L11: Coma Flashcards
Consciousness
Wakefulness
arousal, vigilance, alertness
Awareness
self or environment
- No awareness without wakefulness
- Wakefulness can occur without awareness (vegetative state)
….
Def of Coma
Def of Coma
- The Eyes
Closed & do Not open spontaneously or to verbal command (E2).
Def of Coma
- Awareness & Arousal
No
Def of Coma
- Verbal Stimulation
No Response
Def of Coma
- Painful Stimulation
- No response or non-purposeful reflex movements mediated through spinal cord or brainstem pathways.
Def of Coma
- speech
No Spontaneous Speech or Movement
Def of Coma
- Movemenmt
No Purposeful movement of the face or limbs
Def of Coma
- Duration
Lasts > 1h (of syncope and concussion)
Def of Coma
- Noxiuos Stimuli
- Vocalization → limited or Absent (V2)
- Motor activity → Absent/Abnormal/Reflexive (not purposeful or defensive) (M4)
Coma is Characterized by …..
- No sleep wake cycles.
- Transitional.
- Injury or functional disruption of bilateral cortical structures or ARAS.
Causes of Coma
Causes of Coma
- Structural
Causes of Coma
- Metabolic
Generalized Neuronal Dysfunction
Diffrentiating Features of Metabolic Coma
GCS
GCS
- Eye
GCS
- Verbal
GCS
- Mltor
GCS
- Interpretation
Basic Approach to trauma sccording to GCS
Basic Approach to trauma sccording to GCS
- GCS 15
- Age < 65
- No clinical evidence skull
- No retrograde amnesia
- No seizure
- No significant mechanism of injury or serious assault
Basic Approach to trauma sccording to GCS
- Otehrwise
CT
Basic Approach to trauma sccording to GCS
- GCS 13-14
but 15 within 2 hours of injury and above
General Ex of Coma
INVx for Coma
INVx for Coma
- Blood
INVx for Coma
- CT
INVx for Coma
- Lumbar Puncture
INVx for Coma
- Pupillary Respones
INVx for Coma
- EEG
Initaial TTT of Coma
Initaial TTT of Coma
- Airway
Indications of Intubation in Coma
Breathing management in Coma
Circulation Managemnet oin Coma
Disability Management in Coma
