabalnabi Approach to Unconscious Patient

    2. *Requirements: Blood, nutrients, circulation BRAIN Method of expression If any of these factors are impaired, unconsciousness may follow. Consciousness

    3. Alcohol Epilepsy Insulin Overdose Uremia (and other metabolic causes) Trauma Infection Psychiatric Stroke, syncope Possible Causes

    4. ABC Immediate management Examination History Investigations APPROACH

    5. ABC

    6. -Open, clear, maintain -If trauma present or no history available, immediately control C-spine Airway

    7. -Assess presence, adequacy -High concentration O2 immediately on all patients with decreased LOC -Assist if respiratory rate, tidal volume inadequate Breathing

    8. Pulses? Perfusion? bleeding? Circulation

    9. Maintain i.v line, oxygen inhalation Blood sample Control seizures Consider i.v glucose, thiamine, naloxone, flumazenil Immediate management

    10. Examination

    11. Vitals 1.Pulse Tachycardia Hypovolemia/haemorrhage hyperthermia Intoxication Bradycardia Raised intracranial pressure Heart blocks CONTD.

    12. 2.Temperature Increased Sepsis Meningitis ,encephalitis Malaria ,Pontine haemorrhage Decreased Hypoglycemia Hypothermia (less than 31 C) Myxedema Alcohol, barbiturate ,sedative or phenothiazine intoxication. CONTD.

    13. 3.Blood pressure Increased Hypertensive encephalopathy Cerebral haemorrhage Raised intracranial pressure Decreased Hypovolemia Myocardial infarction Intoxication/poisoning CONTD.

    14. 4.Respiratory rate Increased Pneumonia Acidosis (DKA, renal failure) Pulmonary embolism Respiratory failure Decreased Intoxication/poisoning CONTD.

    15. Skin petechial rash Meningococcal meningitis Endocarditis Sepsis,thrombotic thrombocytopenic purpura CONTD.

    16. Multiple injection marks Drug addiction Acute endocarditis Hepatitis B /C with encephalopathy HIV CONTD.

    17. Neurological assessment; 1)General posture 2)Level of conciousness CONTD.

    18. 1)Posture; Lack of movements on one side Intermittent twitching Multifocal myoclonus DECORTICATION DECEREBRATION CONTD.

    19. 2)Level of conciousness Glasgow coma scale (GCS) Best motor response Best verbal response Eye opening -GCS score 3 –severe injury -less than or equal to 8 – moderate injury -9 to 12 – minor injury CONTD.

    20. Eyes open Never To pain To verbal stimuli spontaneously Best verbal response No response Incomprehensible sounds Inappropriate words Disoriented and converses Oriented and converses Best motor response No response Extension (decerebrate rigidity) Abnormal flexion (decorticate rigidity) Flexion-withdrawal to pain Localizes pain Obeys commands Glasgow Coma Scale Monitoring level of consciousness (score 3-15)

    21. Pupillary changes

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