Author/Editor		Gradišek, Primož; Visočnik, Božidar; Pernat, Andrej
Title		Nezavest - posledica poškodbe glave ali motnje ritma? - Prikaz primera
Translated title		Unconsciousness - caused by head injury or rhythm disturbance? - Case report
Type		članek
Source		In: Bručan A, Gričar M, Vajd R, editors. Urgentna medicina: izbrana poglavja. Zbornik 10. mednarodni simpozij o urgentni medicini; 2003 jun 11-14; Portorož. Ljubljana: Slovensko združenje za urgentno medicino,
Publication year		2003
Volume		str. 215-8
Language		slo
Abstract		We report a case of a patient admitted to the emergency department with a 24 hours old history of head trauma. The data available on the admission and physical examination (fall, unconsciousness with GCS 8, injury of the fronto-temporal region with periorbital haematoma) suggested the head injury. However, the initial diagnosis and applied measures based upon history and physical examination rapidly changed when the patient became hemodynamically unstable. Considering his cardiac rhythm (ventricular pauses >3 seconds and transitional ventricular asystole) we assumed high risk of asystole. After applying the non-invasive transcutaneous electrical pacing, patient's cardiac and respiratory function significantly improved. CT scan of the head revealed no signs of acute traumatic changes. Patient was referred to the centre of intensive internal medicine, where the permanent pacemaker was inserted due to complete AV heart block. On the 8th day he was discharged from hospital without evident clinical signs of neurological impairment. A rapid and effective evaluation of an unconscious patient is critical in the first minutes. The outcome may depend on therapy initiated within minutes of the patient's arrival. The represented case is an example of successful recognition and treatment of the underlying bradycardia which was the cause of impaired consciousness.
Descriptors		INTENSIVE CARE UNITS UNCONSCIOUSNESS HEAD INJURIES HEART ARREST CARDIAC PACING, ARTIFICIAL AGED