Neurology
Altered level of consciousness
An altered level of consciousness (ALOC) is a critical presentation in the ICU, requiring urgent evaluation to determine its underlying cause and guide appropriate management. Conditions such as syncope, coma, and metabolic encephalopathy can indicate severe neurological, cardiovascular, or metabolic dysfunction.
This section covers:
- Syncope: Differentiating benign from life-threatening causes and guiding appropriate interventions.
- Coma: A systematic approach to assessing and managing the unconscious patient, including airway, breathing, circulation (ABC) and neurological evaluation.
- Differential diagnosis and monitoring: Using a structured framework to identify causes such as intracranial hemorrhage, ischemic stroke, intoxications, or sepsis.
A timely and systematic approach to ALOC is essential for early diagnosis, optimizing treatment, and improving neurological outcomes in critically ill patients.
Syncope
Syncope
2018 ESC Guidelines for the diagnosis and management of syncope
Michele Brignole et al., European Heart Journal (2018)
What’s inside
This article presents the 2018 ESC guidelines for the diagnosis and management of syncope, providing evidence-based recommendations for evaluating patients with unexplained fainting episodes and guiding appropriate interventions.
Why it’s relevant
Syncope is a common condition encountered in ICU and emergency settings. Proper evaluation and management are crucial to identify underlying causes and prevent recurrence, making these guidelines highly relevant for ICU professionals.
Key focus
- Diagnostic work-up, including clinical history, ECG, and imaging
- Risk stratification and indications for further investigation
- Treatment strategies based on underlying causes (cardiogenic, neurally mediated, etc.)
- Long-term management and prevention of recurrence
Takeaway
The 2018 ESC guidelines offer valuable recommendations for ICU professionals managing patients with syncope, focusing on accurate diagnosis, risk stratification, and effective treatment to improve patient outcomes.
Coma
Unconsciousness
A systematic approach to the unconscious patient
Tim Cooksley et al., Clinical Medicine (2018)
What’s inside
This article provides a systematic approach to the unconscious patient, outlining key steps in assessment and management. It covers clinical evaluation, monitoring, and appropriate interventions to guide ICU professionals in managing patients who are unconscious due to various causes.
Why it’s relevant
Unconscious patients are common in ICU settings, requiring prompt and thorough evaluation to identify the underlying cause and ensure appropriate treatment. This approach helps ICU professionals make informed decisions and improve patient outcomes.
Key focus
- Initial assessment, including airway management, breathing, and circulation (ABC)
- Detailed neurological examination and diagnostic work-up
- Differential diagnosis, including metabolic, cardiovascular, and neurological causes
- Monitoring strategies and when to escalate care
Takeaway
This article offers a systematic framework for ICU professionals to manage unconscious patients effectively, focusing on early assessment, differential diagnosis, and timely intervention to optimize care.