The document provides an overview of coma, defining it as a complete arrest of cerebral function characterized by unresponsiveness to stimuli and closed eyes. It discusses the Glasgow Coma Scale (GCS), signs and symptoms associated with varying consciousness levels, and outlines evaluation and treatment protocols for patients in comatose states. The grading system for coma severity and specific responses related to respiratory patterns, pupils, eye movements, and motor response are also detailed.

1. COMA
PATEL.YASH.GIRISHBHAI

2. INTROUCTION
 Defined as complete arrest of all the cerebral
function.
 A state of unresponsiveness to even strong noxious
stimuli.
 The eyes are closed.
 There are no sleep/wake cycles.
 Patient is ventilator dependent

3. GLASSGOW COMA SCALE
 The GCS scored between 3 and 15,
 3 being the worst,
 15 the best
 It is composed of three parameters:
Best eye response, best verbal response, best motor
response

4. SIGN AND SYMPTOMS
1. STATE OF CONCSIOUESS
2. RESPIRATORY PATTERNS
3. PUPILS
4. EYE MOVEMENTS AND OCULAR REFLEX
5. MOTOR RESPONSE

5. 1) FULL CONSCIOUSNESS
 Awake and attentive to stimulation.
 Proper orientation
 Normal awareness about self and environment
 Interaction with the therapist are normal and
appropriate

6. 2) LETHERAGY OR HYPERSOMNIA
 General slowing of motor process including
speech and movement
 Patient appears drowsy and may fall asleep if not
stimulated in some way
 Interaction with therapist may get diverted.
 Patient may have difficulty in focusing or
maintain attention on a question or task.
 Does not really appreciate the environment.

7. 3) OBTUNDATION
 Difficulty to around sleeping state and frequently
confused when awake.
 Repeated stimulation is required to maintain
consciousness
 Interaction little interest or awareness of
environment.
 Demonstrate little or awareness of environment

8. 4) STUPOR / SEMICOMA
 The patient response only to strong generally
noxious stimuli and returns to unconsciousness
state when stimulation is stopped.
 When arouse, the patient Is unable to interact
with therapist.
 Mass movement patterns with pain or loud noises.

9. 5) COMA / UNCONSCIOUSNESS
 The patient cannot be aroused by any type of
stimulation.

10. EVALUTION OF SEVERITY OF COMA
 GRADE 0 : fully conscious
 GRADE 1 : drowsy, but responds to verbal
command
 GRADE 2: unconscious, but respond to strong pain
stimuli.
 GRADE 3: unconscious, but response pain stimuli
 GRADE 4: unconscious with no response to pain

11. B) RESSPIRATORY PATTERNS
 HYPERVENTILATION
Hypoxia
Positioning
Infection
 HYPOVENTILATION
Respiratory failure
Narcotic over dose

12.  CHYNE STOKE REPIRATION
Altered periods of hyperapnea and apnea
 APNUSTIC PREATHING
Pause at full inspiration
Lesion at lower pons

13. C) PUPILS
 Equal and normal reaction to pupils suggest
normal occulomotor nerve and upper brain stem
 Irregular pupils : coulometer palsy
 HIPPUS : spontaneous, rhythmic constriction and
dilatation of pupil

14. 4) EYE MOVEMENTS AND OCULAR
REFLEX
 Sundown deviation mid brain compression
 Doll’s eye phenomena
 Cilio spinal reflex
 Corneal reflex

15. 5) MOTOR RESPONSE
 Decorticate posture
 Decerebrate posture
 Triple flexion
 Cortical response

16. TREATMENT
1. Reparation
2. Circulation
3. Nutrion
4. Oral cavity
5. Urinary care
6. Bowel
7. Skin
8. Eyes
9. Passive movement