Acute Disorders of Consciousness

In this episode of Critical Matters, Dr. Sergio Zanotti interviews Dr. Cherylee Chang about the evaluation and management of acute disorders of consciousness in ICU patients. Dr. Chang provides a framework for understanding the different etiologies—structural, functional, infectious, inflammatory, and pharmacological—and emphasizes the importance of a thorough neurological exam, objective scoring, and considering conditions like cerebral vein thrombosis, PRES syndrome, and non-convulsive status epilepticus. They discuss the use of EEGs, lumbar punctures, and pupillometers, as well as the ABCs of initial management, including airway management, hemodynamic management, and ICP control. The conversation also covers when to involve neurocritical care specialists and transfer patients, highlighting the role of telemedicine. Finally, they touch on the importance of empathy and continuous learning in intensive care medicine, recommending relevant books and discussing the need to question established practices.