Coma

Definition
• Loss of consciousness in total / almost total and can not be awakened
even if given a stimulus
• Coma is a condition such as deep sleep (deep sleep) where the
patient cannot be awakened to provide an appropriate response to
stimuli even with strong stimuli (vigourous stimulation).
Etiology
• - Metabolic disorders (uremia, hypoglycemia, hyperglycemia
and electrolyte disorders
• - Structural disorders that damage the structure relationship
between cerebral cortex and ARAS
• CONSCIOUS
• CONFUSION
• DROWSINESS
• STUPOR
• COMA
Diagnosis
• Anamnese
• Physical examination
 Glasgow Coma Scale (GCS)
Best eye Best verbal Best motor
response (E) response (V) response (M)
4 Eyes opening 5 Oriented 6 Obeys commands
spontaneously

3 Eye opening to 4 Confused 5 Localizes to pain

speech

2 Eye opening in 3 Inappropriate words 4 Withdraws from pain

response to pain

1 No eye opening 2 Incomprehensible 3 Flexion in response to

sounds pain

1 None 2 Extension to pain

1 No motor response
• Individual elements as well as the sum of the score are
important.
• Hence, the score is expressed in the form "GCS 9 = E2
V4 M3 at 07:35

Generally, comas are classified as:

• Severe, with GCS ≤ 8
• Moderate, GCS 9 - 12
• Minor, GCS ≥ 13.
• Complete Blood Count
• GD Random
• Elektrolit serum
• Chest X- Ray
• ECG
• CT or MRI
• Lumbal Puncture
• EEG
 Approaches to DD
Unresponsive

ABCs
Glucose, ABG, Lytes, Mg, Ca,
Tox, ammonia
Pseudo-Coma
Y N Psychogenic,
IV D50, narcan, Looked-in,
flumazenil
Unconscious
NM paralysis

Brainstem N Diffuse brain dysfunction

LP± CT
or other metabolic/ infectious
Focal signs
Y Focal lesions
CT Tumor, ICH/SAH/ infarction
complication
• Wounds on the back of the body (pressure sores)
• Pneumonia
• Urinary tract infection
• Deep vein thrombosis