An approach to stuporous patient**
When patients came in to the ED in the state of near-unconsciousness or what we called as stupor, we shall first think of the possible causes.
1.Hypoglycemia
Never miss this cause especially when the patient is diabetic. The most common drugs of causing hypoglycemia are insulin and sulfonylurea.
This is something that you can correct it rapidly!
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Opioid overdose
This is less common now as compared to the other illicit drug use
Rx : Naloxone injection -
Benzodiazepine overdose
It’s well known for its sedating effect so those who are suffering from insomnia may end up taking a lot of doses without even realising it
Rx : Flumazenil (Anexate) -
Alcohol overdose
Rx : Thiamine -
Electrolyte abnormality
The most common one is hyponatremia. So, what will be the most common cause of hyponatremia in the hospital that you can think of? Don’t forget thiazide diuretics as it is one of the most common antihypertensive drugs.
So how are you going to treat the patient when he/she has hyponatremia? Remember, never give hypertonic normal saline as correcting hyponatremia too fast can cause cerebral oedema due to central pontine myelinolysis -
Malathion poisoning
Remember this in your mind especially when the patients are working at the plantation.
Malathion is an anticholinesterase drug, so it increases the parasympathetic effects, which the patient can present with sweating, pinpoint pupils, bronchospasm, increase in body secretion, including lacrimation, salivation and urination - SO TOUCH YOUR PATIENTS’ HANDS TO FEEL WHETHER THEY’RE WET OR DRY
Rx : Atropine to correct it
Dr Wong: “What if you’re now in the jungle without any atropine and your partner is having malathion poisoning?” Answer is give him/her caffeinated products such as tea and drink as it can cause palpitations / increase sympathetic effects
CCTVRU are for shock approach
So how are you going to examine a stuporous patient when they cannot respond to you by doing what we usually ask them to do e.g. “Resist my force!”
First, you can check for their ABCD GCS. You can elicit pain to see whether they will respond to withdraw the pain. For example, you can press on their nail beds and also supraorbital ridge.
Don’t forget to check for their pupils too. Pinpoint pupils can either mean pontine damage, cholinergic crisis or opioid overdose.
Check the patients’ muscle tone. Lift up their upper limbs or lower limbs and then let go to see the way they are falling down. If the patients are not in a stupor phase, when you lift up their hands above their heads and let them fall,their hands will not be falling onto their faces.
Check the patients’ reflexes. Upper limb and lower limb reflex. If there are totally no reflex, check for 5 SIGNS - Babinski, Gordon, Oppenheim, Schaffer, Chaddock sign.