Coma - 58-1
Coma, whether transient or persistent, is a state of pathologic unconsciousness. Coma requires urgent evaluation to avoid permanent brain injury or death.
- Focal disease (e.g., tumor, stroke)
- Diffuse disease
- Vascular (e.g., hypertensive encephalopathy, syncope)
- Infectious (e.g., meningitis, encephalitis)
- Metabolic (e.g., uremia, hypercalcemia, hypoglycemia)
- Substance use and overdose
Given a patient in coma, the candidate will diagnose the cause, severity, and complications, and will initiate an appropriate management plan. Particular attention should be paid to urgent and emergent conditions.
Given a patient in coma, the candidate will
- list and interpret critical clinical findings, including those derived from
- a complete history and corroboration of information from appropriate sources;
- the identification of most likely causes of coma by means of a complete physical examination including appropriate neurological examination;
- the determination of level of consciousness using an appropriate assessment tool (e.g., glasgow coma scale);
- list and interpret critical investigations, including
- laboratory investigations (e.g., toxin screen, glucose), diagnostic imaging (e.g., computerized tomography, magnetic resonance imaging) and others (e.g., lumbar puncture, electroencephalography);
- construct an effective initial management plan, including
- initiating urgent care (e.g., airway, breathing, circulation) and appropriate empiric treatment as indicated (narcotic/benzodiazepine reversal, glucose);
- instituting immediate treatment as required (e.g., antibiotics, anticonvulsants);
- referring the patient for specialized care (e.g., neurosurgery), if necessary;
- seeking clarification of proxy decision-making while the patient is incapacitated.