3. GLASGOW COMA SCALE E : Eye Opening V : Best Verbal Response M : Best Motor Response total scoring
4. -> Open * Spontaneously 4 * To Verbal 3 * To Pain 2 -> No response 1 EYE OPENING
5.
6. BEST MOTOR RESPONSE -> To Verbal Command * Obey 6 -> To Painful Response * Localizes pain 5 * Flexion withdrawal 4 * Flexion - abnormal 3 * Extension – abnormal 2 * No response 1
7. * Greek word “ Koma ” meaning state of sleep” * Hippocrates, describe this very state of the brain at the lowest end of the spectrum of function. * "coma is a state of unresponsiveness from which an individual has not yet been aroused " . What is COMA
9. Advanced Trauma Life Support (ATLS) Level of consciousness-- AVPU A – Alert V – Response to Verbal stimuli P – Response to Pain stimuli U - Unconscious
15. Blood EtOH level 20-50 Impair fine motor function 50-100 Impair judge & coordination 100-150 Difficult walk & balance 150-200 Lethargy 300 Coma 400 Respiratory depression 500 Potential death
16. E – ENDOCRINE / ELECTROLYTES *Hypothyroidism *Hyperthyroidism *Hyperparathyroidism *Adrenal hypofunction *Diabetes Mellitus *Hyponatremia <120mEq/dl *Hepatic coma *Serum Osmolality <260mOsm/L > 330mOsm/L *Hypercalcemia Ca >19mg/dl *Hyperviscosity > 4cp (1.4-1.8)
17. I – INSULIN Hypoglycemia Adult Plasma < 45mg/dl Child < 40mg/dl Hyperglycemia Glucose > 600 + OSM > 340
18. O – OPIATES / OXYGEN * Meperidine,opiate,codeine, morphine,cocaine etc * CO 2 retension + acidosis Hypoxia
26. HEENT Mydriasis - organophosphate Miosis - narcotic, anticholinergic, potine lesion Loss of pupillary reflex or anisocoria - structural lesion Evidence of head trauma - contusion, hematoma, laceration, hemotympanum. Neck - nuchal rigidity, meningitis, SAH
27. NEUROLOGICAL Decorticate Posturing - suggest severe damage above the midbrain. Decerebrate Posturing - suggest damage at the midbrain or diencephalon Asymmetrical Movements - structural lesion Persistent twitching of an extremity - stutus epilepticus