UNCONSCIOUS?What to look for

CONSCIOUSNESS• Arousal-

• Level of alertness• Deep brainstem and medial thalamus• Ascending reticular activating system (RAS)

• Cognition-• Level of awareness and coherence• Cerebral cortex and major subcortical nuclei

COMA – WHAT IS IT?• A state of complete loss of consciousness from which the

patient cannot be aroused by ordinary stimuli

• Quantification difficult

• Glasgow coma scale

GLASGOW COMA SCALE

ASK FOR…….• Sequence of events-

• Relatives• Co-habitants• First responders• Witnesses

• Past history• Current medications

WHAT TO DO FIRST• Safe position – neck

• Airway

• Breathing

• Circulation

GENERALLY SPEAKING……..• Evidence of injury• Vitals-

• PR, BP, Respiration, Temperature• Posture• Movements-

• Spontaneous• Response to stimuli

• Appearance, Grooming• Signs of chronic disease• Neurologic examination• Blood sugar value

NEUROLOGICALLY SPEAKING…..• Pupils• Breathing• Motor response• Sensory response• Reflexes• Meningeal signs

PUPILS• Size• Shape• Position• Equality• Reactivity• Reflexes-

• Oculocephalic• Vestibulocephalic

BREATHING• Pattern-

• Frequency• Depth

• Involvement of respiratory centers

• Metabolic

MOTOR RESPONSE• Face is an important area!• Presence of movement• Asymmetry• Abnormal movement• Unprovoked movements• Tone

• Dropping the limb

POSTURE

SENSORY• Stimuli to both sides to be checked• Asymmetry noted• All modalities-

• Touch• Pain• Temperature

REFLEXES• Corneal• Conjunctival• Tendon• Plantar• Primitive

MENINGEAL SIGNS• Neck stiffness• Kernig’s• Brudzinski’s

WHAT IS IT ALL FOR?!