management of coma patient

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December 8, 2020

An alert patient has a normal state of arousal. Initial management of the comatose patient involves the same steps needed to manage any critically ill patient … Matthes G, Bernhard M, Kanz KG, et al. This may include early neurosurgical intervention, efforts to reduce brain tissue shift and raised intracranial pres … Assessment of coma Management of coma is a time-sensitive process. Initial management steps include airway, breathing, and circulatory (ABC) support. Prevention and management. The aim of immediate management is to minimise any ongoing neurological damage whilst making a definitive diagnosis. The assessment of patients in coma is a medical emergency. The cause should be identified and, where possible, corrected and the brain provided with appropriate protection to reduce further damage. The clinical approach to an unconscious patient should be structured. Elements of the history, examination, investigation and treatment will therefore occur simultaneously. It can happen as a result of a traumatic accident, such as a blow to the head, or a medical condition, for example, some types of infection. This chapter provides a general approach to the emergency care of comatose patients. Attend to airway, breathing and … By necessity, it re-quires the clinician to deviate from the traditional sequential approach of history, examination, investigation and manage- Patients in the deepest level of coma: do not respond with any body movement to pain, do not have any speech, and; do not … A coma is a deep state of unconsciousness. 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. In patients brought to the emergency department, coma can be due to traumatic brain injury, cerebral or cerebellar hemorrhage, acute basilar artery embolus, anoxic-ischemic brain injury after cardiopulmonary resuscitation, and drug overdose. All patients with hypotension or oliguria refractory to initial rehydration and those patients with mental obtundation or coma with hyperosmolarity (effective osmolality >320 mOsm/kg H 2 O) should be considered for admission to stepdown or intensive care units in order to receive continuous intravenous insulin therapy. It then becomes important to identify those patients for whom the prognosis is hopeless and in whom the institution or … In the unresponsive patient, airway protection is paramount. Emergency anesthesia, airway management and ventilation in major trauma. Coma is defined as "unarousable unresponsiveness" . Medically induced coma vs. sedation for general anesthesia differs in the level of unconsciousness. Coma is a symptom, not a diagnosis. Coma has many causes but there are a few urgent ones in clinical practice. Myxedema coma, the extreme manifestation of hypothyroidism, is an uncommon but potentially lethal condition. In fact, general anesthesia is a type of medically induced coma. It presents a clinical regimen for the diagnosis and management of patients suffering from stupor or coma. Once the cause of coma is established, management should proceed … Immediate management. It is a deep, but reversible unconsciousness that doctors purposely induce. Figure 1 outlines a management algorithm. These imprecise descriptors should generally not be used in clinical situations without further qualification. Management must start with establishing the cause and an attempt to reverse or attenuate some of the damage. A medically induced coma uses drugs to achieve a deep state of brain inactivity. The Glasgow Coma Scale was developed to provide health-caregivers a simple way of measuring the depth of coma based upon observations of eye opening, speech, and movement. Of all the acute problems in clinical medicine, as the chapter explains, none is more challenging than the prompt diagnosis and effective management of the patient in coma. The terms "stupor," "lethargy," and "obtundation" refer to states between alertness and coma.

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