MANAGEMENT OF COMA By Dr. G.Srinivas Associate Professor of Medicine

INVESTIGATIONS GUIDED BY HISTORY AND EXAMINATION GUIDED BY HISTORY AND EXAMINATION PTS WITH RAISED ICT – LP PTS WITH RAISED ICT – LP CT SCAN CT SCAN MRI MRI

KNOWN CASE OF EPILEPSY KNOWN CASE OF EPILEPSY 1. LEVELS OF ANTICONVULSANTS. 1. LEVELS OF ANTICONVULSANTS. 2. EEG 2. EEG  URINE ANALYSIS FOR GLUCOSE, KETONEBODIES, PROTEIN

PS FOR LEUCOCYTOSIS, MP PS FOR LEUCOCYTOSIS, MP BLOOD FOR RBS,UREA,AMMONIA BLOOD FOR RBS,UREA,AMMONIA SERUM CREATININE,ELECTROLYTES SERUM CREATININE,ELECTROLYTES SERUM CALCIUM SERUM CALCIUM SGOT SGOT

SUSPECTED POISONINGS SUSPECTED POISONINGS 1. ASPIRATION AND ANALYSIS OF GASTRICCONTENTS 1. ASPIRATION AND ANALYSIS OF GASTRICCONTENTS 2. CHROMATOGRAPHIC ANALYSIS OF BLOOD & URINE 2. CHROMATOGRAPHIC ANALYSIS OF BLOOD & URINE

MANAGEMENT INTIALLY BY TAKING CARE OF INTIALLY BY TAKING CARE OF 1. AIRWAY 1. AIRWAY 2. BREATHING 2. BREATHING 3. CIRCULATION 3. CIRCULATION

MONITORING HAEMODYNAMIC MONITORING HAEMODYNAMIC MONITORING PULMONARY MONITORING PULMONARY MONITORING NEUROLOGIC MONITORING NEUROLOGIC MONITORING

HAEMODYNAMIC MONITORING HEART RATE HEART RATE BLOOD PRESSURE BLOOD PRESSURE CVP CVP PULMONARY CAP.WEDGE PRESSURE PULMONARY CAP.WEDGE PRESSURE

PULMONARY MONITORING ABG ABG END TIDAL CAPNOGRAPHY END TIDAL CAPNOGRAPHY PULSE OXIMETRY PULSE OXIMETRY

NEUROLOGIC MONITORING EEG EEG EVOKED POTENTIALS EVOKED POTENTIALS INFRARED SPECTROSCOPY INFRARED SPECTROSCOPY BISPECTRAL INDEX BISPECTRAL INDEX INVASIVE NEUROLOGIC MONITORING INVASIVE NEUROLOGIC MONITORING JUGULARBULB MONITORING JUGULARBULB MONITORING

TREATMENT MENINGITIS / ENCEPHALITIS MENINGITIS / ENCEPHALITIS 1. DEFINITIVE 1. DEFINITIVE 2. SYMPTOMATIC 2. SYMPTOMATIC 3. SUPPORTIVE 3. SUPPORTIVE  SUBDURAL EFFUSION/EMPYEMA – DRAINAGE OF PUS

DKA-CORRECT DEHYDRATION DKA-CORRECT DEHYDRATION INSULIN DRIP INSULIN DRIP MAINTAINENCE FLUIDS MAINTAINENCE FLUIDS  HYPOGLYCEMIA-DEXTROSE BOLUS & MAINTAINENCE

HEPATIC COMA HEPATIC COMA 1. LACTULOSE 1. LACTULOSE 2. 10% DEXTROSE WITH MVI 2. 10% DEXTROSE WITH MVI 3. SUPPORTIVE 3. SUPPORTIVE

POISONINGS POISONINGS 1. STOMACH WASH 1. STOMACH WASH 2. ANTIDOTE 2. ANTIDOTE 3. SUPPORTIVE 3. SUPPORTIVE

OPIOD POISONING – NALAXONE 0.01mg/kg OPIOD POISONING – NALAXONE 0.01mg/kg BENZODIAZEPINES – FLUMAZENIL BENZODIAZEPINES – FLUMAZENIL SALICYLATE – 1. STOMACHWASH WITH SALICYLATE – 1. STOMACHWASH WITH CHARCOAL CHARCOAL 2. REHYDRATION 2. REHYDRATION 3. INCREASE URINARY PH- 3. INCREASE URINARY PH- IV NAHCO3 IV NAHCO3 4. SEVERE CASES-DIALYSIS 4. SEVERE CASES-DIALYSIS

CEREBRAL MALARIA-QUININE IV CEREBRAL MALARIA-QUININE IV SUPPORTIVE SUPPORTIVE  ENTERIC ENCEPHALOPATHY 1. ANTIBIOTICS 1. ANTIBIOTICS 2. DEXAMETHASONE 2. DEXAMETHASONE

DYSELECTROLYTEMIAS HYPONATREMIA-REDUCE LOSS HYPONATREMIA-REDUCE LOSS MAINT. DEFICIT MAINT. DEFICIT 3% NACL 1-3ml/kg 3% NACL 1-3ml/kg  HYPERNATREMIA-RESTICT Na INTAKE 1/2 NS 1/2 NS  HYPERKALEMIA-CAL.GLUCONATE INSULIN DRIP INSULIN DRIP K+BINDING RESINS K+BINDING RESINS

General measures Monitoring Vitals Monitoring Vitals Maintaining fluid & electrolyte balance Maintaining fluid & electrolyte balance Input & output Input & output Temp. control Temp. control Bladder, bowel, back care Bladder, bowel, back care Eye care Eye care Nutrition Nutrition

Prognosis Depends on Etiology, Depends on Etiology, Duration & Duration & Depth of Coma Depth of Coma

Prognosis Etiology Etiology Postictal coma – recovery good Postictal coma – recovery good Anoxic coma – poor outcome Anoxic coma – poor outcome Infections – mortality 40 % Infections – mortality 40 %

Prognosis Duration Duration Longer the duration poorer the outcome Longer the duration poorer the outcome

Prognosis Depth Depth Glasgow coma scale 5 or <5 Glasgow coma scale 5 or <5 Fixed dilated pupils for > 2 hrs Fixed dilated pupils for > 2 hrs Decerebration Decerebration Cardiorespiratory arrest Cardiorespiratory arrest ass. With poor outcome ass. With poor outcome

THANK U