>
> she had hit her head on a wall. She was knocked out for a few
> seconds, and he called an ambulance
> and the Police. She recovered by the time they arrived, and
> sent them away.
Confirms the need for a CT scan asap.
> Although the skin was warm and dry, her temperature (done by
> me) was normal at 36.9.
>
> noise of her getting out of bed to clean
> herself up at 5:30 as she has been doubly incontinent.
Another pointer to anticholinergic effects (or combined dietary and alcohol
indiscretion; but still wouldn't alter my management. Absence of pyrexia
does not exclude anticholinergic or sympathomimetic poisoning (or indeed CNS
infection of any type); but I still wouldn't treat specifically as long as
haemodynamically OK.
> She has a pulse around 90 and a blood pressure
> of 117/60. This all seems to point away
> from intracranial mischief, and there is a degree of
> difficulty in my mind pinning all this down. Blood
> tests, including glucose, are unhelpful.
>
> Is there anything significant now?
As before. Treat anything anatomical. If nothing shows up on CT, then I'd
still think of anticholinergic poisoning or acute hepatic encephalopathy. As
long as QT and QRS normal on ECG and haemodynamically OK, treatment
supportive at this stage. Not sure about blood tests being unhelpful: H+,
CO2, WBC, Na, PT, Ca etc would be useful even if normal.
Matt Dunn
Warwick
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