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HANNA
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Immediate investigations of the unconscious patient
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06.16.04 (4 years ago)
#1
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Theme: Immediate investigations of the unconscious patient
Options
A ABGs
B Blood carbon monoxide levels
C Blood culture
D Blood glucose
E Blood Paracetamol level
F Blood salicyclate
G Chest x-ray
H CT brain scan
I ECG
J Lumbar puncture
K Serum osmolality
L Skull x-ray
M Temperature
Instructions
For each patient described below, choose the single most useful discriminating investigation from the above list of Options. Each option may be used once, more than once, or not at all.
243 A 43-year-old man is brought to the A&E unconscious (GCS-7). On initial exam his HR is 80-beats/min, he is sweating & has a SaO2 of [snip]% on air.
244 A 45-year-old woman is brought to the A&E unconscious (GCS-7). O/E her pulse rate is 110-beats/min, temperature normal, BM (glucose) 4.6 .She was found with an empty bottle of antidepressant Dothiepin (prothiaden).
245 A 43-year-old man is brought to the A&E unconscious (GCS-7). On initial examination his pulse rate is 90-beats/min, BM (glucose) 5.3, SaO2 97% on air. He smells of alcohol. There are no external signs of injury.
246 A 44-year-old man is brought to the A&E unconscious (GCS-7). On initial examination, his pulse rate is 100-beats/min, SaO2-100% on air, BM (glucose) 4.3. He is accompanied by other members of his family who also report feeling unwell.
247 A 41-year-old woman is brought to the A&E unconscious (GCS-7). On initial examination her pulse rate is 110-beats/min, SaO2 95% on air, BM (glucose) 4.5. A purpuric rash is noted on both her arms.
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sajida
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06.16.04 (4 years ago)
#2
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1--d
2--i
3--h
4--b
5--c
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HANNA
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06.16.04 (4 years ago)
#3
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ans given for 246 is also C
why not 247....................J (is it because the pt is unconscious...........but obviously he is having meningitis..............so?)
what is the relevance of going for blood culture for 246...........? if we agree of course (co posoning will have some typical h/o I believe)
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Bebo2006
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04.17.06 (2 years ago)
#4
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1- Hypoglycemia----- RBS
2-TCAs Toxicity. ECG monitoring is the best followed by ABGs
3-?? Subdural Hage. CT brain is best.
4- ?? CO poisoning i dont think that blood coulture would b of any benifit
5- Bacterial Toxiemia, Blood culture is the best.
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ripa
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03.15.07 (1 year ago)
#5
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in an alcoholic patient too the cause of unconsciousness could be hypoglycemia ... in the 4th question relevant history of carbon monoxide exposure will be present mostly and in this case sao2 is 100 % ..whats the correct match list?
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githika
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03.20.07 (1 year ago)
#6
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Hi Ripa, Hypoglycemia is one of the reasons which causes unconciousness in alcoholic patients,but in quetion 245 BM(glucose) is 5.3.NORMAL FASTING GLUCOSE RANGE IS 3.5-5.5mmol/L, so it is with in normal range.If plasma glucose is<2.5mmol/L, then we can think of hypoglycemia.NOW WE HAVE TO THINK THE OTHER COMMON CAUSE WHICH IS SUBDURAL HAEMATOMA.
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githika
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03.20.07 (1 year ago)
#7
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| githika wrote: |
| Hi Ripa, Hypoglycemia is one of the reasons which causes unconciousness in alcoholic patients,but in quetion 245 BM(glucose) is 5.3.NORMAL FASTING GLUCOSE RANGE IS 3.5-5.5mmol/L, so it is with in normal range.If plasma glucose is<2.5mmol/L, then we can think of hypoglycemia.NOW WE HAVE TO THINK THE OTHER COMMON CAUSE WHICH IS SUBDURAL HAEMATOMA. |
247. MININGOCOCCAL MENINGITIS TYPICALLY OCCURS IN CHILDHOOD OR ADOLESCENCE, BUT CAN AFFECT ANY AGE GROUP.
A PRESUMPTIVE DIAGNOSIS OF PYOGENIC MENINGITIS IS MADE, NOW THE QUESTION IS WHAT INV WE SHOULD CHOOSE?
Pt should undergo ct scanning before lumbar puncture, in view of the altered level of conciousness.
Arranging for ct will take some time as it is a sophisticated investigation, but the potential delay in giving treatment increases morbidity and mortality in pyogenic meningitis.
Pt should be given high -dose intravenous antibiotics(Benzyl pencilline and cefotaxime) immediately, before doing ct, ONCE BLOOD HAD TAKEN FOR CULTURE.
THE REASON FOR DOING BLOOD CULTURE IN THIS PT IS no organisms are seen on gram stain and no bacteria are cultured from the csf after giving high dose antibiotic, it is very difficult to predict which type of bacteria is causing meningitis, and we can not give appripriate antibiotic to the pt which should be given atleast 7-14 days after the pt HAS BECOME AFEBRILE.
BACTERIA CAN GROWN FROM THE BLOOD CULTURE AS BLOOD IS TAKEN BEFORE GIVING ANTIBIOTIC
ANSWER TO 247 IS C as lp can not be done in an unconcious pt with out doing ct.CT IS ADVISED TO RULE OUT ANY SPACE OCCUPYIG LESIONS OR CEREBRAL OEDEMA WHICH ARE CONTRAINDICATIONS FOR LP.
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githika
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03.20.07 (1 year ago)
#8
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243.D, blood glucose
244.I, ECG
245.H, CT brain
246.B, Blood carbon monoxide levels
247.C, Blood culture
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cerasella
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05.08.07 (1 year ago)
#9
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why not lumbar punction for 247
Is meningococcus meningitis
Spinal fluid for culture maybe
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githika
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05.14.07 (1 year ago)
#10
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247. PLZ read the question carefully, pt is unconcious so We can can not go for LP with out doing CT scan, and they are asking for immediate investigation.
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