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    Examination of A Comatose Patient

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    Reinaldy Basra
    This document discusses the examination of a comatose patient. It begins by defining coma as an unarousable unresponsive state that exists on a spectrum of altered arousal, ranging from alert to comatose. It then describes various levels of consciousness from alert to comatose. The causes of coma are discussed as being either diffuse brain dysfunction, supratentorial structural lesions, or infratentorial structural lesions. The evaluation of a comatose patient involves obtaining a history, performing a physical exam including vital signs and neurological exam, and assessing cranial nerves, motor function, sensory function and reflexes. Respiratory patterns and signs of herniation are also discussed.

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    Examination of A Comatose Patient

    Uploaded by

    Reinaldy Basra
    139 views13 pages
    This document discusses the examination of a comatose patient. It begins by defining coma as an unarousable unresponsive state that exists on a spectrum of altered arousal, ranging from alert to comatose. It then describes various levels of consciousness from alert to comatose. The causes of coma are discussed as being either diffuse brain dysfunction, supratentorial structural lesions, or infratentorial structural lesions. The evaluation of a comatose patient involves obtaining a history, performing a physical exam including vital signs and neurological exam, and assessing cranial nerves, motor function, sensory function and reflexes. Respiratory patterns and signs of herniation are also discussed.

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    Examination of a Comatose Patient

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    This document discusses the examination of a comatose patient. It begins by defining coma as an unarousable unresponsive state that exists on a spectrum of altered arousal, ranging from alert to comatose. It then describes various levels of consciousness from alert to comatose. The causes of coma are discussed as being either diffuse brain dysfunction, supratentorial structural lesions, or infratentorial structural lesions. The evaluation of a comatose patient involves obtaining a history, performing a physical exam including vital signs and neurological exam, and assessing cranial nerves, motor function, sensory function and reflexes. Respiratory patterns and signs of herniation are also discussed.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    139 views13 pages

    Examination of A Comatose Patient

    Uploaded by

    Reinaldy Basra
    This document discusses the examination of a comatose patient. It begins by defining coma as an unarousable unresponsive state that exists on a spectrum of altered arousal, ranging from alert to comatose. It then describes various levels of consciousness from alert to comatose. The causes of coma are discussed as being either diffuse brain dysfunction, supratentorial structural lesions, or infratentorial structural lesions. The evaluation of a comatose patient involves obtaining a history, performing a physical exam including vital signs and neurological exam, and assessing cranial nerves, motor function, sensory function and reflexes. Respiratory patterns and signs of herniation are also discussed.

    Copyright:

    © All Rights Reserved
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    of 13

    Examination of A Comatose

    Patient
    Imran I Ali MD
    Professor of Neurology

    Coma
    Coma is a state of unarousable
    unresponsiveness
    Alteration of arousal are a spectrum of
    abnormalities that range from being alert to
    unresponsive (comatose)
    Lethargy, stupor, delirium are descriptors of
    various states of awareness
    Stupor- State of partial responsiveness with partial
    consciousness
    Delirium- Altered state of awareness with confusion

    Level of Consciousness
    Alert
    normal awake and responsive state

    Lethargic
    easily aroused with mild stimulation. Can maintain arousal.

    Somnolent
    easily aroused by voice or touch; awakens and follows
    commands; requires stimulation to maintain arousal

    Obtunded/Stuporous
    arousable only with repeated and painful stim; verbal output is
    unintelligible or nil; some purposeful movement to noxious stim

    Comatose
    no arousal despite vigorous stimulation, no purposeful
    movement- only posturing, brainstem reflexes often absent

    Localization of Coma
    Diffuse brain dysfunction
    metabolic encephalopathy
    status epilepticus

    Supratentorial structural lesions


    bilateral hemispheric lesions
    bilateral thalamic lesions

    Infratentorial structural lesions


    brainstem lesions or compression

    Evaluation of Coma
    History
    seek historical data from friends & family

    Physical Examination
    Vitals (ABC)
    Observe appearance and behavior
    Assess movements & response to stimuli
    Skin
    Respiration

    Evaluation of Coma
    Neurological Examination
    May vary with degree of impairment
    Level of responsiveness
    Pupillary responses
    Eye movements
    Reflex eye movements

    Fundoscopic examination
    Motor examination
    Reflexes
    Meningeal signs

    Respiratory Patterns in Coma


    Cheyne Stokes breathing
    Bilateral hemispheric lesions
    Increased intracranial pressure
    Cardiopulmonary dysfunction

    Central Neurogenic Hyperventilation


    Brainstem lesions

    Ataxic breathing
    Medullary lesions

    Apneustic breathing
    Pontine or cervico-medullary junction

    Slow regular breathing


    Drug intoxications
    Severe hypothyroidism

    Cranial Nerve Findings


    Pupil
    Size, shape, equality/symmetry and reactivity

    Eye movements
    Position at rest (nystagmus)
    Oculocephalic movements
    Cold caloric testing

    Corneal
    Facial muscles
    Gag reflex

    Motor Examination
    Observation
    Muscle tone
    Response to stimuli
    Decorticate posturing
    Decerebrate posturing

    Sensory/Reflexes
    Pain sensation
    Biceps/Knee/Ankle
    Plantar responses

    Signs of Herniation in Coma


    Abnormal respiration
    Fixed or minimally reactive pupils or
    asymmetric dilated pupil
    Gaze deviation
    Decerebrate or decorticate posturing
    Transient hypertension
    Bradycardia

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