Assessment of Coma; systematic evaluation to determine depth of unconsciousnes, Causes скачать в хорошем качестве

Assessment of Coma; systematic evaluation to determine depth of unconsciousnes, Causes

Assessment of Coma is a systematic process that helps determine the depth of unconsciousness, identify potential causes, and guide urgent management. It combines clinical observation, neurological examination, and diagnostic testing. Here's a structured overview: 🩺 1. Initial Clinical Evaluation Confirm unresponsiveness: No eye opening, verbal response, or purposeful movement to stimuli Vital signs: Assess for hypoxia, hypotension, fever, or bradycardia Airway, Breathing, Circulation (ABCs): Stabilize immediately if compromised Blood glucose check: Rule out hypoglycemia—a reversible cause 🧠 2. Neurological Examination Component What to Assess Level of consciousness Use Glasgow Coma Scale (GCS) or FOUR Score Pupillary response Size, symmetry, and reaction to light—pinpoint (pontine), dilated (midbrain) pupils Eye movements Oculocephalic reflex (“doll’s eyes”), oculovestibular reflex (cold calorics) Motor response Posturing (decorticate vs. decerebrate), tone, reflexes, asymmetry Brainstem reflexes Corneal, gag, cough reflexes Breathing pattern Cheyne-Stokes, Kussmaul, or ataxic breathing may localize lesions 🔬 3. Diagnostic Investigations CT brain (non-contrast): Rule out hemorrhage, mass effect, or trauma MRI brain: For subtle lesions or posterior fossa pathology EEG: Detect non-convulsive seizures or encephalopathy Lumbar puncture: If CNS infection is suspected and no contraindications Blood tests: CBC, electrolytes, renal/liver function, toxicology, endocrine panel Arterial blood gases (ABG): Assess acid-base status and oxygenation 🧾 4. History Gathering From family, paramedics, or witnesses: Onset and progression of symptoms Preceding events (e.g. trauma, seizures, substance use) Medical history (e.g. diabetes, epilepsy, liver/kidney disease) Medications or recent travel 📊 5. Coma Scoring Tools Tool Purpose Glasgow Coma Scale (GCS) Measures eye, verbal, and motor responses (score 3–15) FOUR Score Includes brainstem reflexes and respiratory pattern—useful in intubated patients #Coma