Alterations of Consciousness in the Emergency Department
Foreword A l t e r a t i o n s of C o n s c i o u s n e s s in the Emergency Department
Amal Mattu, MD Consulting Editor
Since the time of ancient civilizations, philosophers and scientists have tried to define and understand “consciousness.” A simple internet search using this term reveals more than 47 million sites, many of them various definitions or quotes by philosophers, from Aristotle to Freud, about this term. A consistent description of consciousness that emerged from a cursory review of those sites was the description of consciousness as a sense of one’s own identity. It is therefore arguable that an altered or loss of consciousness represents one of the most heinous medical presentations we encounter in emergency medicineda loss of one’s identity. Not surprisingly, one of the most basic and also most vital components of any medical student or resident curriculum in emergency medicine and one of the critical chapters in every major textbook of emergency medicine address the assessment and management of patients with altered levels of consciousness. This topic may be, in fact, the second thing students and residents in emergency medicine are taught, right after A-B-C. In this issue of Emergency Medicine Clinics of North America, Guest Editor Dr Chad Kessler and an outstanding group of authors have done an excellent job of addressing the various causes and presentations associated with altered states of consciousness. An initial article addresses the mental status examination, after which an article addresses perhaps the most vexing of all emergency department presentationsdthe dizzy patient. Three articles are devoted to syncope in adults and pediatric patients. Other “bread-and-butter” causes of altered consciousness are addressed as well, including trauma, infections, psychiatric causes, metabolic causes, and drug toxicities. An entire article is devoted to the most common toxic cause of altered consciousnessdethanol, and an entire article is devoted to what is perhaps the most commonly overlooked, deadly cause of altered consciousnessddelirium in the elderly patient. This issue of Emergency Medicine Clinics is an invaluable addition to the library of emergency physicians and other health care providers that care for acutely ill patients.
Emerg Med Clin N Am 28 (2010) xiii xiv doi:10.1016/j.emc.2010.06.008 0733 8627/10/$ see front matter Ó 2010 Elsevier Inc. All rights reserved.
emed.theclinics.com
xiv
Foreword
More importantly, this is must-reading for students and residents training in emergency medicine. Dr Kessler and colleagues have provided a comprehensive curriculum addressing the care of patients with altered consciousness. The contributors are to be commended for providing this outstanding resource to us all. Amal Mattu, MD Department of Emergency Medicine University of Maryland School of Medicine 110 S. Paca Street, 6th Floor, Suite 200 Baltimore, MD 21201, USA E-mail address:
[email protected]
Alterations of Consciousness in the Emergency Department
Preface A l t e r a t i o n s of C o n s c i o u s n e s s in the Emergency Department
Chad Kessler, MD Guest Editor
You know that awesome feeling, the one you get when you walk up to the rack (now computer tracking board) to find out who your next patient is? What disease process are you up against next? How can you use your detective skills to solve the next mystery, whether you are Inspector Clouseau or Inspector Gadget? That investigation might be one of the best parts of emergency medicine, unless the patient happens to have altered mental status, perhaps the most dreaded chief complai