I can see how you might decide to "wait and see" whilst knowing the exam
answer. I can think of situations where, for a short time, I have done this
in order not to loose "clinical contact" with the patient.
The possibility of vomiting / aspiration and the attendant complications are
obviously the main immediate risk of this approach.
The bruising needs explaining and in my view keeps trauma in there in which
case the wait and see policy becomes harder to defend. Perhaps if you had
grounds to think this was some sort of post-ictal presentation in which you
expected rapid improvement, the risk might be justified but the presentation
does not give a clear indication that this is likely. The long period of
possible unconsciousness is a concern tilting the argument towards early
intervention.
Charlie Fee
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]]On Behalf Of Andy Webster
Sent: 02 March 2004 11:53
To: [log in to unmask]
Subject: Re: Case presentation - acute confusion
I agree with the others, RSI, intubate and ventilate. CT scan, check
electrolytes. Consider acyclovir for herpes infection.
Andy Webster
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Scott, Charles
Sent: 02 March 2004 10:59
To: [log in to unmask]
Subject: Case presentation - acute confusion
24 year old local woman brought to Emergency Unit by husband who had come
home from work in the afternoon to find her lying on the floor confused and
very restless. Been doubly incontinent . Last seen by husband that
morning as she left the house to take children to school. Has 5 week old
baby, normal delivery.
No known other medical Hx, no known drug or alcohol abuse.
O/E
Restless++
Not talking, moaning. Fights off any touch. Bruises (?24+ hrs old) on
both upper arms and sides of head and ear lobes. Not petechial. No neck
stiffness.
Pulse 125, BP 119/70, resps 24, Temp 37.0; Cap refill <2 secs. BM 6.4
Pupils 5mm react to light equally.
Bloods, ECG, Xray or CT scan unobtainable without violent struggle/sedation
so decide to wait and see.
What should I have done?
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