II. Approach: Psychogenic Coma

  1. Electroencephalogram (EEG)
  2. Amytal interview

III. Approach: Physiologic Coma with Nonfocal exam

  1. Evaluate laboratory data and correct abnormalities
  2. If labs Normal then evaluate as with Focal exam below

IV. Approach: Physiologic Coma with 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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