[Apologies to anyone offended by the title, my tongue is firmly in cheek if that helps…]
The hospital I currently work in is in one of the poorer areas of Dublin. There are a few hospitals with populations like ours but not many. It makes for an interesting working environment. As a result you become an expert in inner city emergency medicine which has its own specific problems. Here’s a list of differentials for the unconscious patient in my current context. Feel free to suggest any other important ones that i’ve left out
Common:
- alcohol
- heroin
- alcohol and heroin
- alcohol and heroin and benzos
- more alcohol
- benzos
- ICH/stroke
- hyponatremia
- hypercarbia
The ones I probably miss because I assume everything is in the first category:
- serotonin syndrome
- the chronic sub dural
- carbon monoxide
- myxodema coma
- liver failure
- toxic alcohols
- NMS
[Image via wikimedia commons]
DKA/hypoglycemia with alcohol and benzo’s
Haha great post… I’m studying for my emergency medicine OSCE at QUB- plan to repeat this verbatim!
maybe no so much verbatim. Not that much heroin in belfast
So young male presents like this to your ED. You are assuming its one of the top differentials, and indeed they smell of booze. But what baseline invxs would u ALWAYS do?
I’m assuming glucose obviously, and “routine” bloods (FBC, UE, CRP?).
Do they all get a carboxyHB?
JC
I don’t think I do anything beyond the glucose routinely. I don’t do the routine bloods. The rest is just good old fashioned, unquantifiable clinical judgement. If you’re unconscious from COHb then you’re gonna look sick (again, another unquantifiable clinical judgement thing)