Disorders of Consciousness: Practical Management in an Emergency Room

Abstract

Lowering of the level of consciousness is a very common presentation at the emergency room, often without any history that helps finding an etiology. This emergency requires quick empirical measures to reduce neuronal mortality, with additional protection against sequelae. According to the Advanced Cardiac Life Support (ACLS) guidelines, there are current emergency neurological support protocols, such as the Emergency Neurological Life Support (ENLS) created by the Neurocritical Care Society. The present paper shows how to approach unconscious patients, highlighting possible etiologies and proposed treatments.

Resumo

O rebaixamento do nível de consciência é uma situação frequente na sala de emergência, muitas vezes sem qualquer história prévia que auxilie no esclarecimento etiológico. Trata-se de uma situação de emergência que exige medidas empíricas imediatas no intuito de reduzir a mortalidade neuronal com proteção adicional à zona de penumbra. A exemplo do preconizado pelo Suporte Avançado da Vida Cardiovascular (SAVC), atualmente estão disponíveis os protocolos de suporte neurológico de emergência (ENLS, na sigla em inglês) preconizados pela Neurocritical Care Society. O presente artigo apresenta os princípios gerais no manejo inicial do paciente com rebaixamento do nível de consciência, destacando as suas possíveis etiologias e seus tratamentos propostos.

Keywords

coma - coma in emergency room - reversible causes of coma - ascending reticular activating system - consciousness and coma - brainstem

Palavras-chave

coma - coma na sala de emergência - causas reversíveis de coma - sistema reticular ativador ascendente - consciência e coma - tronco encefálico

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