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What characterizes a patient in a comatose state?
What characterizes a patient in a comatose state?
Which of the following is NOT a toxic cause of coma?
Which of the following is NOT a toxic cause of coma?
What is the maximum possible score on the Glasgow Coma Scale?
What is the maximum possible score on the Glasgow Coma Scale?
Which Glasgow Coma Scale category assesses a patient's ability to follow commands?
Which Glasgow Coma Scale category assesses a patient's ability to follow commands?
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What is indicated by a Glasgow Coma Scale score of less than 8?
What is indicated by a Glasgow Coma Scale score of less than 8?
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Which of the following is part of the initial emergency management for a comatose patient?
Which of the following is part of the initial emergency management for a comatose patient?
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Which condition can indirectly cause coma?
Which condition can indirectly cause coma?
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What is a direct CNS depressant that can lead to coma?
What is a direct CNS depressant that can lead to coma?
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What is a critical initial step when treating a comatose patient potentially suffering from CNS trauma?
What is a critical initial step when treating a comatose patient potentially suffering from CNS trauma?
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Which of the following measures can help prevent stress gastric ulcers in comatose patients?
Which of the following measures can help prevent stress gastric ulcers in comatose patients?
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What is an important consideration when managing urinary output in a comatose patient?
What is an important consideration when managing urinary output in a comatose patient?
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Which of the following interventions helps to avoid deep venous thrombosis in a comatose patient?
Which of the following interventions helps to avoid deep venous thrombosis in a comatose patient?
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What is a key component of proper care for the skin in comatose patients?
What is a key component of proper care for the skin in comatose patients?
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Study Notes
Definition of Coma
- Coma is an unresponsive state where the patient cannot communicate and cannot be aroused.
- Responsiveness varies, necessitating grading via classification scales like the Glasgow Coma Scale (GCS).
Toxic Causes of Coma
- Direct CNS depressants include:
- Alcohol
- Narcotics (e.g., opiates)
- Sedative-hypnotics (e.g., barbiturates, benzodiazepines)
- Anticonvulsants
- Antidepressants (e.g., MAO inhibitors, tricyclic antidepressants)
- Antipsychotics
- Anticholinergics
- Indirect causes include toxins that result in:
- Shock
- Seizures
- Hypoglycemia (due to oral hypoglycemics or insulin)
- Severe acidosis
Other Causes of Coma
- Brain injury often associated with fractures or intracranial bleeding.
- Possible causes include:
- Head trauma
- Metabolic issues (e.g., hypo or hyperglycemia)
- Endocrine disorders (e.g., hypothyroidism)
- Organ failure (e.g., liver or renal failure)
- Hypothermia or hyperthermia
- Serious infections (e.g., encephalitis, meningitis)
Glasgow Coma Scale (GCS)
- GCS is based on three patient responses: Eye, Verbal, and Motor.
-
Eye Response:
- Spontaneous (4)
- To verbal stimulus (3)
- To painful stimulus (2)
- None (1)
-
Verbal Response:
- Oriented (5)
- Confused (4)
- Inappropriate words (3)
- Incomprehensible sounds (2)
- None (1)
-
Motor Response:
- Follows commands (6)
- Localizes pain (5)
- Withdrawal from pain (4)
- Abnormal flexion (3)
- Abnormal extension (2)
- None (1)
- Total GCS score ranges from 3 to 15; lower scores indicate more severe coma.
- A score below 8 typically requires intubation for airway protection.
Management
-
Emergency Measures:
- Assess and maintain airway patency, assist ventilation as needed, and provide supplemental oxygen.
- Administer intravenous glucose, thiamine, and naloxone (the "coma cocktail").
- Flumazenil, a benzodiazepine antagonist, should not be given routinely.
- Investigate and treat the underlying cause through arterial blood gases, blood glucose levels, serum electrolytes, and specific drug tests.
- If CNS trauma or stroke is suspected, a CT scan is warranted.
Care for Comatose Patient
- Connect the patient to cardiac monitors and pulse oximeters.
- Insert urinary catheters and monitor fluid input/output daily.
- Conduct regular care for:
- Mouth (suctioning secretions)
- Eyes (apply ointment and keep closed to protect corneas)
- Skin (clean with alcohol)
- Prevent deep vein thrombosis with prophylactic heparin.
- Avoid stress gastric ulcers through H2 blockers or proton pump inhibitors.
- Treat infections with antibiotics.
- Physical therapy for chest and limb muscles, and joint mobility.
- Frequent repositioning to prevent bed sores and aspiration pneumonia.
- Provide nutrition and hydration via Ryle tube or total parenteral nutrition.
- Daily clinical evaluations and monitoring of electrolytes, glucose, hematocrit, and kidney function.
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Description
This quiz explores the definition of coma, its classifications, and various causes, including toxic and non-toxic factors. It covers the Glasgow Coma Scale and specific conditions that can lead to a comatose state, helping to deepen understanding of this critical medical topic.
