Coma - Emergency Management

Coma

·        Immediate actions:

o   Establish unresponsiveness

o   Act as though cervical spine injury

o   Check ABC

o   If arrested ® CPR

o   Consider ventilation/intubation

o   100% O2

o   IV access.  Take blood for glucose, U&E, drug levels

o   Access depth of coma: GCS

o   Expose and examine patient 

o   Look for localising neurological signs, ­intracranial pressure

o   Bladder catheterisation

·        Further diagnostic options:

o   Chest, skull and cervical spin X ray

o   CT scan

o   Gastric lavage after protection of airway by intubation

·        Consider:

o   Drugs/toxic (See also Topic Poisoning and Overdose):

§  Alcohol: thiamine 100 mg iv

§  Opiod overdose: naloxone 0.4 mg iv

o   Benzodiazepine overdose: flumazenil

o   Also CO, fumes, antidepressants 

·        Metabolic: renal failure, endocrine (eg hypoglycaemia – Dextrose 25g iv), renal/hepatic encephalopathy, porphyria

·        Miscellaneous: hypoxia, post epileptic fit

·        Extracranial: hypoxia (due to arrest, asphyxia), hypo/hyperthermia, electrocution