Disposition

Patients with readily reversible causes of coma, such as insulin-induced hypoglycemia, may be discharged if home care and follow-up care is adequate and a clear cause for the episode is suspected. For patients with enduring altered consciousness, admission is necessary. Most systems depend on emergency physicians to stabilize the patient and correctly assign a tentative diagnosis so that the patient may be admitted to the proper specialty service. For example, neurosurgery at most institutions will admit patients with isolated cranial trauma or intracranial hemorrhage. Medical intensivists commonly care for patients with toxic or systemic etiologies of coma. Neurologists may admit patients with primary CNS causes of coma. Patterns of admission vary among institutions. If the appropriate intensive care unit is not available, transfer should be considered after stabilization.

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