Your SlideShare is downloading. ×
Coma
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Coma

1,809

Published on

Published in: Health & Medicine
0 Comments
4 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
1,809
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
0
Comments
0
Likes
4
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. COMA DR. SHAFAQ SHAIKH FCPS II TRAINEE
  • 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
  • 4. NEUROANATOMY
  • 5. Epidemiology of Coma Plum and Posner  500 consecutive cases of coma  101 supratentorial (44/101 ICH)  65 subtentorial lesions (40/65 brainstem infarcts)  326 diffuse or metabolic brain dysfunction  149 drug intoxication
  • 6. CAUSES According to etiology Traumatic Metabolic Vascular Infectious Toxic Structural Psychogenic
  • 7.  Focal versus nonfocal. Focal: intracerebral hemorrhage, ischemic stroke, demyelinating diseases. Nonfocal: vascular, toxic, metabolic conditions, nutritional deficiencies, seizures, psychiatric conditions. Either: trauma, infections, tumors
  • 8. DIAGNOSIS Medical History Physical Exam & Neurological Evaluation Eye Examination Laboratory Tests Imaging Studies EEG
  • 9. Clues from History Onset of symptoms  sudden onset  fluctuations Associated neurologic symptoms Medications
  • 10. 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.
  • 11. 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.
  • 12. Eye examinationPupils (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
  • 13. eye examination Corneal reflex Ciliospinal reflex Eye movements Oculocephalic/ calorics fundoscopy
  • 14. Cranial Nerve Exam Cranial Nerve Exam  Pupillary light response (CN 2-3)  Occulocephalic/calorics (CN 3,4,6,8)  Corneal reflex (CN 5,7)  Gag refelx (CN 9,10)
  • 15. Motor Exam Assess tone, presence of asterixis Response to painful stimuli  none  abnormal flexor  abnormal extensor  normal localization/withdrawal Reflexes
  • 16. The Glasgow Coma ScaleEYE OPENING VERBAL RESPONSE MOTOR RESPONSESpontaneous 4 Oriented 5 Obeys command 6To speech 3 Confused 4 Localizes pain 5To pain 2 Inappropriate words 3 Withdraws 4None 1 Incomprehensible words 2 Abnormal flexor posturing 3 None 1 Abnormal extensor posturing 2
  • 17. LABS Blood cp Blood glucose Serum eletrolytes Serum calcium ABGs Liver and renal function tests Toxicologic studies
  • 18. Other investigations Imaging studies: CAT scan, MRI EEG, BCI LP
  • 19. TREATMENT Recovery position
  • 20. TREATMENT Appropriate treatment must be commenced concomitantly with routine measures Treat according to the cause The "Coma Cocktail" Its a mixture of thiamine 50mg , dextrose 50 % (25g) , and naloxene 0.4-1.2 mg given intravenously.
  • 21. 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
  • 22. Long term treatment preventing infections such as pneumonia maintaining the patients physical state (preventing bed sores, for example) providing adequate nutrition.
  • 23. 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
  • 24. THANK YOU

×