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Questions and Answers
What should be monitored regularly for a comatose patient according to best practices?
What should be monitored regularly for a comatose patient according to best practices?
What preventative measure should be taken to protect against deep venous thrombosis in a comatose patient?
What preventative measure should be taken to protect against deep venous thrombosis in a comatose patient?
Which of the following is a primary concern for treating comatose patients to prevent complications?
Which of the following is a primary concern for treating comatose patients to prevent complications?
In the case of a mixed drug ingestion involving TCAs, which diagnostic tool is crucial if CNS trauma is suspected?
In the case of a mixed drug ingestion involving TCAs, which diagnostic tool is crucial if CNS trauma is suspected?
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What is a recommended method for assisting in respiratory function for a comatose patient?
What is a recommended method for assisting in respiratory function for a comatose patient?
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What state is a patient in if they are unresponsive to stimuli and cannot communicate?
What state is a patient in if they are unresponsive to stimuli and cannot communicate?
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Which of the following is NOT a direct cause of coma due to CNS depressants?
Which of the following is NOT a direct cause of coma due to CNS depressants?
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Which score on the Glasgow Coma Scale indicates a more severe condition of coma?
Which score on the Glasgow Coma Scale indicates a more severe condition of coma?
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What is the highest possible score a patient can achieve on the Glasgow Coma Scale?
What is the highest possible score a patient can achieve on the Glasgow Coma Scale?
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Which of the following is a necessary emergency measure for a patient in coma?
Which of the following is a necessary emergency measure for a patient in coma?
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What degree of level of consciousness is indicated by a motor response of 'withdrawal from pain' in the Glasgow Coma Scale?
What degree of level of consciousness is indicated by a motor response of 'withdrawal from pain' in the Glasgow Coma Scale?
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Which of the following is an example of metabolic causes of coma?
Which of the following is an example of metabolic causes of coma?
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What should NOT be routinely administered to a patient in coma for management?
What should NOT be routinely administered to a patient in coma for management?
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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 covers essential concepts related to coma, including its definition, toxic causes, the Glasgow Coma Scale (GCS), and management strategies. It is crucial for healthcare professionals to understand these aspects for effective patient care. Test your knowledge on the various facets of coma management.
