Coma again 513 A.pptx njjknmkjksksjdjnenebrn

Coma

1. COMA Tejas palaskar513A

2. What is Coma?  Definition:   A state of prolonged unconsciousness where a person cannot be aroused, even with vigorous stimulation. Characterized by a lack of both arousal (waking up) and awareness (thinking, responding). 

3. Causes of Coma  Brain Injuries:  Structural damage to the brain from trauma.  Lack of Oxygen:  Insufficient oxygen supply to the brain.  Toxicity:  Poisoning from substances or toxins.  Infections/Inflammation:  Central nervous system infections or inflammation.  Metabolic Issues:  Conditions like diabetes, kidney, or liver failure can lead to coma.  Seizures:  Prolonged seizure activity.

4. Pathogenesis Coma pathogenesis  involves damage to brain areas critical for consciousness, specifically the cerebral hemispheres and the ascending reticular activating system (ARAS) .  Two main mechanisms cause coma: a diffuse insult (injury) to the hemispheres or a disruption of the ARAS, which sends arousal signals to the cortex. 

5. Mechanism Diffuse Cerebral Insult :   Damage to both cerebral hemispheres impairs the ability of the cortex to be aware and process information.  Ascending Reticular Activating System (ARAS) Disruption :   The ARAS, located in the midbrain and pons, is responsible for wakefulness. A disruption in this system or its pathways to the thalamus and cortex leads to a lack of arousal.

6. Symptoms of Coma Unresponsive Eyes:  Eyes are closed or do not open to stimulation, including to light.  No Response:  No voluntary movement of limbs, only possible reflex responses.  Lack of Arousal:  Cannot be awakened by any stimulus, even painful ones.  Absence of Verbal Communication:  Inability to speak or produce meaningful sounds. 

7. Diagnosis: The Glasgow Coma Scale (GCS) Purpose:  To assess the level of consciousness and severity of brain injury.  Components: Eye Opening  (E):  Spontaneously, to speech, to pain, or no response.  Verbal Response  (V):  Oriented, confused, inappropriate words, incomprehensible sounds, or no response.  Motor Response  (M):  Obeys commands, localizes to pain, withdraws from pain, abnormal flexion, abnormal extension, or no response. 

8. GCS Scoring: Scores range from 3 (worst) to 15 (best).  A total score of ≤ 8 generally indicates a severe injury and defines coma. 

9. Glasgow Coma Scale (GCS) Best eye response (E)  Best verbal response (V)  Best motor response

10. Consciousness A state of awareness of  self  and  surrounding The content of consciousness Sum of patient’s  intellectual  (cognitive) functions and  emotions  (affect)   Sensations, emotions, memories, images, ideas (SEMII) ● Depends upon the activities of the  cerebral cortex , the  thalamus  & their interrelationship

11. Mental Status  =  Arousal + Content            

12. State of consciousness The  ascending RAS , from the lower border of the  pons  to the  ventromedial thalamus ● The cells of origin of this system occupy a  paramedian area in the brainstem

13. Altered mental status Abnormal change in level of  arousal  or altered  content  of  a patient's thought processes Change in the level of arousal or alertness ● inattentiveness, lethargy, stupor, and coma. ● Change in content ● “Relatively  simple ” changes: e.g.  speech, calculations, spelling ● More  complex  changes:  emotions, behavior or personality ● Examples:  confusion ,  disorientation ,  hallucinations ,  poor comprehension , or  verbal expressive difficulty   

14. Definitions of levels of arousal (consciousness) Alert (Conscious)  - Appearance of wakefulness,  awareness of the self and environment  ● Lethargy -   mild   reduction in alertness ● Obtundation   -   moderate  reduction in alertness. Increased  response time  to stimuli. ● Stupor -  Deep sleep,  patient can be aroused only by  vigorous and repetitive  stimulation. Returns  to deep sleep when not continually stimulated. ● Coma (Unconscious) -   Sleep like  appearance and behaviorally   unresponsive  to all external stimuli  ( Unarousable   unresponsiveness ,  eyes closed )

15. Loc Assessment Tools AVPU  Scale:   A quick assessment tool:  A  - Awake  V  - Responds to Verbal stimuli  P  - Responds to Painful stimuli  U  - Unresponsive 

16. Treatment Treatment for coma focuses on :   stabilizing the patient's airway, breathing, and circulation (ABCs), identifying and treating the underlying cause (e.g., hypoglycemia , drug overdose, infection, bleeding), and providing supportive care such as postural management to prevent complications like pressure sores and contractures .

17. Treatment Initial & Supportive Care (ABCs & Basic Care) ABCs First:  Immediately assess and support the patient's airway, breathing, and circulation.  Stabilize Vital Signs:  Obtain vital signs (including temperature and pulse oximetry) and manage blood pressure aggressively, especially hypotension.  Intravenous Access :  Secure two large-bore intravenous lines for fluids and medications.  Positioning:  Keep the patient's head elevated to reduce  intracranial pressure .