DIAGNOSTIC DILEMMAS IN A PATIENT WITH A CONSCIOUSNESS
Radica Krstić, Biljana Radisavljević, Snežana Mitrović, Tatjana Mićić, Ivana Ilić, Goran Živković
Emergency Medicine Service, Niš, Serbia
INTRODUCTION: Hypoglycemic coma is the most common acute complication of diabetes mellitus, which emergency physicians encounter in the field often. After substitution therapy, there is usually a complete recovery of consciousness.
AIM: By presenting the case, we wanted to point out the importance of a careful approach to a patient who has a disorder of consciousness, hypoglycemia, and when a hypertonic solution with glucose does not lead to complete recovery.
MATERIALS AND METHODS: The protocol of the field intervention, the medical documentation of the Emergency medical service, the discharge document of the Clinic for Neurology of the Clinical Center Nis.
CASE REPORT: The paper presents a sixty-
DISCUSSION: Patients with consciousness disorder rarely, but can still have two different etiopathogenetic factors at the same time as in the case of our patient where the picture of subarachnoid hemorrhage is masked with the clinical picture of hypoglycemic coma. Emergency medicine specialist during the clinical assessment of the patient's condition need to think widely which is different from other specialties that usually consider only conditions in their domain. Assessment and differential diagnosis in admission triage wards and in prehospital conditions is a great challenge and requires great knowledge and experience of every doctor who deals with emergency medicine.
CONCLUSION: Making a working diagnosis in prehospital conditions is based on good anamnestic data and clinical examination with help of limited diagnostic methods. The emergency physician must make multiple work diagnoses and suspect any pathological conditions that may present a similar clinical picture.
Key words: hypoglycemia, coma, subarachnoid hemorrhage, disturbance of consciousness.
Dr Radica KRSTIĆ
Zavod za hitnu medicinsku pomoć
ul. Vojislava Ilića bb
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