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Coma AlgorithmAka: Approach to Coma

See Also
1. Altered Level of Consciousness
2. ALOC Causes
3. Coma Exam
Psychogenic Coma
1. Electroencephalogram (EEG)
2. Amytal interview
Physiologic Coma: Nonfocal exam
1. Evaluate laboratory data and correct abnormalities
2. If labs Normal then evaluate as with Focal exam below
Physiologic Coma: Focal exam
1. Step 1: Obtain CT Head, If Abnormal:
  1. Ischemic CVA: Supportive care
  2. Hemorrhagic CVA, Tumor or brain Abscess
    1. Herniation
      1. Neurosurgical Consultation stat
      2. Decadron
      3. Mannitol
      4. Hyperventilation
    2. No Herniation
      1. Supportive care
      2. Neurosurgical Consultation
2. Step 2: Obtain Lumbar Puncture, If Abnormal
  1. Meningitis
    1. Antibiotics
  2. Subarachnoid Hemorrhage
    1. Neurosurgical Consultation
3. Step 3: Unclear etiology (above testing normal)
  1. Etiologies
    1. Brain stem infarct
    2. Drug overdose
    3. Complex partial Status Epilepticus
  2. Evaluation
    1. Electroencephalogram (EEG)
    2. MRI Head
  3. Management
    1. Supportive Care

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.