Causes and approach to coma authorstream presentation. Impaired functioning of either anatomical system may cause coma. When encountering a comatose patient, the clinician must have an organized approach to detect easily remedial causes, prevent ongoing neurologic injury, and. Approach to coma sc final free download as powerpoint presentation.
Approach to management of the unconscious patient oxford. Patients in a coma are unable to think consciously and lack awareness of their surroundings, but they do retain basic life support functions, such as breathing and. The approach to coma by the emergency physician is described, beginning with a discussion of pathophysiology and cause. The various aspects of history discussed in details. Turn your pdf presentations to editable powerpoint ppt and pptx slideshows. Smith neurocritical care society 2012 abstract coma is an acute failure of neuronal systems governing arousal and awareness and represents a neurological emergency. Unless the cause of coma is immediately obvious and reversible, input from senior physicians and critical care colleagues is. Coma is therefore the most profound degree to which the two components of consciousness, arousal and awareness, can be diminished.
A coma is a deep state of prolonged unconsciousness in which a person cannot be awakened. Contemporary approach to neurologic prognostication of coma. Cont the management of an unconscious patient is never an easy task in clinical practice. Wijdicks, mdb introduction many patients present to the emergency department with an alteration in mental status simply as a complication of many serious illnesses. Coma is defined and the anatomy of consciousness explained. A phased approach is a stepwise strategy that works on the implementation of various interrelated components. In addition to deaths, injury results in about 39 million emergency department visits. Approach to the comatose child background definitions consciousness.
Level of consciousness represents a continuum between being. The various levels of arousal, avpu scale and glasgow coma scale described. Approach to a child with coma prof rashmi kumar department of pediatrics, kg medical university, lucknow coma. The gcs score is helpful in providing a baseline for comparison but is not prognostic in. Approximately 3% of all ed patients arrive in some sort of altered mental state. Glasgow coma scale the glasgow structured approach to.
The management of ntc is discussed, with reference to clinical approach, treatment of seizures, and increased intracranial pressure. Clinical approach and diagnosis moore, wijdicks 111 this document was downloaded for personal use only. A good knowledge of the causes of coma and its management is of vital essence to the medical practitioner. Approach to the comatose patient linkedin slideshare. A free powerpoint ppt presentation displayed as a flash slide show on id. Wakefulness depends on the integrity of both cerebral hemispheres and the ascending reticular activating formation of the brain stem. Note that in infants, consciousness can be defined operationally. This ppt presentation help to evaluate a comatose patient when come to emergency ward. Altered level of consciousness aloc has an extensive differential diagnosis, and mnemonics such as aeioutips and movestupid can assist providers in recalling potential etiologies. Glasgow coma scale glasgow coma scale or gcs is a neurological scale that aims to give a reliable, objective way of recording the conscious state of a person for. Dakurah division of neurosurgery department of surgery u.
Ppt glasgow coma scale powerpoint presentation free to. Clinical examination of the unconscious patient dr. Appropriate clinical circumstances initial examination suggests structural brain damage a scan may identify the cause of the alteration of consciousness and dictate the therapy when the scan does not give the cause, there is no simple solution usually no single laboratory test or screening procedure will shift out the critical initial. The glasgow coma scale is a useful tool for the grading of the degree of altered consciousness and the severity of cns insult. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Airway breathing circulation establishing iv access blood should be withdrawn. Pediatric coma related conditions altered mental status, neurologic depression, stupor, lethargy, drowsiness, obtundation 1. Contemporary approach to neurologic prognostication of. Description of the problem what every clinician needs to know coma in. Monitoring neurological function clinical examination of the unconscious patient.
Second international symposium coma and consciousness 6 the contributions presented at the meeting are likely to help form the scientific foundations for frameworks to systematically organize information and approaches to future clinical assessments of consciousness. Patient in coma is the property of its rightful owner. Primary objective the physician should be able to stabilize, evaluate, and treat the comatose patient in the emergent setting. Coma is a fairly common problem encountered in emergency departments eds across the country. Injury is the number one cause of death for people aged 1 to 44. After the initial abc assessment, the level of consciousness should be formally measured and documented using the glasgow coma scale gcs. Coma in children refers to a child in a state of unconsciousness and unresponsiveness.
A the child is awake, alert, and interactive with parents and care providers v the child responds only if the care provider or parents call the childs name or speak loudly p the child responds only to painful stimuli, such as pinching the nail bed of a toe or finger u the child is unresponsive to all stimuli. Coma can be defined in many ways, but a standard definition is. Approach home our profile approach whether youre running a business, managing your personal finances or building wealth, its important that you have a great team behind you. The physician should understand this involves an organized, sequential, prioritized approach. A subset of these patients will present comatose, a clinical state that is a true medical emergency. Originally developed for victims of traumatic head injury in 1974 and revised in 1976, it consists of three parts.
Ttm and sedatives used to maintain controlled cooling might delay neurologic reflexes and reduce the accuracy of. Approach to the patient with coma vanderbilt university medical. The approach is based on the belief that after a history and a general physical and neurologic examination, the informed physician can, with reasonable confidence, place the patient into one of four major groups of illnesses that cause coma. This chapter has presented a physiologic approach to the differential diagnosis and the emergency management of the stuporous and comatose patient. Approach to acute encephalopathy and coma obgyn key. Ppt patient in coma powerpoint presentation free to. A systematic and logical approach is necessary to make the correct diagnosis, the broad. Background coma is a medical emergency and may constitute a diagnostic and therapeutic challenge for the intensivist. Coma is a state of unresponsiveness in which the patient cannot take in information from the environment and cannot respond to it in a meaningful way.
Abstract coma is an acute failure of neuronal systems governing arousal and awareness and represents a neurological emergency. Glasgow coma scale at 40 the new approach to glasgow coma. Approach to the patient in coma requires a systematic exam that will then direct diagnostic testing. The potential causes are numerous, and the critical window for diagnosis and effective intervention is often short. Evaluation of coma differential diagnosis of symptoms bmj. Approach whether youre running a business, managing your personal finances or building wealth, its important that you have a great team behind you. The approach to clinical evaluation is used to categorise coma into. To propose an evidencebased approach for the clinical management of the comatose patient. Basic approach to comatose patient system to allow accurate assessment of coma and diagnosis of the cause of coma allow appropriately directed further investigation no ct interpretation not about outcome not about management of specific diseases.
The common causes of nontraumatic coma include central nervous system infections, metabolic encephalopathy hepatic, uremic, diabetic ketoacidosis etc. See detailed information below for a list of 57 causes of coma in children, symptom checker, including diseases and drug side effect causes. The state of consciousness can be assessed by glasgow coma scale. Start studying approach to coma and altered consciousness. Coma is very broad in all aspects vague in presentation vague in approach long list of differentials needs very meticulous examination neurological assessment is vital to the diagnosis confusion. This is the most common form of coma and results from anoxicischaemic, metabolic, toxic, and drug induced insults, infections, and post ictal states coma without focal signs with meningism. To understand this involves an organized, sequential, prioritized approach.
Questions regarding the possible seizure can be divided into preictal, ictal, and postictal categories. Coma is a medical emergency and may constitute a diagnostic and therapeutic challenge for the intensivist objective. Coma is an alteration of consciousness in which a person appears to be asleep, cannot be aroused, and shows no awareness of the environment. Process oriented coma work, for an approach to working with residual consciousness in comatose patients. A patient in this state may follow simple commands, make nonreflexive gestures or yesno responses regardless of response accuracy, or exhibit. Sep 10, 2010 coma and other states of impaired consciousness represent a medical emergency. The experience gained since it was first described in 1974 has advanced the assessment of the scale through the development of a modern structured approach with improved accuracy, reliability, and communication in its use. Coma is a medical emergency that can challenge the diagnostic and management skills of any clinician. Appropriate measures to resuscitate, stabilise and support an unconscious patient must be performed rapidly. Coma is an acute failure of neuronal systems governing arousal and awareness and represents a neurological emergency. Of intentional injury deaths, more than 70% were due to selfharm.
Stupor and coma are clinical states in which patients have impaired responsiveness or are unresponsive to external stimulation and are either difficult to arouse or are unarousable. The glasgow coma scale is an integral part of clinical practice and research across the world. A patient in a minimally conscious state has severely altered consciousness but has definite behavioral evidence of self or environmental awareness. In the us, there were 231,991 trauma deaths in 2016, about 70% being accidental. Sep, 2015 this video useful to all postgraduate students and doctors to approach a comatose patient when come to an emergency ward. To propose an evidencebased approach for the clinical. Coma causes and management free download as powerpoint presentation.
Hypoglycemic coma recovery from hypoglycemia may be delayed, because of cerebral edema. Hyponatremia usually presents with seizures and should be corrected slowly, with a goal of correction of 12 to 15 meql 1215 mmoll over a 24hour. When encountering a comatose patient, the clinician must have an organized approach to detect easily remedial causes, prevent ongoing neurologic injury, and determine a hierarchy of diagnostic tests, treatments, and neuromonitoring. This is the most common form of coma and results from anoxicischaemic, metabolic, toxic, and drug induced insults, infections, and post ictal states coma. Ppt patient in coma powerpoint presentation free to view. The glasgow coma scale gcs is the most common of such scales. In this post we dive into the emergency department evaluation of.
Glasgow coma scale at 40 the new approach to glasgow. Second international symposium coma and consciousness. Coma is a medical emergency and may constitute a diagnostic and therapeutic challenge for the intensivist. Second international symposium coma and consciousness 5 welcome address dear colleagues, following the success of the first coma and consciousness symposium held in antwerp in 2004, satellite to the 8th annual meeting of the association for the scientific studies of consciousness assc8, it is a pleasure to welcome you to berlin for the. Full consciousness is an awake state in which one is aware of oneself and the environment, including the ability to perceive and interpret stimuli and to interact and communicate with others in the absence of motor deficits. Nishtha jain senior resident department of neurology gmc, kota.
Introduction coma is among most common and striking problems in medicine accounts for large number of admissions to emergency requires immediate attention and an organised approach. A systematic approach to the unconscious patient ncbi. A 5 year old child was brought with history of fever, progressive lethargy and posturing for 3 days. The differential diagnosis is broad, but initial evaluation should center on treating any reversible causes and attempting to differentiate a structural brain lesion from a more systemic toxicity. Causes of coma and biochemical evaluation dr amit agrawal department of neurosurgery narayana medical college, nellore. A systematic and logical approach is required, with an emphasis on teamwork. Work with the most accurate pdf to powerpoint converter. Scribd is the worlds largest social reading and publishing site. Start with asking the witness to describe the spell from beginning to end. Approach to a child with coma authorstream presentation. Unconsciousness lasting more than 30 30 minutes after plasma glucose is corrected is called posthypoglycemic coma, iv mannitol 40 g as a a 20% % solution over r 20 20 minutes or glucocorticoids e. Google search plum and posners diagnosis of stupor and coma pdf first hit.
Coma after cardiac arrest ca is an important cause of admission to the icu. It can be used to overcome a challenge, implement a project, run a campaign, or to perform a wide range of other activities. Coma can result from injury such as head trauma, or an underlying illness such as an infection or tumor, or toxins that enter the body. Initial diagnosis and management of coma stephen j. Definition of coma coma is a state of complete behavioral unresponsiveness to external stimulation. Pdf a systematic approach to the unconscious patient. Consciousness, ras and approach to coma slideshare. Coma is defined as the total absence of arousal and awareness lasting at least 1 hour associated with injury or functional disruption of the ascending reticular activating system in the brainstem or bilateral cortical structures. Coma coma is a state in which the patient is unresponsive to environmental stimuli, unable to communicate in any manner and from which he or she cannot be aroused. Coma approach powerpoint ppt presentations powershow. Able to stabilize, evaluate, and treat the comatose patient in the emergent setting.
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