Skip to main content
Top
Published in: Neurocritical Care 1/2017

01-09-2017

Emergency Neurological Life Support: Approach to the Patient with Coma

Authors: Rhonda S. Cadena, Aarti Sarwal

Published in: Neurocritical Care | Special Issue 1/2017

Login to get access

Abstract

Coma is an acute failure of neuronal systems governing arousal and awareness and represents a medical emergency. When encountering a comatose patient, the clinician must have an organized approach to detect easily remediable causes, prevent ongoing neurologic injury, and determine a hierarchical plan for diagnostic tests, treatments, and neuromonitoring. Coma was chosen as an Emergency Neurological Life Support protocol because timely medical and surgical interventions can be life-saving, and the initial work-up of such patients is critical to establishing a correct diagnosis.
Literature
1.
go back to reference Plum F, Posner JB. The diagnosis of stupor and coma. 3rd ed. Philadelphia: F. A. Davis Co.; 1980. Plum F, Posner JB. The diagnosis of stupor and coma. 3rd ed. Philadelphia: F. A. Davis Co.; 1980.
3.
go back to reference Adams HP Jr, del Zoppo G, Alberts MJ, et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation. 2007;115:e478–534.CrossRefPubMed Adams HP Jr, del Zoppo G, Alberts MJ, et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation. 2007;115:e478–534.CrossRefPubMed
4.
go back to reference Saposnik G, Caplan LR. Convulsive-like movements in brainstem stroke. Arch Neurol. 2001;58(4):654–7.CrossRefPubMed Saposnik G, Caplan LR. Convulsive-like movements in brainstem stroke. Arch Neurol. 2001;58(4):654–7.CrossRefPubMed
5.
go back to reference Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2:81–4.CrossRefPubMed Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2:81–4.CrossRefPubMed
6.
go back to reference Wijdicks EF, Rabinstein AA, Bamlet WR, Mandrekar JN. FOUR score and Glasgow Coma Scale in predicting outcome of comatose patients: a pooled analysis. Neurology. 2011;77:84–5.CrossRefPubMed Wijdicks EF, Rabinstein AA, Bamlet WR, Mandrekar JN. FOUR score and Glasgow Coma Scale in predicting outcome of comatose patients: a pooled analysis. Neurology. 2011;77:84–5.CrossRefPubMed
7.
go back to reference Wijdicks EF, Bamlet WR, Maramattom BV, Manno EM, McClelland RL. Validation of a new coma scale: the FOUR score. Ann Neurol. 2005;58:585–93.CrossRefPubMed Wijdicks EF, Bamlet WR, Maramattom BV, Manno EM, McClelland RL. Validation of a new coma scale: the FOUR score. Ann Neurol. 2005;58:585–93.CrossRefPubMed
8.
go back to reference Ferbert A, Bruckmann H, Drummen R. Clinical features of proven basilar artery occlusion. Stroke J Cereb Circ. 1990;21:1135–42.CrossRef Ferbert A, Bruckmann H, Drummen R. Clinical features of proven basilar artery occlusion. Stroke J Cereb Circ. 1990;21:1135–42.CrossRef
9.
go back to reference Tatman A, Warren A, Williams A, Powell JE, Whitehouse W. Development of a modified paediatric coma scale in intensive care practice. Arch Dis Child. 1997;77:519–21.CrossRefPubMedPubMedCentral Tatman A, Warren A, Williams A, Powell JE, Whitehouse W. Development of a modified paediatric coma scale in intensive care practice. Arch Dis Child. 1997;77:519–21.CrossRefPubMedPubMedCentral
10.
go back to reference Kirkham KJ, Newton CR, Whitehouse W. Paediatric coma scales. Dev Med Child Neurol. 2008;50(4):267–74.CrossRefPubMed Kirkham KJ, Newton CR, Whitehouse W. Paediatric coma scales. Dev Med Child Neurol. 2008;50(4):267–74.CrossRefPubMed
11.
go back to reference Michelson DJ, Ashwal S. Evaluation of coma and brain death. Semin Pediatr Neurol. 2004;11(2):105–18.CrossRefPubMed Michelson DJ, Ashwal S. Evaluation of coma and brain death. Semin Pediatr Neurol. 2004;11(2):105–18.CrossRefPubMed
Metadata
Title
Emergency Neurological Life Support: Approach to the Patient with Coma
Authors
Rhonda S. Cadena
Aarti Sarwal
Publication date
01-09-2017
Publisher
Springer US
Published in
Neurocritical Care / Issue Special Issue 1/2017
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-017-0452-1

Other articles of this Special Issue 1/2017

Neurocritical Care 1/2017 Go to the issue