2011年3月30日 星期三

意識不清與昏迷


意識不清與昏迷
Altered Mental Status (AMS) and Coma

Mnemonic for Treatable Causes of AMS (AEIOU-TIPS)
  • A Alcohol
  • E Endocrine, Electrolytes, Encephalopathy
  • I  Insulin
  • O O2, Opiates
  • U Uremia
  • T Trauma
  • Infection, Intra-cranial
  • P Poisoning
  • S Seizure, Stroke, Sepsis, Shock

Reversible cause of AMS
  • Hypoglycemia, narcotic overdose, hypoxia, hypercarbia should be quickly investigation and treatment
  • If structural lesion etiology is indicated → non-contrast head CT
Delirium
Diffuse metabolic and multifocal cerebral lesion, generalized impairment of brain functions or at least a bilateral involvement limbic structure
Major brainstem reflexes used in coma examination
  • oculocephalic reflex
  • pupillary light reflex
  • corneal reflex
  • oculovestiblar reflex
  • gag reflex
  • apnea test
Adapted from Rosen's Emergency Medicine, 7E
Chapter 14 Depressed Consciousness and Coma
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