coma
the comatose patient
introduction
usual resuscitation measures addressing airway, breathing, circulation
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if trauma possible, protect cervical spine
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if evidence of seizures, Mx as per
seizures, but be aware that hypoxia, shock, eclampsia and hypoglycaemia can all be the cause.
move to a resuscitation area as soon as possible for ongoing cardiorespiratory and neurologic monitoring
if persistent coma with GCS < 9 and no readily identifiable reversible cause, and no NFR status, consider intubation to protect airway and ensure adequate ventilation.
baseline investigations for undifferentiated reduced cognitive states
consider
CT brain
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CXR
blood culture if possibly febrile illness
toxicology - eg. blood ethanol, salicylate, etc.
ammonia
metabolic screen in children
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investigate and Mx cause if not already evident
if fever
if history of febrile illness, petechial/purpuric rash or neck stiffness consider:
if history of febrile illness and hypotensive or clinically in shock, consider
septic shock
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if fever and young child with no sinister features, consider febrile convulsion
if recent international travel, consider:
NOTE: many of the conditions below also cause a raised temperature, and some are often precipitated by infections (eg. hepatic and Wernicke's encephalopathy)
if no history of fever
coma.txt · Last modified: 2019/01/20 10:22 by wh