Current clinical approach to patients with disorders of consciousness

Abstract

In clinical practice, hospital admission of patients with altered level of consciousness, sleepy or in a non-responsive state is extremely common. This clinical condition requires an effective investigation and early treatment. Performing a focused and objective evaluation is critical, with quality history taking and physical examination capable to locate the lesion and define conducts. Imaging and laboratory exams have played an increasingly important role in supporting clinical research. In this review, the main types of changes in consciousness are discussed as well as the essential points that should be evaluated in the clinical management of these patients.

Adaptation of Evidence-based Clinical Practice Guidelines for Management of Altered Level of Consciousness in Children: An Emergency Guide

“…Concerning the neuroimaging the adapted guideline recommended to carry out emergency neuroimaging scan when the child is stable if the working diagnosis is unknown or possible intracranial abscess or the cause is unknown. In accordance with our recommendations for best practices, According to Amorim et al (2016) (18) , head tomography is required when there is a suspicion of an intracranial lesion and should be the first image evaluation ordered. Moore et al (19) further stated that MRI is not a standard evaluation performed in the emergency room.…”

Avaliação Do Estado Mental Do Paciente Na Sala De Emergência

“…A escala de coma de Glasgow é uma escala padronizada usada para analisar o nível de consciência projetada para pacientes com lesão traumática, mas também podem ser utilizadas na avaliação de qualquer distúrbio da consciência em fase aguda (AMORIM et al, 2016). A escala mede o grau de consciência em três categorias diferentes de funcionamento neurológico, que são abertura de olhos, resposta verbal e melhor resposta motora.…”

A 25-year-old woman with continues unconsciousness for 12 days; a case report and review of literature

“…The first intervention in patients with GCS< 8 or in unresponsiveness patients to pain is intubation, ventilation and stabilizing breathing to prevent hypoxemia and brain damage. In circulation assessment it is important to check pulses and temperature of extremities to figure out if the patient is in shock (6,13). In disability evaluation natural posture, pupil size and reaction and neck stiffness are important to approximately exclude most of emergency situations such as significant neurological injury, intracranial hemorrhage, and meningitis.…”

“…Helpful laboratory exams include blood test, electrolytes and biochemistry (sodium, calcium, phosphorus, magnesium, chlorine, glucose), renal and hepatic function tests have to be considered to exclude myxedema coma and Addison crisis. Additionally, thyroid test function and plasma level of cortisol should be evaluated (13,15).…”