Altered Level Of Consciousness: Evidence-Based Management In The Emergency Department
A child who presents to the emergency department with an altered level of consciousness can be clinically unstable and can pose a great diagnostic challenge. The emergency clinician must quickly develop a wide differential of possible etiologies in order to administer potentially life-saving medications or interventions. The history, physical examination, and appropriate diagnostic tests can aid greatly in rapidly narrowing the differential diagnosis. Once initial stabilization, workup, and first-line interventions are completed, most patients who present with unresolved or unidentified altered level of consciousness should be admitted for further evaluation and close monitoring. This issue provides a review of the etiologies of altered level of consciousness as well as guidance for the management and disposition of patients with this condition.
Key words: altered level of consciousness, ALOC, altered mental status, clouding of consciousness, confusion, lethargy, obtundation, stupor, coma, Glasgow Coma Scale, GCS, pediatric, children
- Altered level of consciousness (ALOC) has an extensive differential diagnosis, and mnemonics such as “AEIOUTIPS” and “MOVESTUPID” can assist providers in recalling potential etiologies.
- Hyponatremia usually presents with seizures and should be corrected slowly, with a goal of correction of 12 to 15 mEq/L (12-15 mmol/L) over a 24-hour period.
- Bedside tests (eg, point-of-care glucose and venous blood gas with electrolytes) may quickly reveal easily reversible causes of ALOC.
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- » Authors And Peer Reviewers
- » Case Presentations & Case Conclusions
- » Introduction
- » Critical Appraisal Of The Literature
- » Etiology And Pathophysiology
- » Differential Diagnosis
- » Prehospital Care
- » Emergency Department Evaluation
- » Diagnostic Studies
- » Treatment
- » Special Populations
- » Disposition
- » Summary
- » Risk Management Pitfalls In Patients With Altered Level Of Consciousness
- » Time- And Cost-Effective Strategies
- » Clinical Pathway For Managing The Patient With Altered Level Of Consciousness In The Emergency Department
- » Tables
- » References
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- » Evidence-Based Management Of Metabolic Emergencies In The Pediatric Emergency Department (FREE) - Emergency Medicine Practice - Oct 2009
- » Emergency Department Management Of Seizures In Pediatric Patients - Pediatric Emergency Medicine Practice - Mar 2015