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Richard Brown
Richard Brown
Santé & Médecine
1  sur  42
MANAGEMENT OF UNCONSCIOUS PATIENT DR. B. PRAKASH. Prof. M.B. PRANESH DEPT. OF NEUROLOGY KG HOSPITAL AND POSTGRADUATE INSTITUTE, COIMBATORE – INDIA
INTRODUCTION ,[object Object],[object Object],[object Object],[object Object]
STAGES OF CONSCIOUSNESS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Eye opening 4 Spontaneous 3 To speech 2 To pain 1 None Best motor response 6 Obeying 5 Localizing pain 4 Withdrawal 3 Abnormal flexing 2 Extensor response 1 None GLASGOW COMA SCALE Best verbal response 5 Oriented 4 Confused conversation 3 Inappropriate words 2 Incomprehensible sounds 1 None USED MOSTLY FOR HEAD INJURY PATIENTS RATHER THAN STROKE (HEMIPLEGIA,APHASIA)
Algorhythm COMA Airway/?Intubate IV Line CFCD Tests-Eme History-Eme CBC, ESR Sugar,RFT ABG,Lytes CXR,ECG Ca,Mg, Toxic Scr’n TRAUMA CT Scan No Trauma Neu.Surg Stiff Neck CT Scan Normal SAH LP Meningitis Toxin Alc->Thiamine 100mg / 50% Dextose 50 ml Opiate -> Inj.Naloxone 0.4-0.8mg IV BenzDia ->Inj.Flumazenil 0.2-1 mg IV Others -> Stomach wash / Antidote / Sympt Supple CNS Exam Normal Lateralising Metabolic CT Scan
SELECTIVE HISTORY TAKING ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SELECTIVE EXAMINATION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Gen. Phy. Exam ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
NEUROLOGIC EXAMINATION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],7.Gag Reflex 8.Pupils 9.Ocular Movements 10.Motor Response 11.Sensory Resp’se 12.Reflexes
NEU.EXAM-1.GEN.APPEAR’CE ,[object Object],[object Object],[object Object],[object Object],NEU.EXAM- 2.LEVEL OF CONS. ,[object Object],[object Object]
NEU.EXAM- 3.RESPIRATION. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
NEUROLOGIC EXAMINATION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],NEU.EXAM- 8.PUPILS.
[object Object],[object Object],[object Object],[object Object],[object Object],NEU.EXAM- 9.Ocular Movements.
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],NEU.EXAM- 9.Ocular Movements.
[object Object],[object Object],[object Object],[object Object],NEU.EXAM- 9.Ocular Movements.
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],NEU.EXAM- 9.Ocular Movements.
NEU.EXAM–MOTOR RESPONSES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],NEU.EXAM–MOTOR RESPONSES
DIAGNOSTIC TESTING ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],DIAGNOSTIC TESTING
EMERGENCY TREATMENT FOR COMA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CAUSES OF STUPOR AND COMA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CEREBRO VASCULAR ACCIDENT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ischemic Gliosis of Pons
SLE
Pontine Infarct
Intra Cerebral Hemorrhage
ANEURYSM & SAH ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Aneurysms
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],TRAUMA
Contusion / Concussion / DAI / SAH
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ALCOHOL INTOXICATION
[object Object],[object Object],[object Object],[object Object],[object Object],Post ictal state DIABETES ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Poisoning Meningitis ,[object Object],[object Object],[object Object],[object Object]
ENCEPHALITIS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Herpes Simplex Encephalitis
PSEUDOCOMA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
VEGETATIVE STATE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
GENERAL CARE FOR COMATOSE PTS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
BRAIN DEATH ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
THANK YOU

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  • 1. MANAGEMENT OF UNCONSCIOUS PATIENT DR. B. PRAKASH. Prof. M.B. PRANESH DEPT. OF NEUROLOGY KG HOSPITAL AND POSTGRADUATE INSTITUTE, COIMBATORE – INDIA
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  • 4. Eye opening 4 Spontaneous 3 To speech 2 To pain 1 None Best motor response 6 Obeying 5 Localizing pain 4 Withdrawal 3 Abnormal flexing 2 Extensor response 1 None GLASGOW COMA SCALE Best verbal response 5 Oriented 4 Confused conversation 3 Inappropriate words 2 Incomprehensible sounds 1 None USED MOSTLY FOR HEAD INJURY PATIENTS RATHER THAN STROKE (HEMIPLEGIA,APHASIA)
  • 5. Algorhythm COMA Airway/?Intubate IV Line CFCD Tests-Eme History-Eme CBC, ESR Sugar,RFT ABG,Lytes CXR,ECG Ca,Mg, Toxic Scr’n TRAUMA CT Scan No Trauma Neu.Surg Stiff Neck CT Scan Normal SAH LP Meningitis Toxin Alc->Thiamine 100mg / 50% Dextose 50 ml Opiate -> Inj.Naloxone 0.4-0.8mg IV BenzDia ->Inj.Flumazenil 0.2-1 mg IV Others -> Stomach wash / Antidote / Sympt Supple CNS Exam Normal Lateralising Metabolic CT Scan
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  • 26. SLE
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  • 32. Contusion / Concussion / DAI / SAH
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