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Coma Exam
- Key goal of coma exam is distinguish cause
- Toxic or metabolic cause
- Structural cause
- Vitals
- Hyperventilation
- Consider underlying Metabolic Acidosis or Hypoxemia
- Abnormal pulse
- Abnormal Blood Pressure
- Rectal temperature
- General Exam
- Breath (also see Toxin Induced Odors)
- Alcohol
- Fruity breath (Diabetes Mellitus)
- Almonds (Cyanide toxicity)
- Insecticides (Organophosphate Toxicity)
- Head Trauma signs
- Hemotympanum
- Cephalohematoma
- CSF leakage from nares or ear canal
- Neck
- Meningismus
- Thyromegaly
- Cardiopulmonary exam
- Pulmonary Rales or Wheezes
- Chest Scars
- Cardiac Murmurs
- Irregular rhythm (Atrial Fibrillation)
- Abdomen
- Bowel sounds
- Ascites or Hepatomegaly (Hepatic Encephalopathy)
- Abdominal Aortic Aneurysm
- Skin
- Jaundice
- Needle Tracks (Intravenous Drug Abuse)
- Petechiae
- Skin temperature
- Hydration
- Neurologic Observation
- Autisms (Involuntary protective-type acts)
- Yawning
- Hiccups
- Sneezing
- Swallowing
- Respiratory patterns
- Neurologic Exam
- Mental Status Exam
- Eye Neurologic Exam
- Oculocephalic Reflex (Doll's Eyes)
- Oculovestibular Testing (Cold Calorics)
- Motor Testing
- Observe at rest
- Spontaneous movements
- Posturing
- Purposeful movement
- Indicates intact brainstem
- Indicates intact cortex
- Response to painful stimuli
- Abduction or adduction
- Posturing
- Decorticate posturing
- Decerebrate posturing
- Triple flexion response (spinal reflex)
- Asymmetric response
- Flaccid paralysis
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