Evaluation of unconsciousness

Evaluation must be rapid since morbidity is often related to how quickly therapy is begun. Many of the diffuse metabolic or toxic causes of coma resolve without long-term central nervous system damage, whereas acute structural disease may rapidly be fatal, particularly if causing herniation.

A key tenet of the care of the comatose patient is that initial treatment must proceed simultaneously with diagnosis ( Bio£k...§nd BJ.§£k...1.9.9.5.). Acute coma (seconds to minutes) suggests cerebrovascular disease, either hemorrhagic or ischemic, or cardiac arrest. A recent history of head injury may indicate a subdural or epidural hematoma. A subacute course (many minutes to hours) may suggest intoxication or infection, while a more prolonged period of altered mental status might be caused by a central nervous system tumor or a systemic metabolic disturbance. Weakness or falling to one side suggests a focal lesion. A history of epilepsy may point to a postictal state. Witnesses should be carefully questioned about possible toxic ingestion.

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