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is a state of unconsciousness in which a person: cannot be
awakened; fails to respond normally to painful stimuli, light, or
sound; and, does not initiate voluntary actions.
Coma
Coma
Pathophysiology:
History of present illness is vital to determine the underlying
cause.
Determine when the patient was last seen normal.
Evaluate the speed of onset.
is a neurological scale that aims to give a reliable recording about
the conscious state of a person.
A patient is assessed against the criteria of the scale, and the
resulting points give a patient score between 3 (indicating deep
unconsciousness) and15.
Glasgow Coma Scale (GCS)
Best eye response (E)
Best verbal response (V)
Best motor response (M)
4 Eyes opening spontaneously
5 Oriented 6 Obeys commands
3 Eye opening to speech
4 Confused 5 Localizes to pain
2 Eye opening in response to pain
3 Inappropriate words 4 Withdraws from pain
1 No eye opening 2 Incomprehensible sounds 3 Abnormal Flexion
1 None 2 Abnormal Extension
1 No motor response
Glasgow Coma Scale (GCS)
brain injury is classified as:
Severe, with GCS < 8-9.
Moderate, GCS 8 –12 .
Minor, GCS ≥ 13.
Normal : 14 - 15
Management
Support vital functions ( ABC ).
Special attention to the history about the cause.
Administer naloxone if you suspect narcotic overdose.
Patients may need:
Urine and blood analysis.
Radiography.
Computed tomography.
Magnetic resonance imaging.
Seizures
Incidence:
Account for up to 30% of EMS calls.
In the United States, it is estimated that 4 million people
have epilepsy.
Pathophysiology
Sudden firing of neurons.
Signs and symptoms include:
Muscle spasms.
Increased secretions.
Cyanosis.
• If a seizure continues for a long time:
Cerebral glucose and oxygen supplies can be depleted.
There can be serious, long term effects, including death.
Seizures
Absence seizures (petit mal seizures)
Pseudoseizures
partial seizures
generalized seizures ( grand mal seizures )
Absence seizures (petit mal seizures) Typical patient: child.
Patient stops and freezes mid action.
Usually no longer than several seconds.
Pseudo seizures: Cause is of psychiatric origin.
Triggered by emotional event, stress, lights, or pain.
partial seizures:
Only a limited part of the brain is involved.
Simple partial seizures involve one part of the body.
generalized seizures ( grand mal seizures ):
• Full body continuous strong jerking movements.
• It may be caused by psychological trauma.
• The patient is not pretending.
Other problems associated with the seizure:
Patients who have fallen during a seizure may have a head injury.
Patients having a generalized seizure may also experience
incontinence.
Decrease in the oxygen and glucose demand of the brain.
Management:
Remain calm.
Prevent the patient from becoming injured.
Do not place anything in the patient’s mouth.
Loosen the tie.
Let the patient to lie in a recovery position.
Correct hypoglycemia as needed.
Ventilatory assistance may be necessary.
All patients should be transported.
Be prepared to administer diazepam or lorazepam.
Pathophysiology:
Seizure that lasts longer than 4 to 5 minutes or consecutive
seizures without a return to consciousness between seizures.
Refer to local guidelines regarding intervention.
Nearly 20% of patients die.
May result in neurons being damaged or killed.
Goal: stop seizure and ensure adequate ABCs.
Status epileptics
Reference:
AAOS Emergency Care in the Streets 7th Edition, Caroline
Jones & Bartlett, 2012; ISBN 13: 978-1-469-0922-1
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