Patient won’t wake up

 

Causes:

Narcotic sensitivity

·      Sleep-disordered breathing

·      Neurological disease (e.g. cerebral palsy)

Drugs

·      Hypnotic

·      Opioid

·      Benzo

·      Relaxant

Physiology

·      CO2

·      Acid-base

·      Temperature

·      Glucose

·      Sodium

Pathology

·      Stroke (CT brain)

·      Non-convulsive status epilepticus (EEG)

·      Delirium

·      Toxidrome

·      Parkinson’s – akinetic crisis

 

What to do:

Reversal

·      Hypnotic: BIS and time

·      Opioid: naloxone

·      Benzo: flumazenil

·      Relaxant: ensure TOF ratio ≥ 0.9

Diagnosis

History:

·      Check anaes chart

Examination:

·      GCS

·      Pupils

Investigations:

·      ABG

·      CTB

Disposition

·      Transfer to ICU

·      Refer to neurology

·      Notify home team

·      Notify family