Neurology Book

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Coma Algorithm

Aka: Coma Algorithm, Approach to Coma
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  1. See Also
    1. Altered Level of Consciousness
    2. ALOC Causes
    3. Coma Exam
  2. Psychogenic Coma
    1. Electroencephalogram (EEG)
    2. Amytal interview
  3. Physiologic Coma: Nonfocal exam
    1. Evaluate laboratory data and correct abnormalities
    2. If labs Normal then evaluate as with Focal exam below
  4. 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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