Question: What important historical facts should be obtained from the patient with altered mental status or coma?
This seems like a stupid question because the patient with altered consciousness cannot give you a reliable history, and the comatose patient cannot give any history at all! You should question carefully prehospital personnel and attempt to contact the patient’s friends or family. Ask about the onset of symptoms (acute or/gradual), recent neurologic symptoms (headache, seizure, or focal neurologic abnormalities), drug or alcohol abuse, recent trauma, prior psychiatric problems, and past medical history (neurologic disorders, diabetes, renal failure, liver failure, or cardiac disease). If you are having trouble getting historical information, search the patient’s belongings for pill bottles, check the patient’s wallet for telephone numbers or names of friends, and review previous medical records.