Coma

Question 1

What does coma mean?

Answer 1

Unconscious sand with no response to external stimuli or inner need

Question 2

Under what GCS is classed as coma?

Answer 2

GCS <8

Question 3

What may happen when a patient is in a coma but doesn’t mean they are responding to external stimuli?

Answer 3

Occasional groans, eye or limb movements

Question 4

Causes:

What vascular or traumatic event may cause it?
What are some inflammatory causes?
What metabolic causes are there?
What toxicities may cause this?]
What neurological event leading to seizures could cause this?

There are numerous causes!!!

Answer 4

Infarct or haemorrhage

Encephalitis
Meningitis

Hyper/hypoglycaemia
Raised or lowered electrolytes

Overdose, especially opioids or benzodiazepines

Epilepsy - post-ictal state

Question 5

IMMEDIATE MANAGEMENT:

ABCDE!

What is given if there is Wernicke’s encephalopathy?

What is given for opiate intoxication?

What is given for benzodiazepines?

Answer 5

IV Thiamine - Pabrinex

IV Naloxone

IV Flumazenil

Question 6

Examination:

DO EXAM TO LOOK FOR CAUSE!

Answer 6

Examination:

DO EXAM TO LOOK FOR CAUSE!

Question 7

Coma-like syndromes:

Persistent vegetative state - What is it?

Locked-in syndrome - What is it? What is a cause for this?

Answer 7

Coma patient progresses to partial arousal but no awareness, with spontaneous respiration and a stable circulation

Conscious but complete muscle paralysis (de-efferented), with the exception of the eye muscles (though these may also be absent in total locked-in syndrome)

Bilateral ventral pontine lesions due to POCS