Approach to a patient with generalised tiredness in emergency room.

Added: 2026-05-27

[00:00:06]Welcome to ATSM. Should I start sir?

[00:00:09]>> Yes. Today we are going to uh take a class on approach to generalized dias.

[00:00:14]So the first step is ABCD assessment. uh in A and B we check for hypoxia any respiratory failure is there any severe acidosis is there in the patient >> by taking an >> primary survey >> and >> hypoxia [clears throat] >> hypoxia respiratory failure and severe acidosis >> then in circulation part we check for if the patient is in shock or severe anemia any sepsis is there or any arhythmia is there for the patient then In disability part we check for hypoglycemia, stroke features, CNS infection or toxic or metabolic encphilopathy and in exposure we check for if there is any trauma infection or any electrolyte abnormalities.

[00:01:03]So this is the ABCD approach for generalized tiredness and the bedside tests which we can use is fingerstick glucose test, ECG, pulse oximter, VBG or ABG if sick.

[00:01:16]So when we go to the type of tiredness there are actually two type of tiredness actually true muscle weakness in >> the emergency department what are we basically facing patient coming with generalized tiredness what are we basically worried [clears throat] like because tiredness can be because of several reasons >> ranging from very minimal like uh tribute things like some depression transient depression >> depressive illness or anxiety ity or uh sleep disturbance like patient has not slept either he can come with generalized tiredness or the patient may may have taken some drugs like some anti- steaming drugs a can cause tiredness okay the beta blockers anti-hypertensives can cause tiredness so it can these things we we are not much worried about these things we are basically worried. What are we worried about?

[00:02:17]>> Hypoglycemia if anything is there.

[00:02:19]Stroke and >> hypoglycemia is okay.

[00:02:21]>> Weakness of limbs mean stroke.

[00:02:24]>> Stroke new onset.

[00:02:26]>> Okay. Tiredness. Okay.

[00:02:29]>> Then congestive heart failure.

[00:02:30]>> And some DH can present with generalized tiredness.

[00:02:36]>> Okay.

[00:02:37]visitia, hyponetremia can >> sepsis >> or infection sepsis can generalize diasis or if the BP is low because of some reason cardiogenic shock or septic shock or >> either patient had some hematis or some sort of bleeding or something BP can be low even because of diarrhea can be low patient can present with generalized tiredness.

[00:03:00]uh all these are uh things what what else >> then other than that uh severe anemia also >> severe anemia can cause because of some onology problems >> trauma >> blood loss trauma blood blood loss that can cause lifestyical issues >> yeah alcohol alcohol is being substance abuse >> which patient was given some benefit isopines but that's all I'm things like that some patient on some anti-epileptic drugs can cause [clears throat] >> drug overdose >> drug overdose can cause >> tiredness because the sedative toxidrome >> kind of thing that can cause tiredness so it's a very very >> broad vague and very broad term >> yes >> okay [snorts] >> then the type of tire can be classified >> if you go according to the ABC in the prim Angry if you go according to A what what all things can cause problems in A >> a severe acidosis >> a airway >> airway >> airway means if there is oxygen decrease in oxygen level saturation level because of some heart failure >> or hypoxy hypoxia can cause analyze tiredness >> hypercarbia can cause an tiredness so if you take an ABG so A and B if you take an ABG PCO will be high that can cause enaly tiredness and especially in case of COPD obstructive sleep apnea Yeah. Or or even some some neurological conditions, motor neuron disease, >> things like that to keeps on building up >> then circulation >> okay and so hypoxia, hypercarbia, any problem in P2 or PCO2 because of several reasons can cause generaliz. Then if there is a problem in C, if there is a problem in >> circulation, sharpness, if there is a heart attack or a brad arithmia or hypotension, unstable arithmia, unstable brad ariththmia or if there is severe anemia, >> when you draw blood samples naturally, you check for point of care blood investigations [clears throat] and there is features of infection or the hyponetriia.

[00:05:19]>> Yes.

[00:05:22]uh diab hypoglycemia GCS the GCS drop is there or not whether the hemorrhagic stroke or schemic stroke can cause >> generaliz okay or the postal the patient had already thrown a seizure and patient is in postal state that can also present with generalized >> okay so eas pupil Start ED all these things then >> exposure any trauma hemorrhage >> trauma hemorrhage and all can cause hypotension can cause that there is any rash and all even some features of success that can cause oxy oxymia and all water house all these things can cause tiredness Yes.

[00:06:17]>> Then then hypothermia, hyperothermia, hypothermia.

[00:06:25]This can also cause >> hypothyroidism, mixedma, all endocrine emergencies, [clears throat] even adrenal insufficiency.

[00:06:36]>> Even hypoglycemia, mixedma, [clears throat] coma, then adrenal insufficiency.

[00:06:43]Even hypothyroidism can also cause hypothyroidism causing increased heart rate and finally the heart will be function will be affected and finally that can lead to congestive heart failure and that can post.

[00:06:58]>> So all these things are >> our like our concerns. [clears throat] >> Yes.

[00:07:05]>> Okay. So all these things have to be dealt in the emergency uh department.

[00:07:10]Even severe metabolic acidosis because of several reasons can cause tiredness.

[00:07:18]So then we go to the type of tiredness.

[00:07:23]>> True muscle weakness is there that is main causes of true muscle weakness are neuromuscular disorders or electrolytes or myopathy or neuropathy.

[00:07:33]Whereas fatigue or low energy that means normal strength but exhaustion is there.

[00:07:38]The main cause of that is infection, anemia, endocrine or any chronic diseases.

[00:07:44]Then also sleepiness uh main cause of that is drugs or CNS disease or hypercapneia mainly due to COPD.

[00:07:53]Then we can also classify this generalized tiredness based on the time time period whether it's acute, subaccute or chronic. Acute means within hours to days because due to infection or sepsis, electrolyte abnormalities, stroke, uh acute anemia, drugto toxicity or MI.

[00:08:12]Whereas subacute means days to weeks it takes mostly endocrine, malignancy, chronic infection, depression or medication side effects. All these things are already mentioned and chronic is more than 3 months hypothyroidism, chronic organ failure and [gasps] so the main focus history we have to look for the red flag signs which is fever, weight loss, dysnia, chest pain, neurological deficits or any GI bleed, hemis, melanina all that history we have to look for and also we have to look for medications especially beta blockers, benzoipines, antihistamines, opioids, analesics statins also.

[00:08:54]So uh >> even the routine drug the tramodol which you can cause less tiredness.

[00:09:02]Okay.

[00:09:03]>> Then uh when we go to the physical examination general examination we have to look for par anemia jaundice liver disease cexia malignancy anything. And vital wise if there is a fever we have to suspect for infection. Tachicardia we have to suspect anemia or sepsis.

[00:09:20]Hypertension we have to suspect adrenal crisis or sepsis.

[00:09:27]Neurologically we have to look for if there is any focal deficits look for stroke and if there is ascending weakness we have to always keep GBS in mind. Lenberry syndrome we have to keep in mind. Then uh cardiovascular wise you have to look for any murmurss endocarditis features. Then signs of heart failure if there is any and endocrine wise you have to look for goer or hyperpigmentation if it's there's disease and the DDS are mainly hematological wise anemia leukemia endocrine wise hypothyroidism hypothyroidism adrenal insufficiency diabetes electrolyte wise hyponetriia hypocalemia hypercalcemia also can cause generalized weakness Infection wise calcium can cause infection wise sepsis TB or viral illness. Cardiac wise heart failures uh and myioardial infections. Neurological wise uh myia gravis stroke neuropathy muscle weakness and and uh psychiatric depression anxiety and toxicological wise alcohol seditis and drug overdose.

[00:10:44]So investigations as told before bedside is RBS and ECG lab mainly CBC electrolytes RF LFT TSH VBG and ABG also look for if there is any myioardial infection ECG changes proponin then cortisol level for adance crisis and all then creatinus and blood cultures if infected endocarditis is suspected.

[00:11:10]So main red flag signs are hypotension, severe anemia, hypoglycemia, severe electrolyte disturbances, progressive neurological weakness and sepsis.

[00:11:21]So anything under the sun can cause generalized that's any system can be involved. Yes.

[00:11:32]Okay.