Presentation on theme: "Consciousness State of wakefulness with awareness of self and surrounding. Confusion Altered consciousness (the subject misinterprets his surrounding)."— Presentation transcript:
Consciousness State of wakefulness with awareness of self and surrounding. Confusion Altered consciousness (the subject misinterprets his surrounding).
Delirium state of high arousal ( acute confusion ) There is confusion and visual hallucination. Stupor Is abnormal sleepy stat from which the subject can be aroused by repeated stimuli.
Coma ( or unconsciousness ) Is a state in which a patient is totally unaware of both self and external surroundings. Coma is not a disease. It is a symptom of disease or a response to an event.
Pathophysiology: A reduction in neuronal function resulting from disruption of cerebral cortical or brain stem integrity.
* Encephalopathy: hypoxia ischemia seizures and post ictal states * Infection: encephalitis meningitis septicemia * Pressure effects: cerebral edema hydrocephalus space occupying lesions
Neurological examination Determine level of consciousness by GCS
* The Glasgow Coma Scale is used to determine the severity of a brain injury. It is often used at the emergency scene or emergency room. * The scale is used as part of the initial evaluation of a patient, but does not assist in making the diagnosis the cause of coma * Motor, verbal, and eye responses are rated.
Spontaneous To loud voice To pain None Spontaneous To loud voice To pain None Eye Opening
smile, follows objects. spontaneous irritable cry Cries only to pain Moans to pain None Oriented disoriented and converses inappropriate words Incomprehensible sounds None Verbal Response
Drugs screen(eg_salicylates- -diazepam-narcotics-amphetamines) -Routine biochemistry (urea-electrolytes- glucose-calcium-liver biochemistry) -Metabolic and endocrine studies (TSH-serum cortisol) - Blood cultures such as cerebral malaria(thick blood film) -If the explanation remains unclear,further investigation are needed. INVESTIGATION
IMAGING CT or MRI brain imaging may indicate an otherwise unsuspected mass lesion or intracranial hemorrhage.
CSF examination Lumber puncture should be performed in coma only after careful risk assessment.it is usually contraindicated when an intracranial mass lesion is a possibility.CT is necessary to exclude this. CSF examination is likely to alter therapy only if undiagnosed meningoencephalitis or other identifiable infection is present.
Electroencephalography EEG is of some value in the diagnosis of metabolic coma and encephalitis.
Management of comatose patient Immediate Therapy Specific Therapy