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This topic is from Rosen and Barkin's 5-Minute Emergency Medicine Consult About our sources

Coma Updated 10/2010

Gregory D. Jay, Linda C. Cowell
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BASICS

  • Description
  • Etiology

DIAGNOSIS

  • Signs and Symptoms
  • Essential Workup
  • Tests
  • Differential Diagnosis

TREATMENT

  • Pre-hospital
  • Initial Stabilization
  • ED Treatment
  • Medication (Drugs)
  • In-patient Considerations

Ongoing Care

  • Follow-Up Recommendations
The following is an excerpt....
BASICS
Description
  • Light coma:
    • Responds to noxious stimuli
  • Deep coma:
    • Does not respond to pain
  • Unresponsiveness:
    • Loss of either arousability or cognition:
      • Loss of arousal
      • Arousal is primarily a brainstem function.
      • Impairment of the reticular activating system
      • Loss of cognition
      • Requires dysfunction of both cerebral hemispheres
    • Stupor:
      • Deep sleep, although not unconsciousness
      • Exhibits little or no spontaneous activity
      • Awaken with stimuli
      • Little motor or verbal activity once aroused
  • Obtundation:
    • Mental blunting with mild or moderate reduction in alertness
    • Delirium:
      • Floridly abnormal mental status
      • Irritability
      • Motor restlessness
      • Transient hallucinations
      • Disorientation
      • Delusions
    • Clouding of consciousness:
      • Disturbance of consciousness
      • Impaired capacity to think clearly or perceive, respond to, and remember current stimuli
Etiology
  • Diffuse brain dysfunction (69%):
    • Lack of nutrients:
      • Hypoglycemia
      • Hypoxia
    • Poisoning ...

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