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
