By Chad Kessler MD FACEP FAAEM
Visitor editor Chad Kessler has assembled knowledgeable panel of authors related to adjustments of awareness. Articles comprise: The psychological prestige exam in Emergency perform, Dizzy and harassed: A step by step overview of the Clinician’s favourite leader criticism, prognosis and review of Syncope within the Emergency division, The Emergency division method of Syncope: Evidence-based guidance and Prediction principles, Pediatric Syncope: instances from the Emergency division, Seizures as a reason for Altered psychological prestige, relevant apprehensive approach Infections as a explanation for an Altered psychological prestige? what's the Pathogen becoming on your important fearful System?, tense changes in awareness: demanding mind damage, and extra!
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Extra info for Alterations of Consciousness in the Emergency Department, An Issue of Emergency Medicine Clinics (The Clinics: Internal Medicine)
She has been seen by several physicians for complaints ranging from foot drop and dizziness to paresthesias and generalized fatigue. Several laboratory and diagnostic tests have been run and her primary care physician suggested she start treatment for anxiety and stress. On examination, she is noted to have internuclear ophthalmoplegia. 5 Other prominent presenting symptoms are sensory complaints, such as frank numbness, or paresthesias. Sensory symptoms are typically vague and patients will often have a normal sensory examination.
55 Higher levels produce lethargy and coma. 56 Treatment is generally supportive, with focus on fall prevention for milder toxicity, although intubation for airway protection may be required in more severe toxicity. Because phenytoin is mainly protein bound, extra-corporeal methods of elimination are generally not effective. 60 CARBAMAZEPINE Carbamazepine is another widely used antiepileptic medication that can cause altered mental status and dizziness, but has more severe effects in overdose. 62 Many of the toxic effects result from the sodium channel blocking and anticholinergic effects.
The partial pressure of O2 and CO2 will be normal, and metabolic acidosis may be present. Because the oxygen saturation of hemoglobin reported on the blood gas is calculated rather than measured, it will be normal. 52 If co-oximetry is unavailable or will be delayed, a drop of the patients’ blood can be placed on a piece of filter paper next to a drop of normal blood. The normal blood will appear dark red, but brighten with exposure to oxygen. 50 The patient described previously should be treated with high flow oxygen to increase the oxygen-carrying capacity of the blood.