Coma

Question 1

What is a coma and how is it quantified?

Answer 1

1. Unarousable unconsciousness

2. GCS

Question 2

What are the scores in the best motor response section of GCS?

Answer 2

1. No response
2. Extension
3. Abnormal flexion
4. Normal flexion
5. Localises pain
6. Obeys commands

Question 3

What are the scores in the best verbal response section of GCS?

Answer 3

1. None
2. Incomprehensible sounds
3. Random words
4. Coherent sentences, not orientated
5. Orientated (name, date, location)

Question 4

What are the scores in the eye opening section of GCS?

Answer 4

1. None
2. Response to pain
3. Response to speech
4. Spontaneous

Question 5

What are the metabolic causes of a coma?

Answer 5

1. Drugs, poisoning (CO, alcohol, TCA)
2. Hypoglycaemia, hyperglycaemia
3. Septicaemia
4. Hypoxia, hypothermia
5. Myxoedema, Addisonian crisis
6. Hepatic/uraemic encephalopathy

Question 6

What are the neurological causes of coma?

Answer 6

1. Trauma
2. Infection
3. Tumours
4. Stroke, subdural, subarachnoid
5. Epilepsy

Question 7

What should you include in an examination of a comatose patient?

Answer 7

1. Signs of trauma
2. Stigmata of disease - liver, alcohol, diabetes, myxoedema
3. Skin for needle marks, cyanosis, pallor, rash
4. Breath smell - alcohol, ketosis
5. Meningism
6. Pupils fixed + dilated - raised ICP - CT head
7. Foci of infection - chest and abdominal exam

Question 8

What is the management of a comatose patient?

Answer 8

1. A-E, intubate if GCS under 8
2. IV access
3. Stabilise cervical spine
4. Control seizures
5. Treat underlying cause
6. Brief collateral history
7. ABG, FBC, U&Es, LFTS, CRP, alcohol, toxic screen
8. CT head

Question 9

What is the acute treatment for each of these issues?

1. Hypoglycaemia
2. Hypoxia
3. Wernicke’s encephalopathy
4. Opiate overdose
5. Benzodiazepine overdose

Answer 9

1. 200ml 10% dextrose
2. High flow oxygen
3. IV thiamine
4. IV naloxone
5. IV flumazenil