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Approach to a Patient with Coma

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Acute Neuro Care

Abstract

Coma is a state in which a patient is not responsive to external or internal stimuli. Early assessment and aggressive management is essential for a good outcome. Neurological examination in a comatose patient includes AVPU scale, Glasgow Coma Scale (GCS), pupillary examination, assessment of respiratory pattern and motor examination. Aetiology of coma includes several conditions which lead to structural brain injury, endocrine or metabolic derangement and diffuses physiological brain dysfunction. Management of a comatose patient begins with stabilization of airway, breathing and circulation, toxicological screening, lab investigations and radiology with further treatment tailored to the aetiological diagnosis causing coma.

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Author information

Authors and Affiliations

  1. Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India

    S. Srinivasan & Prasanna Udupi Bidkar

Authors
  1. S. Srinivasan
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  2. Prasanna Udupi Bidkar
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Editor information

Editors and Affiliations

  1. Division of Neuroanaesthesiology, Department of Anaesthesiology and critical care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

    Prasanna Udupi Bidkar

  2. Senior consultant and Head, Neuroanaesthesiology & Neurocritical care, MGM Healthcare Pvt Ltd, Chennai, Tamil Nadu, India

    Ponniah Vanamoorthy

Multiple Choice Questions

Multiple Choice Questions

  1. 1.

    Pick out the correct statement about coma

    1. (a)

      Coma is a state of unresponsiveness to external and internal stimuli.

    2. (b)

      Patient does not have awareness of environment.

    3. (c)

      Sleep–wake cycle is absent

    4. (d)

      All of the above.

  2. 2.

    Pick out the wrong statement about vegetative state

    1. (a)

      Arousal and sleep–wake cycle return.

    2. (b)

      Cognitive function intact.

    3. (c)

      It is termed as persistent vegetative state if it persists for 1 month.

    4. (d)

      It can be declared permanent if it persists 3 months after non traumatic injury.

  3. 3.

    What are the disadvantages of Glasgow Coma Scale(GCS)

    1. (a)

      Pupillary examination not included.

    2. (b)

      Respiratory pattern not considered.

    3. (c)

      Not useful in intubated patients.

    4. (d)

      All of the above.

  4. 4.

    A patient with severe head injury got admitted in casualty. He was not having any eye opening even after painful stimuli, motor examination reveals abnormal flexion posturing of limbs and makes a verbal response with incomprehensible sounds. What will be the GCS score?

    1. (a)

      6/15

    2. (b)

      3/15

    3. (c)

      12/15

    4. (d)

      10/15

  5. 5.

    A comatose patient was observed with respiratory pattern of Cheyne–Stokes breathing. What could be the probable site of lesion in brain presenting with that pattern of breathing?

    1. (a)

      Bilateral cortical and forebrain

    2. (b)

      Midbrain

    3. (c)

      Dorsomedial medulla

    4. (d)

      Pons.

  6. 6.

    Normal, reactive pupils in a comatose patient is usually suggestive of:

    1. (a)

      Metabolic cause.

    2. (b)

      Pontine haemorrhage.

    3. (c)

      Narcotic overdose.

    4. (d)

      None of the above.

  7. 7.

    Characteristic features of locked-in syndrome include:

    1. (a)

      Self-awareness is present.

    2. (b)

      Sleep–wake cycle is intact.

    3. (c)

      Normal EEG.

    4. (d)

      All of the above.

  8. 8.

    Management of coma in the first hour includes:

    1. (a)

      Assessment of airway, breathing and circulation.

    2. (b)

      Blood sugar, serum electrolytes, toxicological screening.

    3. (c)

      CT brain

    4. (d)

      All the above.

  9. 9.

    Which of the following is not a part of coma cocktail :

    1. (a)

      50% dextrose

    2. (b)

      Naloxone

    3. (c)

      Thiamine

    4. (d)

      IV magnesium.

  10. 10.

    Pick out the incorrect statement:

    1. (a)

      Decorticate posture involves flexion of upper limbs with flexion at elbow.

    2. (b)

      Decerebrate posturing is extensor response with adduction of upper limb with pronation.

    3. (c)

      Decerebrate posturing indicates brainstem damage.

    4. (d)

      Decorticate posturing carries a poorer prognosis than decerebrate posturing.

Answers: 1. (d), 2. (b), 3. (d), 4. (a), 5. (a), 6. (a), 7. (d), 8. (d), 9. (d), 10, (d)

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Srinivasan, S., Bidkar, P.U. (2020). Approach to a Patient with Coma. In: Bidkar, P., Vanamoorthy, P. (eds) Acute Neuro Care. Springer, Singapore. https://doi.org/10.1007/978-981-15-4071-4_2

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  • DOI: https://doi.org/10.1007/978-981-15-4071-4_2

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-15-4070-7

  • Online ISBN: 978-981-15-4071-4

  • eBook Packages: MedicineMedicine (R0)

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