SlideShare une entreprise Scribd logo
1  sur  34
Management of Coma and Altered Sensorium
Why coma management?  ,[object Object],[object Object],[object Object]
Check vital signs  ,[object Object],[object Object],[object Object]
Emergency treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Maintain ventilation ,[object Object],[object Object],[object Object],[object Object]
Draw Blood for  ,[object Object],[object Object],[object Object],[object Object],[object Object]
Maintain circulation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Control Seizure ,[object Object],[object Object],[object Object],[object Object],[object Object]
Reduce intracranial pressure ,[object Object],[object Object]
Maintain Temperature ,[object Object],[object Object]
Is it Coma ? ,[object Object],[object Object],[object Object]
Psychogenic coma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Spectrum of Coma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What causes coma? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Metabolic encephalopathy   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Supratentorial Lesions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Infratentorial Lesions ,[object Object],[object Object],[object Object],[object Object],[object Object]
History ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Other symptoms of 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]
Examination ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Neurological examination ,[object Object],[object Object],[object Object],[object Object],[object Object]
Circulation ,[object Object]
Breathing ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Breathing in coma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pupil ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Eye movement   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Eye movements in Coma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Posture ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ECG changes in coma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Further investigation ,[object Object],[object Object],[object Object],[object Object]
Agitated  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Agitated patient  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Coma Subsequent management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Thank You

Contenu connexe

Tendances (20)

LEWY BODY DEMENTIA
LEWY BODY DEMENTIA LEWY BODY DEMENTIA
LEWY BODY DEMENTIA
 
Korsakoff’s syndrome (korsakoff’s psychosis)
Korsakoff’s syndrome (korsakoff’s psychosis)Korsakoff’s syndrome (korsakoff’s psychosis)
Korsakoff’s syndrome (korsakoff’s psychosis)
 
Acute confusional state
Acute confusional stateAcute confusional state
Acute confusional state
 
Increased icp
Increased icpIncreased icp
Increased icp
 
Cataract
CataractCataract
Cataract
 
Disorders of thought
Disorders of thoughtDisorders of thought
Disorders of thought
 
Cognitive disorders
Cognitive disordersCognitive disorders
Cognitive disorders
 
Coma
ComaComa
Coma
 
Delirium Tremens
Delirium Tremens Delirium Tremens
Delirium Tremens
 
Pseudoseizure
PseudoseizurePseudoseizure
Pseudoseizure
 
Pituitary Adenoma
Pituitary AdenomaPituitary Adenoma
Pituitary Adenoma
 
The Frontotemporal Dementias
The Frontotemporal DementiasThe Frontotemporal Dementias
The Frontotemporal Dementias
 
coma
comacoma
coma
 
Hallucination
HallucinationHallucination
Hallucination
 
Definitions, and approach to Coma
Definitions, and approach to ComaDefinitions, and approach to Coma
Definitions, and approach to Coma
 
Seizure disorders
Seizure disordersSeizure disorders
Seizure disorders
 
Delusion
DelusionDelusion
Delusion
 
DISORDERS OF THOUGHT
DISORDERS OF THOUGHTDISORDERS OF THOUGHT
DISORDERS OF THOUGHT
 
Delirium by Dr. Aryan
Delirium by Dr. AryanDelirium by Dr. Aryan
Delirium by Dr. Aryan
 
Amnesia
AmnesiaAmnesia
Amnesia
 

En vedette

Altered sensorium
Altered sensorium Altered sensorium
Altered sensorium Sudhir Dev
 
Alteration Of Consciousness
Alteration Of ConsciousnessAlteration Of Consciousness
Alteration Of Consciousnessmed
 
Approach to coma
Approach to comaApproach to coma
Approach to comaPS Deb
 
Consciousness, ras and approach to coma
Consciousness, ras and approach to comaConsciousness, ras and approach to coma
Consciousness, ras and approach to comaNeurologyKota
 
Assessment of an unconscious/comatose patient
Assessment of an unconscious/comatose patientAssessment of an unconscious/comatose patient
Assessment of an unconscious/comatose patientmeducationdotnet
 
Approach to the comatose patient
Approach to the comatose patientApproach to the comatose patient
Approach to the comatose patientMehakinder Singh
 
General approach and differential diagnosis of coma
General approach and differential diagnosis of comaGeneral approach and differential diagnosis of coma
General approach and differential diagnosis of comaAn Chang
 
Comatose patient case discussion
Comatose patient case discussionComatose patient case discussion
Comatose patient case discussionMuhammad Asim Rana
 
Top 8 diversional therapist resume samples
Top 8 diversional therapist resume samplesTop 8 diversional therapist resume samples
Top 8 diversional therapist resume samplesalicewatson007
 
N207 self care deficit blog
N207 self care deficit blogN207 self care deficit blog
N207 self care deficit blogmelaniecerezo
 
Altered Consciousness
Altered Consciousness Altered Consciousness
Altered Consciousness Laura Taylor
 
Coma final
Coma finalComa final
Coma finalashabdou
 
Presentation by dr. mottalib
Presentation by dr. mottalibPresentation by dr. mottalib
Presentation by dr. mottalibMottalib Sarker
 

En vedette (20)

Altered sensorium
Altered sensorium Altered sensorium
Altered sensorium
 
Altered level of consciousness
Altered level of consciousnessAltered level of consciousness
Altered level of consciousness
 
Alteration Of Consciousness
Alteration Of ConsciousnessAlteration Of Consciousness
Alteration Of Consciousness
 
Approach to coma
Approach to comaApproach to coma
Approach to coma
 
Altered Mental Status
Altered Mental StatusAltered Mental Status
Altered Mental Status
 
Altered sensorium Case 2014
Altered sensorium Case 2014Altered sensorium Case 2014
Altered sensorium Case 2014
 
Consciousness, ras and approach to coma
Consciousness, ras and approach to comaConsciousness, ras and approach to coma
Consciousness, ras and approach to coma
 
Assessment of an unconscious/comatose patient
Assessment of an unconscious/comatose patientAssessment of an unconscious/comatose patient
Assessment of an unconscious/comatose patient
 
Coma 1st Aid by Dr.Mohamed El-Abiad
Coma 1st Aid by Dr.Mohamed El-AbiadComa 1st Aid by Dr.Mohamed El-Abiad
Coma 1st Aid by Dr.Mohamed El-Abiad
 
Unconsciousness presentation 1
Unconsciousness presentation 1Unconsciousness presentation 1
Unconsciousness presentation 1
 
Approach to the comatose patient
Approach to the comatose patientApproach to the comatose patient
Approach to the comatose patient
 
General approach and differential diagnosis of coma
General approach and differential diagnosis of comaGeneral approach and differential diagnosis of coma
General approach and differential diagnosis of coma
 
Pediatric Coma
Pediatric ComaPediatric Coma
Pediatric Coma
 
Comatose patient case discussion
Comatose patient case discussionComatose patient case discussion
Comatose patient case discussion
 
Top 8 diversional therapist resume samples
Top 8 diversional therapist resume samplesTop 8 diversional therapist resume samples
Top 8 diversional therapist resume samples
 
N207 self care deficit blog
N207 self care deficit blogN207 self care deficit blog
N207 self care deficit blog
 
Altered Consciousness
Altered Consciousness Altered Consciousness
Altered Consciousness
 
Coma final
Coma finalComa final
Coma final
 
comatosed patient
comatosed patientcomatosed patient
comatosed patient
 
Presentation by dr. mottalib
Presentation by dr. mottalibPresentation by dr. mottalib
Presentation by dr. mottalib
 

Similaire à Management of coma and altered sensorium 19.4.01

NurseReview.Org - Nursing Management of the Adult Client with Neurologic Alte...
NurseReview.Org - Nursing Management of the Adult Client with Neurologic Alte...NurseReview.Org - Nursing Management of the Adult Client with Neurologic Alte...
NurseReview.Org - Nursing Management of the Adult Client with Neurologic Alte...Nurse ReviewDotOrg
 
Medical Emergencies in the Dental Office
Medical Emergencies in the Dental OfficeMedical Emergencies in the Dental Office
Medical Emergencies in the Dental OfficeV. Bonales, M.D.
 
approach to neurologic illness in medical ICU
approach to neurologic illness in medical ICUapproach to neurologic illness in medical ICU
approach to neurologic illness in medical ICUNeurology resident slides
 
21)Altered Mental Status
21)Altered Mental Status21)Altered Mental Status
21)Altered Mental Statusphant0m0o0o
 
Cerebrovascular Disease
Cerebrovascular DiseaseCerebrovascular Disease
Cerebrovascular Diseasemycomic
 
[Int. med] cerebrovascular accident from SIMS Lahore
[Int. med] cerebrovascular accident from SIMS Lahore[Int. med] cerebrovascular accident from SIMS Lahore
[Int. med] cerebrovascular accident from SIMS LahoreMuhammad Ahmad
 
What you should know about Intracranial pressure
 What you should know about Intracranial pressure What you should know about Intracranial pressure
What you should know about Intracranial pressureNapoleon Abonales
 
Obstructive sleep apnoea and Intensive care
Obstructive sleep apnoea and Intensive careObstructive sleep apnoea and Intensive care
Obstructive sleep apnoea and Intensive careoxicm
 
26 USCardio (1).ppt
26 USCardio (1).ppt26 USCardio (1).ppt
26 USCardio (1).pptsharifi3
 
Cardiac lecture pediatrics fall 2012
Cardiac lecture pediatrics fall 2012 Cardiac lecture pediatrics fall 2012
Cardiac lecture pediatrics fall 2012 JHU Nursing
 
HIE Birth asphyxia in Neonates
HIE Birth asphyxia in NeonatesHIE Birth asphyxia in Neonates
HIE Birth asphyxia in NeonatesSujit Shrestha
 
Evaluation & Management Of Child With Arrhythmias
Evaluation & Management Of Child With ArrhythmiasEvaluation & Management Of Child With Arrhythmias
Evaluation & Management Of Child With ArrhythmiasSalma Bashir
 
Recognition of a sick child
Recognition of a sick childRecognition of a sick child
Recognition of a sick childJogeshwar Bosak
 

Similaire à Management of coma and altered sensorium 19.4.01 (20)

NurseReview.Org - Nursing Management of the Adult Client with Neurologic Alte...
NurseReview.Org - Nursing Management of the Adult Client with Neurologic Alte...NurseReview.Org - Nursing Management of the Adult Client with Neurologic Alte...
NurseReview.Org - Nursing Management of the Adult Client with Neurologic Alte...
 
Medical Emergencies in the Dental Office
Medical Emergencies in the Dental OfficeMedical Emergencies in the Dental Office
Medical Emergencies in the Dental Office
 
approach to neurologic illness in medical ICU
approach to neurologic illness in medical ICUapproach to neurologic illness in medical ICU
approach to neurologic illness in medical ICU
 
Syncope iman
 Syncope iman Syncope iman
Syncope iman
 
21)Altered Mental Status
21)Altered Mental Status21)Altered Mental Status
21)Altered Mental Status
 
Cerebrovascular Disease
Cerebrovascular DiseaseCerebrovascular Disease
Cerebrovascular Disease
 
[Int. med] cerebrovascular accident from SIMS Lahore
[Int. med] cerebrovascular accident from SIMS Lahore[Int. med] cerebrovascular accident from SIMS Lahore
[Int. med] cerebrovascular accident from SIMS Lahore
 
Heart failure.pptx
Heart failure.pptxHeart failure.pptx
Heart failure.pptx
 
Cnv disorders
Cnv disordersCnv disorders
Cnv disorders
 
What you should know about Intracranial pressure
 What you should know about Intracranial pressure What you should know about Intracranial pressure
What you should know about Intracranial pressure
 
Neurology
NeurologyNeurology
Neurology
 
Obstructive sleep apnoea and Intensive care
Obstructive sleep apnoea and Intensive careObstructive sleep apnoea and Intensive care
Obstructive sleep apnoea and Intensive care
 
26 USCardio (1).ppt
26 USCardio (1).ppt26 USCardio (1).ppt
26 USCardio (1).ppt
 
Cardiac lecture pediatrics fall 2012
Cardiac lecture pediatrics fall 2012 Cardiac lecture pediatrics fall 2012
Cardiac lecture pediatrics fall 2012
 
HIE Birth asphyxia in Neonates
HIE Birth asphyxia in NeonatesHIE Birth asphyxia in Neonates
HIE Birth asphyxia in Neonates
 
Evaluation & Management Of Child With Arrhythmias
Evaluation & Management Of Child With ArrhythmiasEvaluation & Management Of Child With Arrhythmias
Evaluation & Management Of Child With Arrhythmias
 
Recognition of a sick child
Recognition of a sick childRecognition of a sick child
Recognition of a sick child
 
Mark O
Mark OMark O
Mark O
 
Cerebrovascular Accident
Cerebrovascular AccidentCerebrovascular Accident
Cerebrovascular Accident
 
Syncope ppt
Syncope pptSyncope ppt
Syncope ppt
 

Plus de PS Deb

Lead poisoning in neurology
Lead poisoning in neurologyLead poisoning in neurology
Lead poisoning in neurologyPS Deb
 
Spinal cord disorders Anatomical Approach
Spinal cord disorders Anatomical ApproachSpinal cord disorders Anatomical Approach
Spinal cord disorders Anatomical ApproachPS Deb
 
Should we allow natural death?
Should we allow natural death?Should we allow natural death?
Should we allow natural death?PS Deb
 
Chronic progressive external ophthalmoplegia
Chronic progressive external ophthalmoplegiaChronic progressive external ophthalmoplegia
Chronic progressive external ophthalmoplegiaPS Deb
 
Motivating hospital workers
Motivating hospital workersMotivating hospital workers
Motivating hospital workersPS Deb
 
Brain stem 2014
Brain stem 2014Brain stem 2014
Brain stem 2014PS Deb
 
Muscle tone
Muscle toneMuscle tone
Muscle tonePS Deb
 
Cerebellum Anatomy and Physiology
Cerebellum Anatomy and PhysiologyCerebellum Anatomy and Physiology
Cerebellum Anatomy and PhysiologyPS Deb
 
Corticospinal system
Corticospinal system Corticospinal system
Corticospinal system PS Deb
 
Motor paralysis clinical
Motor paralysis clinical Motor paralysis clinical
Motor paralysis clinical PS Deb
 
Basal Ganglia Clinical Anatomy Physiology
Basal Ganglia Clinical Anatomy PhysiologyBasal Ganglia Clinical Anatomy Physiology
Basal Ganglia Clinical Anatomy PhysiologyPS Deb
 
Myoclonus
MyoclonusMyoclonus
MyoclonusPS Deb
 
Athetosis and dystonia
Athetosis and dystoniaAthetosis and dystonia
Athetosis and dystoniaPS Deb
 
Tic disorder
Tic disorderTic disorder
Tic disorderPS Deb
 
Chorea and ballismus
Chorea and ballismusChorea and ballismus
Chorea and ballismusPS Deb
 
Management of Tremor
Management of Tremor Management of Tremor
Management of Tremor PS Deb
 
Hypertension and stroke
Hypertension and stroke Hypertension and stroke
Hypertension and stroke PS Deb
 
Rapidly Progressive Fatal Neuromyositis
Rapidly Progressive Fatal Neuromyositis Rapidly Progressive Fatal Neuromyositis
Rapidly Progressive Fatal Neuromyositis PS Deb
 
Stroke management
Stroke management Stroke management
Stroke management PS Deb
 
Neurologic manifestation of HIV/AIDS
Neurologic manifestation of HIV/AIDSNeurologic manifestation of HIV/AIDS
Neurologic manifestation of HIV/AIDSPS Deb
 

Plus de PS Deb (20)

Lead poisoning in neurology
Lead poisoning in neurologyLead poisoning in neurology
Lead poisoning in neurology
 
Spinal cord disorders Anatomical Approach
Spinal cord disorders Anatomical ApproachSpinal cord disorders Anatomical Approach
Spinal cord disorders Anatomical Approach
 
Should we allow natural death?
Should we allow natural death?Should we allow natural death?
Should we allow natural death?
 
Chronic progressive external ophthalmoplegia
Chronic progressive external ophthalmoplegiaChronic progressive external ophthalmoplegia
Chronic progressive external ophthalmoplegia
 
Motivating hospital workers
Motivating hospital workersMotivating hospital workers
Motivating hospital workers
 
Brain stem 2014
Brain stem 2014Brain stem 2014
Brain stem 2014
 
Muscle tone
Muscle toneMuscle tone
Muscle tone
 
Cerebellum Anatomy and Physiology
Cerebellum Anatomy and PhysiologyCerebellum Anatomy and Physiology
Cerebellum Anatomy and Physiology
 
Corticospinal system
Corticospinal system Corticospinal system
Corticospinal system
 
Motor paralysis clinical
Motor paralysis clinical Motor paralysis clinical
Motor paralysis clinical
 
Basal Ganglia Clinical Anatomy Physiology
Basal Ganglia Clinical Anatomy PhysiologyBasal Ganglia Clinical Anatomy Physiology
Basal Ganglia Clinical Anatomy Physiology
 
Myoclonus
MyoclonusMyoclonus
Myoclonus
 
Athetosis and dystonia
Athetosis and dystoniaAthetosis and dystonia
Athetosis and dystonia
 
Tic disorder
Tic disorderTic disorder
Tic disorder
 
Chorea and ballismus
Chorea and ballismusChorea and ballismus
Chorea and ballismus
 
Management of Tremor
Management of Tremor Management of Tremor
Management of Tremor
 
Hypertension and stroke
Hypertension and stroke Hypertension and stroke
Hypertension and stroke
 
Rapidly Progressive Fatal Neuromyositis
Rapidly Progressive Fatal Neuromyositis Rapidly Progressive Fatal Neuromyositis
Rapidly Progressive Fatal Neuromyositis
 
Stroke management
Stroke management Stroke management
Stroke management
 
Neurologic manifestation of HIV/AIDS
Neurologic manifestation of HIV/AIDSNeurologic manifestation of HIV/AIDS
Neurologic manifestation of HIV/AIDS
 

Dernier

Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort ServicePremium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Servicevidya singh
 
Call Girls Mumbai Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Mumbai Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Mumbai Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Mumbai Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Call Girls Visakhapatnam Just Call 9907093804 Top Class Call Girl Service Ava...
Call Girls Visakhapatnam Just Call 9907093804 Top Class Call Girl Service Ava...Call Girls Visakhapatnam Just Call 9907093804 Top Class Call Girl Service Ava...
Call Girls Visakhapatnam Just Call 9907093804 Top Class Call Girl Service Ava...Dipal Arora
 
VIP Mumbai Call Girls Hiranandani Gardens Just Call 9920874524 with A/C Room ...
VIP Mumbai Call Girls Hiranandani Gardens Just Call 9920874524 with A/C Room ...VIP Mumbai Call Girls Hiranandani Gardens Just Call 9920874524 with A/C Room ...
VIP Mumbai Call Girls Hiranandani Gardens Just Call 9920874524 with A/C Room ...Garima Khatri
 
Call Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Cuttack Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Call Girls Nagpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Nagpur Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Nagpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Nagpur Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
(Rocky) Jaipur Call Girl - 09521753030 Escorts Service 50% Off with Cash ON D...
(Rocky) Jaipur Call Girl - 09521753030 Escorts Service 50% Off with Cash ON D...(Rocky) Jaipur Call Girl - 09521753030 Escorts Service 50% Off with Cash ON D...
(Rocky) Jaipur Call Girl - 09521753030 Escorts Service 50% Off with Cash ON D...indiancallgirl4rent
 
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...Dipal Arora
 
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Varanasi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
VIP Call Girls Indore Kirti 💚😋 9256729539 🚀 Indore Escorts
VIP Call Girls Indore Kirti 💚😋  9256729539 🚀 Indore EscortsVIP Call Girls Indore Kirti 💚😋  9256729539 🚀 Indore Escorts
VIP Call Girls Indore Kirti 💚😋 9256729539 🚀 Indore Escortsaditipandeya
 
Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Bareilly Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Call Girls Dehradun Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Dehradun Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Dehradun Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Dehradun Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...Call Girls in Nagpur High Profile
 
Chandrapur Call girls 8617370543 Provides all area service COD available
Chandrapur Call girls 8617370543 Provides all area service COD availableChandrapur Call girls 8617370543 Provides all area service COD available
Chandrapur Call girls 8617370543 Provides all area service COD availableDipal Arora
 
Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...
Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...
Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...Dipal Arora
 
Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...
Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...
Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...narwatsonia7
 
Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Kochi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Call Girls Siliguri Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Siliguri Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Siliguri Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Siliguri Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Top Rated Bangalore Call Girls Richmond Circle ⟟ 8250192130 ⟟ Call Me For Gen...
Top Rated Bangalore Call Girls Richmond Circle ⟟ 8250192130 ⟟ Call Me For Gen...Top Rated Bangalore Call Girls Richmond Circle ⟟ 8250192130 ⟟ Call Me For Gen...
Top Rated Bangalore Call Girls Richmond Circle ⟟ 8250192130 ⟟ Call Me For Gen...narwatsonia7
 

Dernier (20)

Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort ServicePremium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
 
Call Girls Mumbai Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Mumbai Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Mumbai Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Mumbai Just Call 9907093804 Top Class Call Girl Service Available
 
Call Girls Visakhapatnam Just Call 9907093804 Top Class Call Girl Service Ava...
Call Girls Visakhapatnam Just Call 9907093804 Top Class Call Girl Service Ava...Call Girls Visakhapatnam Just Call 9907093804 Top Class Call Girl Service Ava...
Call Girls Visakhapatnam Just Call 9907093804 Top Class Call Girl Service Ava...
 
VIP Mumbai Call Girls Hiranandani Gardens Just Call 9920874524 with A/C Room ...
VIP Mumbai Call Girls Hiranandani Gardens Just Call 9920874524 with A/C Room ...VIP Mumbai Call Girls Hiranandani Gardens Just Call 9920874524 with A/C Room ...
VIP Mumbai Call Girls Hiranandani Gardens Just Call 9920874524 with A/C Room ...
 
Call Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service Available
 
Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Cuttack Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service Available
 
Call Girls Nagpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Nagpur Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Nagpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Nagpur Just Call 9907093804 Top Class Call Girl Service Available
 
(Rocky) Jaipur Call Girl - 09521753030 Escorts Service 50% Off with Cash ON D...
(Rocky) Jaipur Call Girl - 09521753030 Escorts Service 50% Off with Cash ON D...(Rocky) Jaipur Call Girl - 09521753030 Escorts Service 50% Off with Cash ON D...
(Rocky) Jaipur Call Girl - 09521753030 Escorts Service 50% Off with Cash ON D...
 
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
 
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Varanasi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service Available
 
VIP Call Girls Indore Kirti 💚😋 9256729539 🚀 Indore Escorts
VIP Call Girls Indore Kirti 💚😋  9256729539 🚀 Indore EscortsVIP Call Girls Indore Kirti 💚😋  9256729539 🚀 Indore Escorts
VIP Call Girls Indore Kirti 💚😋 9256729539 🚀 Indore Escorts
 
Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Bareilly Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service Available
 
Call Girls Dehradun Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Dehradun Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Dehradun Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Dehradun Just Call 9907093804 Top Class Call Girl Service Available
 
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
 
Chandrapur Call girls 8617370543 Provides all area service COD available
Chandrapur Call girls 8617370543 Provides all area service COD availableChandrapur Call girls 8617370543 Provides all area service COD available
Chandrapur Call girls 8617370543 Provides all area service COD available
 
Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...
Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...
Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...
 
Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...
Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...
Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...
 
Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Kochi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service Available
 
Call Girls Siliguri Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Siliguri Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Siliguri Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Siliguri Just Call 9907093804 Top Class Call Girl Service Available
 
Top Rated Bangalore Call Girls Richmond Circle ⟟ 8250192130 ⟟ Call Me For Gen...
Top Rated Bangalore Call Girls Richmond Circle ⟟ 8250192130 ⟟ Call Me For Gen...Top Rated Bangalore Call Girls Richmond Circle ⟟ 8250192130 ⟟ Call Me For Gen...
Top Rated Bangalore Call Girls Richmond Circle ⟟ 8250192130 ⟟ Call Me For Gen...
 

Management of coma and altered sensorium 19.4.01

  • 1. Management of Coma and Altered Sensorium
  • 2.
  • 3.
  • 4.
  • 5.
  • 6.
  • 7.
  • 8.
  • 9.
  • 10.
  • 11.
  • 12.
  • 13.
  • 14.
  • 15.
  • 16.
  • 17.
  • 18.
  • 19.
  • 20.
  • 21.
  • 22.
  • 23.
  • 24.
  • 25.
  • 26.
  • 27.
  • 28.
  • 29.
  • 30.
  • 31.
  • 32.
  • 33.