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Why is this patient unconscious?

Identifying the cause of coma or impaired consciousness is a common piece of detective work in the emergency department. In this issue Forsberg and colleagues provide some estimates of the likely cause from a cohort of 938 patients with a Glasgow Coma Scale (GCS) score of 10 or below. If you want to guess the cause before even seeing the patient then poisoning is a good bet, accounting for 38% of all cases and 80% of those aged less than 40 years. From the patient’s point of view you might hope that poisoning is the cause. Poisoned patients had a mortality rate of 2.8% with 2% having neurological sequelae at discharge, compared to 39% and 18% respectively in the non-poisoned patients (see page 100).

Prehospital CPAP

The use of continuous positive airway pressure (CPAP) for acute cardiogenic pulmonary oedema (ACPO) seems to be following the same path as thrombolysis for acute myocardial infarction: starting in the coronary care …

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