The Unconcious Patient

Answer 1

The Unconscious Patient
Unconsciousness is a common clinical problem and may be associated with diseases of several organs in the body. The cause of unconsciousness is often not immediately evident, and a systematic approach to its diagnosis and management is therefore important. Obtaining a thorough history from accompanying relatives, friends and the police is essential.

Question 2

Causes

Answer 2

Causes
y Infections e.g. meningitis, cerebral malaria
y Hypoglycaemia (diabetes-related or alcohol induced)
y Diabetic ketoacidosis
y Severe hypertension with encephalopathy
y Cerebrovascular Accident (CVA) or stroke
y Drug ingestion or overdose e.g. alcohol, salicylates, barbiturates,
cocaine
y Electrolyte imbalance
y Epilepsy - status epilepticus
y Head injury
y Major organ failure e.g. hepatic failure, renal failure and myocardial
infarction
y Hypoxia from severe anaemia
y Poisoning e.g. kerosene, pesticides, herbicides

Question 3

Signs and Symptoms

Answer 3

Symptoms
y Depends on the underlying cause (See appropriate sections)

Signs
y Depends on the underlying cause (See appropriate sections)

Question 4

Investigations

Answer 4

Investigations
Tests depend on suspected cause
y FBC
y BF for MPs
y Blood glucose
y Urea and electrolytes

y Liver function tests
y Blood culture and sensitivity
y Urine culture and sensitivity
y ECG
y Toxicology: drug screen, alcohol levels y Lumbar puncture
y Head CT scan

Question 5

Treatment

Answer 5

STG page 204

Answer 6

Referral Criteria
Refer to a specialist for further definitive management if not responding to standard measures of resuscitation.