Unconscious Or Coma Treatment
1. Stabilization of the vital signs
• Breathing:
Check cyanosis, breathing depth and pattern . Any need for oxygen, intubation & ventilation.
• Circulation:
Establish an IV line, IV canula, if low BP give fluids/ dopamine.
2. Send investigations if needful
Blood sugar, ECG, CBP, Urine and Chest X ray, Urea and serum creatinine
Electrolytes Na+, K+, CI-, serum lactate, anion gap, serum osmolality
LFT, ammonia, Arterial blood gases, Drug levels estimation, PSE
3. Vitamin B1 100mg and Dextrose 50% 50ml IV stat
Estimate RBS as early as possible
4. Disease History of coma or unconsciousness:-
| Complaints of | Possible diagnosis |
| Anti diabetic drugs missed / irregular treatment, Diabetic untreated, missed insulin | Hyperosmolar Diabetic coma, Hyponatremia Ketoacidosis |
| Hypertension | Hypertensive encephalopathy, thrombosis, embolism or hemorrhage or SAH, stroke |
| Epilepsy | Postictal state, Drug overdose, aspiration hypoxia |
| Bronchial asthma, COPD | Carbon dioxide narcosis Hypoxia |
| Ischemic heart disease | Acute myocardial infarction, Embolic stroke |
| Renal disease | Metabolic acidosis, Uremic encephalopathy |
| Liver disease | Hepatic encephalopathy |
| On Diuretic | Hypokalemia, Hyponatremia (use of diuretics), electrolyte imbalance |
| On anticoagulation, Bleeding tendency | Intracerebral bleed |
5. Patients state and symptoms prior to become unconscious/ comatose :-
| Events preceding the coma/ unconsciousness | Possible diagnosis |
| Raised ICT- sudden, convulsions progressive headache vomiting blurred vision | (ICSOL) Intracranial space occupying lesion |
| History of head injury, hematoma (even trivial injury, in last 6 months | Chronic subdural hematoma |
| History of sudden Severe headache convulsion and vomiting | CVA- Hemorrhage/ Subarachnoid hemorrhage (neck stiffness) |
| Vomiting / diarrhoea | Dehydration & electrolyte imbalance, CVA, Venous sinus thrombosis |
| Blood loss | shock |
| Fever with CNS symptoms | Brain abscess, meningitis/encephalitis, Subdural empyema |
| High grade fever | Typhoid/ Pneumonia/Malaria |
| Alcoholism | Wernicke’s encephalopathy, Hypoglycemia, Alcohol intoxication, Hepatic encephalopathy, Lactic acidosis, Methyl alcohol poisoning, Chronic subdural hematoma |
| Drug addiction | Drug withdrawal, Drug effect |
| Depression/ stress | Attempted poisoning/ suicide |
| Chest pain palpitations | MI, Cardiogenic shock |
Examination to find out possibilitie.
| 5. Examination | Probabilities |
| Anemia | Blood loss, Haematological CRF, Alcoholism |
| Cyanosis | COPD/ Asthma- hypoxia |
| Clubbing | Bronchogenic CA, Cirrhosis |
| Oedema | Chronic liver disease, Cardiac failure, Renal cause |
| Lymphadenopathy | TB/ HIV / Lymphoma |
| Jaundice | Hepatic coma |
| Bleeding / Purpura | Haematological malignancies, Septicemia, Leptospirosis |
| Skin resh/ blisters | Barbiturates poisoning, Vasculitis, Meningococcal |
| Fever | Meningitis/ encephalitis/ Cerebral malaria/ Enteric Septicaemia |
| Hypothermia | Myxedema coma, CRF |
| Hypertension | Hypertensive encephalopathy, CVA/SAH |
| Hypotension | Shock |
| Pulse Irregularly irregular (AF) | Embolic stroke |
| Dehydration | Hypovolemic shock, electrolyte imbalance |
| Smell of poison | Poisoning |
6. CNS examination –
Glasgow coma scale, pupils, dolls eye movement, deep tendon reflexes, power (movemnt of limbs), tone, superficial reflexes, sensations, neck stiffness, etc.
7. Unconscious Or Coma Treatment After Cause Confirmation:-
find out the cause of coma & treat like
dextrose I/V for hypoglycemia,
Aspirin for ischemic stroke,
Adenosine for PSVT,
Thrombolysis, angioplasty, CABG for Heart attack (MI),
Anti-epilepticus (eg. Levetiracetam) for Seizures,
I/V ceftriaxone and vancomycin for meningitis & add metronidazole for brain abscess,
Dialysis for Kidney failure (CKD),
Liver transplantation for hepatic coma, etc.
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Unconscious or coma treatment help me in management relative and to improve my knowledge it is great website thank you
very useful Post in treating coma, it is helpful for diagnosis also.
Nice, it is very helpful information about coma treatment Thank you sir.