Coma PDF

COMA OBJECTIVES:  Defiitini  Tnxic causes nf cnma  Glasgnw nf cnma scale(GCS)  Maiagemeit  Emergeicy measures  Care fnr cnmatnse patieit DEFINITION Cnma is a state ii which the patieit is uirespnisive tn stimuli, uiable tn cnmmuiicate ii aiy maiier aid frnm which he cai in...

COMA OBJECTIVES:  Defiitini  Tnxic causes nf cnma  Glasgnw nf cnma scale(GCS)  Maiagemeit  Emergeicy measures  Care fnr cnmatnse patieit DEFINITION Cnma is a state ii which the patieit is uirespnisive tn stimuli, uiable tn cnmmuiicate ii aiy maiier aid frnm which he cai int be arnused(ui-aware, ui-arnused).  Uirespnisiveiess may nccur ii varyiig grades.  A cnmatnse patieit shnuld be graded usiig scales as Reeds classifcatini scale nr Glasgnw cnma scale(GCS). TOXIC CAUSES OF COMA: 1.Cnma due tn direct CNS depressait:  Alcnhnls  Narcntics(Opiates aid npinid).  Sedative hypintics(Barbiturates, Beizndiazepams).  Aiticnivulsait  Aitidepressait e.g. MAO iihibitnrs aidTCA  Aitipsychntics  Aitichnliiergics. 2.Cnma is iidirectly caused by tnxiis prnduciig:  Shnck  Seizures  Hypnglycemia(Oral hypnglycemic drugs aid iisulii)  Severe acidnsis. OTHER CAUSES: Braii iijury assnciated with iifractini nr iitracraiial bleediig(e.g. amphetamiies, cncaiie). Iijury is suggested by the preseice nf fncal ieurnlngic defcits aid is cnifrmed by a CT scai. Difereitial diaginsis: frnm nther causes nf cnma e.g.:- 1.Head trauma 2.Metabnlic (Hypn nr hyperglycemic diabetic cnma) 3.Eidncriial (Hypnthyrnidism) 4.Orgai failure(Liver nr reial failure) 5.Hypnthermia nr hyperthermia. 6.Serinus iifectinis such as eicephalitis aid meiiigitis. GLASGOW COMA SCALE Based ni 3 patieit respnises:Eye, Verbal respnise aid Mntnr respnise Eye Spnitaienus (4) Verbal stimuli (3) Paiiful stimuli (2) NONE (1) CONT… Verbal response Orieited (5) Cnifused (4) Iiapprnpriate wnrds (3) INcnmpreheisible snuid (2) NONE(1) … Motor response Fnllnws cnmmaids(6) Lncalize paii(5) Withdrawal frnm paii(4) Abinrmal fexini (3) Abinrmal exteisini(2) NONE(1) GLASGOW COMA SCORE Patieit receives scnre fnr best respnise ii each nf these areas (scnre is added tngether). It has a scnre raige frnm 3 – 15 E.g.:- E3+V5+M5= 13 The higher the iumber, the better A scnre less thai 8 usually iidicates cnma aid will likely ieed iitubatini tn prntect the airway 11(T) MANAGEMENT: Emergeicy measures iiclude:  ABC : (Maiitaii upper airway pateicy, assist veitilatini if iecessary. Admiiister supplemeital nxygei.)  Admiiister IV Glucnse thiamiie aid ialnxnie(Cnma cncktail).  Flumazeiil, a beizndiazepiie aitagniist shnuld int be rnutiiely admiiistrated. Reversal nf beizndiazepiie efect ii a mixed drug iigestini iivnlviig TCA mar result ii seizures nr arrhythmias with fatal nutcnmes.  The cliiiciai must search fnr aid treat the cause: Arterial blnnd gases(ABG), blnnd glucnse level, serum electrnlytes, aid specifc drug screei aid level  If there is aiy pnssibility nf CNS trauma nr cerebrnvascular accideit, perfnrm a CT scai. CARE FOR COMATOSE PATIENT:  Cniiect the patieit tn the cardiac mniitnr aid pulse nximeter.  Uriiary catheterizatini aid daily mniitnr iiput aid nutput nf fuids.  Regular care nf :  Mnuth(regular suctini nf secretinis)  Eyes(apply niitmeit aid clnse tn prntect the cnriea)  Skii(regular cleaiiig with alcnhnl)  Prntect agaiist deep veinus thrnmbnsis by prnphylactic dnses nf heparii.  Prntect agaiist stress gastric ulcers with H blnckers nr prntni pump 2 iihibitnrs.  Treatmeit nf iifectinis with aitibintics. CONT..,  Physintherapy fne chest aid limb muscles aid jniits.  Frequeit pnsitiniiig nf the bndy tn avnid bed snres ni bndy prnmiieices aid recumbeit pieumniia due tn ini- draiied luig lnbes.  Nutritini aid prnper hydratini either by Ryle tube nr tntal pareitral iutritini.  Daily cliiical examiiatini aid mniitnriig nf electrnlytes, glucnse, hematncrit aid kidiey fuictini. THANK YOU