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Coma, Emergency Medicine

Reviewed 06/2017
 


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 func...

Diagnosis

Signs and Symptoms

History

Ongoing disturbance of consciousness 

Physical Exam

  • No spontaneous eye opening

  • Lack of response to painful stimuli

  • No motor activity

  • Regular cardiorespiratory function

  • Gla...

Treatment

Pre-Hospital

  • Airway management if loss of airway patency

  • Endotracheal intubation if no response to coma cocktail

  • IV access

  • Dextrose or Dextrostix

  • Narcan

  • Monitor

  • Look for signs of an underlying caus...

Follow-Up

Disposition

Admission Criteria

Patients who do not have a readily identifiable and completely reversible cause of coma should be admitted. 

Discharge Criteria

Comatose patients with correctable ...

Pearls and Pitfalls

  • Rapid medical stabilization

  • Neuroimaging for structural lesions

  • Metabolic and toxicologic assessment

  • Identification of unusual causes of coma

  • Dischargeable patients require period of E...

Additional Reading

Codes

ICD9

780.01 Coma 

ICD10

  • R40.20 Unspecified coma

  • R40.244 Oth coma, w/o Glasgow coma scale score, or w/part score report

  • R40.2110 Coma scale, eyes open, never, unspecified time

  • R40.2120 Coma scale, eyes...

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