Critical Care and the Patient Assessment System Part II

This is the second of two articles on the Patient Assessment System (PAS). In the first article, we reviewed the entire PAS, paying particular attention to the areas of the PAS that can indicate an emergent problem requiring immediate care. In this edition of the WMN, we will review the PAS and Critical Care—taking a close look at the patient’s chief complaints which would indicate an underlying potentially life-threatening injury or illness that would necessitate immediate care and attention. In particular, we will review the differential diagnosis and management for changes in level of consciousness, chest pain, shortness of breath, and shock.

May/June 2007    ISSN-1059-6518    Volume 20 Number 3

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The previous edition of the WMN gave a detailed review of neuroanatomy, neurophysiology, brain mapping by neuronal activity, neurologic deficits, and the neurological exam. This edition will explore and review the various etiologies of changes in levels of consciousness (LOC), their recognition, emergent treatment, and management in the extended care environment.

May/June 2004   ISSN-1059-6518   Volume 17, Number 3

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Change in Level of Consciousness

When an individual presents with a changing or deteriorating level of consciousness, it can be one of the most disconcerting and challenging aspects of providing emergency care.

In urban emergency care, the standard is to maintain the airway, place the patient in a safe position, give oxygen, transport immediately, and do your best to try to find out why they have a deteriorating level of consciousness. Most likely the patient will not deteriorate much more in the intervening minutes until arrival at the emergency department. This is one of the few areas where there may not be a lot that can be done in the prehospital setting, but early recognition and rapid transport can and will save brain cells.


March/April 2004   ISSN-1059-6518   Volume 17, Number 2

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