Altered/Found Down & Don’t Know Why
Steps to consider for the completely undifferentiated, altered patient.
[ ] ABCDE VS monitor IV access early NRM if plan to intubate
[ ] FS +/- D50
[ ] Thiamine
[ ] Narcan
[ ] EKG
- are they down after an MI?
[ ] CXR
- did they dissect or have a trauma?
[ ] Head CT
[ ] CBC CMP Troponin ABG
[ ] Shot-gun labs for A TOTAL PEACE of mind:
Tylenol, Osms, TSH, ASA, Lactate
Prolactin (seizure?), Electrolytes (Ca Mag Phos), Carboxy-Hgb, EtOH
[ ] Smear for schistocytes (do they have TTP, or babesiosis or malaria?)
[ ] LP
[ ] Empiric Ceftriaxone
[ ] Bedside EEG
- Non-convulsive or subtle szs: Eye deviations?
[ ] Other considerations:
- Myxedema Coma: thyroid scar? TSH?
- Evenomations? Black widow spider, rattle snake, botulism …
- Metabolic comas (uremic, hepatic, CO2 narcosis): asterixis? Ammonia level?
- Toxidromes: Clonus? Hyperthermia? Consider Cypropetadine, Bromocriptine, Dantrolene, Physostigmine