Episode 13 Part 1: Killer Coma Cases – The Found Down Patient

Emergency Medicine Cases

Dr. Anton Helman

Science, Courses, Medicine, Health & Fitness, Education

4.7 • 602 Ratings

🗓️ 12 April 2011

⏱️ 77 minutes

🔗️ Recording | iTunes | RSS

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Summary

In Part 1 of Killer Coma Cases - The Found Down Pateint, Dr. Helman presents two challenging cases to Dr. Brian Steinhart and Dr. David Carr, who tell us loads of key clinical pearls in their approaches to the 'found down' patient. They discuss the important components of the neurological exam in the comatose patient, the differential diagnosis of altered mental status and hyperthermia, the controversies around when to get a CT head before performing a lumbar puncture, and much more in this Killer Coma Cases episode. In Part 1 of this episode, we discuss the limitations of plain CT, the interpretation of CSF and the many faces of seizures. Any more information would be giving away the cases.....

Transcript

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0:00.0	Welcome to Emergency Medicine Cases.com. I'm your host, Dr. Anton Hellman, bringing you Canada's
0:08.4	brightest minds in emergency medicine from EMC Studios in Toronto.
0:18.4	On this episode number 13 called Killer Coma Cases, we've got with us Dr. Brian Steinhart and Dr. David Carr.
0:25.6	Dr. Steinhart is an emergency physician at St. Michael's Hospital in Toronto.
0:29.2	He certified an emergency medicine by the Royal College of Physicians and Surgeons of Canada and the American Board of Emergency Medicine.
0:35.3	Dr. Carr is an emergency physician at the University
0:37.5	Health Network in Toronto and an assistant professor in the Department of Family and Community
0:41.0	Medicine, Division of Emergency Medicine at the U of T. He serves as the assistant director of
0:45.6	education at UHN, and in 2009 he was the recipient of both undergraduate and postgraduate
0:50.4	clinical teaching awards. We've all been there.
0:54.7	A patient comes crashing into the resuscitation room with the GCS of six picked up off the street or found down in their apartment, and you got zero history.
1:03.0	All you got is some vitals and a really sick patient.
1:06.4	And so your veterinary medicine skills start to kick in.
1:09.3	You do your usual ABCs, and you've gathered clues,
1:12.5	but nothing seems to fit into a nice, tight package. You're feeling pretty good about stabilizing
1:18.0	the patient, but you're still searching for that data point that'll help you clinch the diagnosis.
1:22.8	You're thinking, what the heck am I missing? You cover the patient for sepsis with some septraaxone,
1:28.7	you order up your confusogram,
1:30.4	and hope that you'll come up with something you can hang your hat on.
1:33.7	Finally, the blood work comes back, and everything is out of whack.
1:37.7	So now you're scratching your head.
1:39.5	You're digging deep into your brain for an answer,
	...

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