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Altered Level of Consciousness: Evidence-Based Management in the Emergency Department (Pharmacology CME)
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Altered Level of Consciousness: Evidence-Based Management in the Emergency Department (Pharmacology CME) - $49.00

Publication Date: January 2017 (Volume 14, Number 1)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. CME expires 1/1/2020

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 0.5 Pharmacology CME credits, subject to your state and institutional approval.

Authors
 
Joo Lee Song, MD
Fellow, Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Los Angeles, CA
 
Vincent J. Wang, MD, MHA
Professor of Pediatrics, Keck School of Medicine of the University of Southern California; Associate Division Head, Division of Emergency Medicine, Children’s Hospital Los Angeles, Los Angeles, CA
 
Peer Reviewers
 
Richard M. Cantor, MD, FAAP, FACEP
Professor of Emergency Medicine and Pediatrics; Director, Pediatric Emergency Department; Medical Director, Central New York Poison Control Center, Golisano Children’s Hospital, Syracuse, NY
 
Emily Rose, MD, FAAP, FAAEM, FACEP
Assistant Professor of Clinical Emergency Medicine, Keck School of Medicine of the University of Southern California, Los Angeles County + USC Medical Center, Los Angeles, CA
 
Abstract

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.

Excerpt From This Issue

A 7-year-old previously healthy girl presents to the ED with fever, neck pain, and increased sleepiness since the previous day. The patient’s mother reports that she has had a nonproductive cough for the past 2 days, with associated nasal congestion and runny nose. She also notes that the girl has had a decreased appetite since the previous day, a temperature of 38.5ºC, neck pain, and has been lethargic. The patient’s mother does not report a rash, and the remainder of the review of systems is negative. On examination, the patient is found to be sleepy and slowly arousable to commands. The girl's pupils are equal, 4 mm, and react briskly to light. She winces with extension of her knees and has reflex flexion of her hips and knees upon passive neck flexion. As you discuss the likely diagnosis with the girl's mother, you start to think about the management of this patient: What laboratory studies should be sent? Which medications should be administered? Are imaging studies indicated at this time?

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