CT scan noncontrast is emergently performed. A CT angiogram can be added to this study in the patient thought to have a potential vascular etiology for the comatose state, such as basilar artery thrombosis. Alternately, emergent MRI may be performed but is not available in the same time frame as a stat head CT in most medical centers. Emergent laboratory studies include serum levels of glucose, sodium, calcium, BUN, creatinine and osmolality; arterial or venous blood gases to evaluate pH, po2 and pco2; as well as blood and urine toxicology testing. Co-oximetry analysis should be included in the emergency room assessment to investigate carbon monoxide poisoning.
Blood and CSF should be cultured if infection is suspected. If the history, physical exam, initial head CT and laboratory studies do not reveal the etiology of coma further studies are pursued. Magnetic resonance imaging provides higher-resolution anatomic imaging. Neurology consultation is usually obtained by this point in the work-up.
Electroencephalography EEG may distinguish coma from locked-in syndrome or psychic unresponsiveness and can detect subclinical status epilepticus non-convulsive seizures. Other studies may be used at this point but are beyond the scope of this chapter. Coma is a medical emergency.
Reflexions - Coma and disorders of consciousness
Rapid clinical, radiologic and laboratory assessment must proceed immediately to rule out acutely life-threatening correctable conditions or injuries. The degree of coma can be assessed by the Glasgow Coma Scale.
It correlates with prognosis in patients with a traumatic etiology of coma. There are numerous potential etiologies for coma that go far beyond this discussion. The intensivist should consider general categories of pathologic states that can lead to coma. This obviously occurs once the patient is confirmed to have adequate oxygenation, ventilation, and hemodynamic function i.
Categories in the differential diagnosis of coma include:.
Coma and disorders of consciousness.
Pseudo-coma residual neuromuscular blockade, psychogenic coma, locked-in syndrome. The locked-in syndrome is another condition that resembles coma. It usually results from ventral pontine damage with sparing of the reticular activating system and cerebral hemispheres. Int Anesthesiol Clin.
Ann Neurol. The main part of the work is devoted to the different techniques available to research and medicine to study consciousness and take care of patients in terms of diagnosis, prognosis and treatment.
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Hence, the book explains the possibilities offered by electrophysiology electroencephalography and evoked potentials , MRI spectroscopy and functional neuroimaging PET scan and fMRI , but also the behaviour scales elaborated to assess consciousness or pain in patients. The emphasis is also on the Brain-Computer Interface, which is, as explained in the book, "a system that allows the brain to communicate with the outside world, without passing by the peripheral nervous system and muscles, by directly converting brain activity into command signals for electronic devices.
The book also deals with other problems, such as sleep in patients with disorders of consciousness, the feasibility of feeding these people orally, pharmacological treatments for subjects recovering from a coma or the ethical and legal questions raised by taking care of patients with disorders of consciousness. Who is the target audience of your work? In particular, it also concerns researchers involved in the domain of consciousness, especially neuroscientists, biologists and all those, including mathematicians, physicians, and computer engineers, who work on neural modelling and the various technical aspects of the procedures implemented in research and in hospitals.
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We have a dedicated site for Germany. This revised and expanded second edition discusses the assessment and treatment of patients recovering from coma and disorders of consciousness.
WFN Launches Coma and Disorders of Consciousness Research Group
Besides diagnostic, prognostic and ethical issues, this book describes well-established techniques and procedures, and also techniques under development. New chapters include consciousness theories, issues relating to long-term care, and neuromodulation treatments. Coma and Disorders of Consciousness, Second Edition is a comprehensive review of the field for clinicians and researchers, regardless of whether they are already familiar with the difficult but exciting field of disorders of consciousness.
The book meets these objectives by addressing questions that remain to be answered regarding comatose patients.