Emergency Medicine Approach to Unconscious Patients

Unconscious patients are tricky. How can you quickly find the cause of their altered mental status? What key aspects should you address in your initial assessment?
This lecture offers a structured and evidence-based framework for assessing an unconscious patient. It covers topics such as: how AEIOU-TIPS can be bad, how to administer antidotes and how to rapidly find preliminary diagnosis in the resus room.
Thank you to GULD and:
Niklas Jonsson & Samuel Bruchfeld (recording)
Björn Kolsrud & Anna Eriksson (inspiration)
Music: Chris Zabriskie - Air Hockey Saloon freemusicarchiv...
Bondi Beach: • Anaphylactic Shock Cau...
Comic: SMBC: www.smbc-comics...
Thumbnail picture: DLR Ritter www.freeimages....
Key references:
[METABOLIC vs STRUCTURAL]
Forsberg et al. Metabolic vs structural coma in the ED--an observational study.
Forsberg et al. Prognosis in patients presenting with non-
traumatic coma.
Ikeda et al. Using vital signs to diagnose impaired consciousness: cross sectional observational study
[FLUMAZENILE]
Pennings et al. Adverse Events Associated with Flumazenil Treatment for the Management of Suspected Benzodiazepine Intoxication - A Systematic Review with Meta-Analyses of Randomised Trials
Ngo et al. Should a benzodiazepine antagonist be used in unconscious patients presenting to the emergency department?
Singh et al. Flumazenil and suspected benzodiazepine overdose.
Haverkos et al. Fatal seizures after flumazenile administration in a patient with mixed overdose.
[GASTRIC LAVAGE]
Benson et al. Position paper update: gastric lavage for gastrointestinal decontamination.
Westergaard et al. Adherence to international recommendations for gastric lavage in medical drug poisonings in Denmark 2007-2010.
[OTHER FUN STUFF]
Yoshino et al. A case of hypoglycemic hemiparesis and literature review.
Ohshito et al. Hypoglycemia with focal neurological signs as stroke mimic: Clinical and neuroradiological characteristics.
Luo et al. A Comparison of Commonly Used QT Correction Formulae: The Effect of Heart Rate on the QTc of Normal ECGs.
Glimåker et al. Early lumbar puncture in adult bacterial meningitis:
rationale for revised guidelines.
Ninio et al. Variations on the Hermann grid: an extinction illusion.
Plum and Posner's Diagnosis of Stupor and Coma, 4th Ed.