This document discusses coma, including its etiology, physical and laboratory evaluation, management and treatment, and prognosis. Coma is assessed using the Glasgow Coma Scale and signs such as eye opening, verbal response, motor response, and pupillary light reflex. Causes of coma are evaluated through history, examination, and tests of the blood, cerebrospinal fluid, imaging, and more. Treatment focuses on stabilizing the patient and removing the underlying cause, while nursing care includes positioning, nutrition, hygiene and physiotherapy. The prognosis depends on the cause, whether it can be corrected, and the duration of the coma, with higher rates of recovery for drug poisonings and head injuries treated promptly.

1. By: Dr. Esraa Alnabilsy

2. • Introduction.
• Etiology.
• Physical Evaluation.
• Laboratory Evaluation.
• Management & Treatment.
• Prognosis & Coma Sequels.

4. Lethargy ( ): Sleepiness & lack of energy.
‫الذهول‬/ Stupor :‫اإلحساس‬ ‫تبلد‬Obtundation:
‫النعاس‬ ‫أو‬ ‫الفتور‬

8.  Stabilize the patient ( Later in Management ).
 Proper detailed History ( to determine the cause ).
 Physical Examination:
- Assessment of coma.
- Neurological examination.
- Assessment of all body systems.
 Laboratory & Imaging Studies ( Later ).

11. Eye Opening
Verbal Response
Motor Response
(‫يئن‬)

13. The GCS is obtained by adding
the value for each category
minimal = 3 / maximum = 15

14. presence of abnormal posturing indicates a severe medical emergency requiring immediate medical attention

15. The pupillary light reflex (PLR)

17. • Verbal or Motor Response.
• Eye Opening / Fixation.
• Motor Response / Posturing.
Worsening of these signs
may indicate increased
intra cranial pressure ( ICP )
• Papillary Light Reflex.
• Oculocephalic Reflex.
Abnormalities indicate
brainstem injury

18. Laboratory evaluation of coma:
• Blood counts leukocytosis.
• Blood culture if infection is suspected.
• CSF examination in cases of infections of CNS & meninges.
• Ct scan or brain MRI in cases of head trauma or injury.
• Metabolic screen, blood sugar, blood urea, serum electrolytes.
• Liver function test in cases of hepatic encephalopathy.
• Urinalysis & Slide for malaria parasite.
• EEG especially if there is seizure activity.

19. • The main objective of therapy is
to find the cause & remove it.
• Maintain clear airway ABCs:
Supplement O2.
IV asses.
Blood pressure support as needed.

20. Treat the cause:
 Supportive care: Antipyretics.
 If the cause is hypoglycemia:
give 1-2 ml of 10 % Dextrose water.
 If patient in shock: start rapid infusion of volume
expansion fluids ( blood plasma & normal saline ).
 Control convulsions: by anticonvulsants medications.

21.  Correct Cerebral edema:
by giving IV Mannitol & Dexamethasone.
 If the cause is infections: give antibiotics.
 In case of Ingestion: give Naloxone 0.1 mg / kg.
 In case of increased ICP: give Mannitol 0.5 - 1 gram / kg.

22. Nursing care:
 Position: change every half hour to prevent bedsores.
 Nutrition: adequate nutrition through NG tube.
 Oral hygiene.
 Care of eyes & skin.
 Ventilator care.
 Care of bowel:
to prevent impaction of stools.
 Physiotherapy to prevent
contractures.

23.  The prognosis for a coma varies with each situation.
 The chances of a child recovery depend on the cause
of the coma, whether the problem can be corrected,
& the duration of the coma.
 If the problem can be resolved, the child can often
return to his or her original level of functioning.
 If the brain damage is severe, a child may permanently
disabled or never regain consciousness.

24.  Comas that result from drug poisonings have a high rate of
recovery, if prompt ( ‫وعاجل‬ ‫فوري‬ ) medical attention is received.
 Comas that result from head injuries tend to have a higher
rate of recovery than comas related to lack of oxygen.
 The longer a child is in a coma, the worse the prognosis. Even
so, many patients can wake up after many weeks in a coma.
 Some children will make a full recovery & become completely
unaffected by the coma. However, they may have significant
disabilities.

25. • Persistent vegetative state: where a child is awake but shows
no signs of being aware of their surroundings or themselves.
• Minimally conscious state:
where a child has limited awareness that comes & goes.
• Brain death: coma, apnea, & absent brainstem reflexes. No
chance of recovery, synonymous with death in most countries.

26. Designed by: Dr. Esraa Alnabilsy