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Transcript
Internal Medicine
•
History of medications: legal or illicit drugs (sedatives, hypnotics, narcotics ) and history
of drug abuse
•
Circumstances and rapidity with which change in mental status developed (sudden
onset indicating vascular causes, gradual onset indicating metabolic and infectious
causes fluctuations suggest subdural hematoma)
•
Recent patient complaints preceding loss of consciousness: medical and neurologic
symptoms (fever suggesting infections, polyuria and polydypsia indicating DKA)
•
Details regarding the site where the patient was found ( e.g. the presence of empty drug
vials or evidence of fall or trauma
Physical examination should be through.
•
Vital signs: Extremes of BP, pulse or temperature and abnormal pattern of breathing.
o
Fever suggests systemic or CNS infections or Neurogenic fever
o
Tachypnea – in pulmonary infections or acidosis
o
Hypertension – hypertensive encephalopathy
•
Head and neck: evidence of trauma and the presence of meningismus
•
Skin: look for signs of trauma or injection.
•
General systemic examination: looking for evidences of systemic illnesses like
cirrhosis, chronic renal, failure, meningococcemia etc.
Neurologic examination: is the cornerstone of assessment of comatose patient. It should be
descriptive and systematic.
1. Level of consciousness: can be assessed semi quantitatively using the Glasgow
coma Scale.
Table VIII-4-1 Glasgow coma Scale:
Eye opening
Score
Spontaneous
4
To verbal stimulus
3
To painful stimulus
2
None
1
Best verbal response
Oriented
5
Confused
4
517