1 / 23

Coma

Coma. By Shireen Gupta. Definition. Consciousness State of awareness of self and the environment Coma Sleep-like state of unresponsiveness. No awareness of self or the environment. Alterations in Sensorium (seat of sensation). “Clouding of Consciousness”

cassia
Download Presentation

Coma

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Coma By Shireen Gupta

  2. Definition • Consciousness • State of awareness of self and the environment • Coma • Sleep-like state of unresponsiveness. • No awareness of self or the environment

  3. Alterations in Sensorium(seat of sensation) • “Clouding of Consciousness” • reduced wakefulness alternating with irritability; Defect in attention • Delirium(acute confusional state) • disorientation, fear, irritability • altered perceptions of sensory stimuli • rapid onset • duration 5-7 days

  4. Obtundation(less than full mental capacity) • mild to moderate reduction in alertness • mental blunting • Stupor • asleep or behaviorally unresponsive • Aroused by repeated vigorous stimulation

  5. Comatose state A person in a coma cannot be: • awakened, • fails to respond normally to pain, light or sound • does not have sleep-wake cycles, and • does not take voluntary actions.

  6. Etiology • intoxication • metabolic abnormalities, • Pyschogenic/CNS diseases • Iatrogenic • Structural lesion • Medications

  7. Anatomy of Coma • Ascending Reticular Activating System (ARAS) • Diencephalon • Cerebral Cortex

  8. ARAS Underlying cause: • Damage to the Reticular formation of the hindbrainwhich is important in regulating sleep.

  9. Diencephalon (Thalamus) • Input from the ARAS • Output to the cerebral cortex • Bilateral injury required to produce coma

  10. Cerebral Cortex • Maintains awareness • Bilateral diffuse cortical dysfunction can result in coma • Focal lesion with mass effect • Vegetative state

  11. HISTORY • Allergies • Medications • Past medical history • Last meal • Event Ask GP, family and check medical records for this information

  12. Coma Examination • Examination of the comatose patient is an examination of the brainstem In the initial assessment of coma, it is common to gauge the level of consciousness by response to • vocal stimuli ("Can you hear me?") • painful stimuli; this is known as the AVPU (alert, vocal stimuli, painful stimuli, unconscious) scale. • Glasgow coma scale quantify individual reactions such as eye opening, movement and verbal response on a scale.

  13. The Glasgow coma scale • Neurological scale - a reliable, objective way of recording the conscious state of a person, for initial as well as continuing assessment. • A patient is assessed against the criteria of the scale, and the resulting points give a patient score between 3 (indicating deep unconsciousness) and • Generally, brain injury is classified as: Severe, with GCS ≤ 8 Moderate, GCS 9 - 12 Minor, GCS ≥ 13

  14. Glascow Coma Score • Eye opening • spontaneous 4 • voice 3 • pain 2 • nil 1 • Best verbal • oriented 5 • confused 4 • inappropriate 3 • incomprehens. 2 • nil 1 • Best Motor • obeys 6 • localizes 5 • nl flexion 4 • decorticate 3 • decerebrate 2 • nil 1

  15. FOUR Score4 components • Eye responsesE4 • Motor responsesM4 • Brainstem reflexesB4 • RespirationR4 CP1199945-54

  16. Four ScoreEye Response .

  17. Motor Response

  18. Brainstem Response

  19. Respiration

  20. Laboratory • Electrolytes • Calcium & magnesium • CBC • Toxicology/drug screen

  21. Ancillary Studies • Head imaging • CXR • ECG • EEG

  22. Emergent Therapies • ABC’s • D50 • Narcan • Thiamine • Flumazenil

  23. References • SnellsNeuroanatomy • http://en.wikipedia.org

More Related