Cite this post as:
Scott Weingart, MD FCCM. Podcast 186 – Coma with Eelco Wijdicks. EMCrit Blog. Published on November 13, 2016. Accessed on July 4th 2022. Available at [https://emcrit.org/emcrit/coma/ ].
Financial Disclosures:
Dr. Scott Weingart, Course Director, reports no relevant financial relationships with ineligible companies.
This episode’s speaker(s), (listed above), report no relevant financial relationships with ineligible companies.
CME Review
Original Release: November 13, 2016
Date of Most Recent Review: Jan 1, 2022
Termination Date: Jan 1, 2025
You finished the 'cast,
Now Join EMCrit!
As a member, you can...
- Get CME hours
- Get the On Deeper Reflection Podcast
- Support the show
- Write it off on your taxes or get reimbursed by your department
.
Get the EMCrit Newsletter
If you enjoyed this post, you will almost certainly enjoy our others. Subscribe to our email list to keep informed on all of the Resuscitation and Critical Care goodness.
This Post was by the EMCrit Crew, published 6 years ago. We never spam; we hate spammers! Spammers probably work for the Joint Commission.
Also worth consideration in the (not uncommon) scenario of the ICU patient, who perhaps presented for some presumably-identified problem (e.g. sepsis, DKA), but who remains persistently unresponsive or altered despite apparent correction of their underlying diagnosis: cefepime encephalopathy. In some datasets this is a surprisingly common phenomenon and can cause a spectrum of altered mental status including obtundation, delirium, abnormal movements (myoclonus), and non-convulsive status. Given the frequency of cefepime use in some centers this is definitely not a theoretical possibility, or even an uncommon one.
This comment stream got deleted during site restore: jneuro says November 17, 2016 at 01:45 I also think that the two settings (ER – coma of unknown origin vs. ICU – won’t wake up syndrome) are to be managed quite differently. The former (CUO-ER) deserves an algorithm just like trauma to free the mind and allow you to think about causes. The algorithm should mirror the prevalence of the various causes in your own ER, so that if you’re flooded with postictal comatose patients you might think about restricting CTAs to pts with focal findings, while other places might keep… Read more »
Regarding the possibility of meningitis – what would be your approach to LP in a patient who’s on a not-easily-reversed antithrombotic agent? E.g. thienopyridines, Xa inhibitors. Standard teaching here is to never do an LP until the effect of these medications wears off, but a diagnostic delay of a week might not be practical in the case of thienopyridines – and depending on the indication, stopping that long might bring its own dangers.
Regards,
Maarten Van Hemelen
I.M. Resident
Belgium