Critical Matters Acute Disorders of Consciousness
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Jul 13, 2023 Dr. Cherylee Chang, a neurointensivist and Professor of Neurology at Duke University, dives into the complexities of acute disorders of consciousness. She highlights the significance of a systematic approach to diagnosis and the importance of objective scoring systems like GCS and NIHSS. Dr. Chang discusses the nuances of neurological examinations and shares insights on imaging strategies, including the use of EEG in critical cases. Her advice on challenging traditional practices reinforces a commitment to evidence-based medicine and improving patient care.
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Use A Systematic Bedside Framework
- Use a structured bedside approach: history, focused neurologic exam, then targeted imaging and labs.
- Let focal findings guide imaging and lab choices instead of shotgun testing.
Do A Precise Neurologic Exam
- Perform a rapid but complete neurologic exam including cranial nerves and pupils; document specifics rather than "non-focal."
- A concise exam often takes only one to two minutes but crucially guides the workup.
Report Objective Neurologic Scores
- Use objective scales (NIHSS, GCS) to track and communicate changes in neurologic status.
- Report numeric changes to prompt rapid reassessment and avoid vague handoffs.
