Acute Onset of Impaired Consciousness: Diagnostic Evaluation in the Emergency Department.
Background: Mortality in patients with acute onset of impaired consciousness is high: as many as 10% do not survive. The spectrum of differential diagnoses is wide, and more than one underlying condition is found in one-third of all cases. In this article, we describe a structured approach to patien...
| Publicado en: | Deutsches Ärzteblatt International Vol. 121; no. 15; pp. 508 - 519 |
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| Autores principales: | , , , , |
| Formato: | Journal Article |
| Publicado: |
Deutscher Aerzte-Verlag GmbH
7/26/2024
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=180134107&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 180134107 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 18660452 5F0N jtl: Deutsches Ärzteblatt International issn: 18660452 maglogo: N pubinfo: dt: 7/26/2024 vid: 121 iid: 15 pid: 25312 pub: Deutscher Aerzte-Verlag GmbH artinfo: ui: 180134107 10.3238/arztebl.m2024.0079 180134107 ppf: 508 ppct: 11 formats: fmt: – @attributes: type: T – @attributes: type: C tig: atl: Acute Onset of Impaired Consciousness: Diagnostic Evaluation in the Emergency Department. aug: au: Weiglein, T. Zimmermann, M. Niesen, W. D. Hoffmann, F. Klein, M. affil: Emergency Department, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Munich sug: ab: Background: Mortality in patients with acute onset of impaired consciousness is high: as many as 10% do not survive. The spectrum of differential diagnoses is wide, and more than one underlying condition is found in one-third of all cases. In this article, we describe a structured approach to patients with acute onset of impaired consciousness in the emergency department. Methods: This review is based on pertinent articles retrieved by a selective search of PubMed and on the AWMF guidelines on the most common causes of impairment of consciousness. Results: Impairments of consciousness are classified as quantitative (reduced wakefulness) or qualitative (abnormal content of consciousness). Of all such cases, 45-50% have a primary neurological cause, and approximately 20% are of metabolic or infectious origin. Some cases are due to intoxications, cardiovascular disorders, or psychiatric disorders. Important warning signs ("red flags") in acute onset of impaired consciousness are a hyperacute onset, pupillomotor disturbances, focal neurologic deficits, meningismus, headache, tachycardia and tachypnea (with or without fever), muscle contractions, and skin abnormalities. Patients with severely impaired consciousness should be initially treated in the shock room according to the ABCDE scheme. Conclusion: Acute onset of impaired consciousness is a medical emergency. Red flags must be rapidly recognized and treatment initiated immediately. Patients with severely impaired consciousness of new onset and uncertain cause, status epilepticus, lack of protective reflexes, or a new, acute neurologic deficit should be admitted via the resuscitation room. pubtype: Academic Journal doctype: Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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