2. What is coma?
A coma ( from the Greek Koma, meaning
deep sleep) is a profound state of
unconsciousness, in which a person is
unresponsive and unarousable.
Reflex movements and posturing maybe
present
3. Biology of consciousness
Two components of conscious behavior
content- the sum of cognitive and affective
function
arousal- appearance of wakefulness
Content depends on arousal but normal
arousal does not guarantee normal content
10. Clues from History
Onset of symptoms
sudden onset
fluctuations
Associated neurologic symptoms
Medications
11. Physical examination
General examination. A thorough general
examination, including vital signs, helps to
establish and rule out potential causes of
coma. Look for evidence of head trauma or
metabolic encephalopathy.
12. Breathing
. Cheyne-Stokes respiration: cerebral
hemispheric or diencephalic injury or an
encephalopathy (hypoxic or metabolic).
Central hyperventilation: brainstem injury.
Ataxic or Biot’s respiration, which can
progress to apnea: injury to the reticular
formation in the medulla and pons.
13. Eye examination
Pupils (size, shape, position, PERLA)
- Unilateral horner syndrome= hypothalamic
lesion
- Ipsilaterl pupil dilation= 3rd nerve palsy due to
uncal herniation
- Smaller than normal but reactive= metabolic
encephalopathy
- Fixed, dilated= overdose of atropine
- Pinpoint, responsive= opiates
22. TREATMENT
Appropriate treatment must be commenced
concomitantly with routine measures
Treat according to the cause
The "Coma Cocktail"
It's a mixture of thiamine 50mg , dextrose 50 %
(25g) , and naloxene 0.4-1.2 mg given
intravenously.
23. Other treatments
Antibiotics
Anticonvulsants
Warm the pt if hypothermic
Correct any electrolyte or metabolic
imbalance
Reduce raised ICP with diuretics or surgery
Ventilation/ cardiovascular support
24. Long term treatment
preventing infections such as pneumonia
maintaining the patient's physical state
(preventing bed sores, for example)
providing adequate nutrition.
25. PROGNOSIS
The prognosis in comatose patients is
typically poor except for those that are drug-
related or result from traumas. In general, the
longer the coma lasts, the poorer the
prognosis. Coma rarely lasts longer than 4
weeks, after which, transition into a
vegetative state or recovery occurs