Today, I reviewed and link to the Internet Book Of Critical Care [TOC] chapter, Approach to Stupor & Coma. June 22, 2022 by Dr. Josh Farkas
All that follows is from the above resource.
Pitfalls
- Trying to guess the diagnosis and failing to perform a complete evaluation (e.g., skipping a full laboratory panel and missing a diagnosis of carbon monoxide intoxication).
- Satisfaction of search: one abnormality is found (e.g., positive ethanol level), causing other abnormalities to be overlooked (e.g., subdural hematoma).
- Failure to perform a complete coma neurological examination. This examination involves only about seven key parts and can be performed in about five minutes. The examination provides critical information regarding which patients should be risk-stratified for emergent or specialized neuroimaging (e.g., STAT CT angiography to evaluate for basilar artery occlusion).
- There are some rare diagnoses which must be diligently screened for (e.g., primary hyperammonemic disorder, carbon monoxide poisoning), even if they don’t seem likely in any particular patient.
Acknowledgement: Thanks to Dr. Casey Albin (@caseyalbin) for thoughtful comments on this chapter.
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