The Clinical Problem Solvers Episode 374 – Rafael Medina Subspecialty Episode – Acute encephalopathy and unresponsiveness
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Jan 17, 2025 Dr. Paul A. Bergl, an intensivist passionate about diagnostic reasoning, joins Dr. Meghan Nothem, a Pulmonary & Critical Care Medicine fellow. They analyze a perplexing case of a 50-year-old man found unresponsive. Topics include the nuances of diagnosing acute encephalopathy, with emphasis on patient history and systemic causes. They explore lab and imaging findings, the implications of metabolic disorders, and the challenges of toxic alcohol intoxication. Their discussion highlights the importance of critical thinking and collaboration in complex medical scenarios.
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Initial Assessment of Unresponsiveness
- Consider if the primary issue is neurological, circulatory, or metabolic.
- Gather information like vital signs, patient history, and medications.
Toilet Syncope and SpO2
- Many serious events occur while using the toilet, often involving parasympathetic tone.
- Low SpO2 is a non-specific finding and can indicate various underlying issues, not just respiratory problems.
Dialysis Patients and Coughing Fits
- Always suspect atypical infectious syndromes in dialysis patients.
- Consider the impact of coughing fits on intrathoracic pressure and potential syncope.
