Neurology Book

Approach

http://www.fpnotebook.com/

Coma Exam

Aka: Coma Exam
  1. See Also
    1. Coma
    2. Level of Consciousness
    3. Altered Level of Consciousness
    4. AVPU Scale
    5. Glasgow Coma Scale
    6. FOUR Score Coma Exam (Full Outline of Unresponsiveness)
    7. Mental Status Exam
  2. Background: Key goal of Coma Exam is distinguish cause
    1. Toxic or metabolic cause
    2. Structural cause
  3. Exam: Vitals
    1. Hyperventilation
      1. Consider underlying Metabolic Acidosis or Hypoxemia
    2. Abnormal Pulse
    3. Abnormal Blood Pressure
    4. Rectal Temperature
  4. Exam: General
    1. Breath (also see Toxin Induced Odors)
      1. Alcohol
      2. Fruity breath (Diabetes Mellitus)
      3. Almonds (Cyanide toxicity)
      4. Insecticides (Organophosphate Toxicity)
    2. Head Trauma signs
      1. Hemotympanum
      2. Cephalohematoma
      3. CSF leakage from nares or ear canal
    3. Neck
      1. Meningismus
      2. Thyromegaly
    4. Cardiopulmonary exam
      1. Pulmonary Rales or Wheezes
      2. Chest Scars
      3. Cardiac Murmurs
      4. Irregular rhythm (Atrial Fibrillation)
      5. Breathing pattern (e.g. Cheyne-Stokes Respiration)
    5. Abdomen
      1. Bowel sounds
      2. Ascites or Hepatomegaly (Hepatic Encephalopathy)
      3. Abdominal Aortic Aneurysm
    6. Skin
      1. Jaundice
      2. Needle Tracks (Intravenous Drug Abuse)
      3. Petechiae
      4. Skin Temperature
      5. Hydration
  5. Exam: Neurologic
    1. Brainstem Reflexes
      1. Eye Neurologic Exam
      2. Oculocephalic Reflex (Doll's Eyes)
      3. Oculovestibular Testing (Cold Calorics)
        1. Normal: Eyes shift with head movement
        2. Absent: Severe brain injury (or awake or Cranial Nerve Injury)
      4. Glasgow Coma Scale
      5. FOUR Score Coma Exam (Full Outline of Unresponsiveness)
    2. Autisms (Involuntary protective-type acts)
      1. Yawning
      2. Hiccups
      3. Sneezing
      4. Swallowing
    3. Motor Testing
      1. Observe at rest
        1. Spontaneous movements
        2. Posturing
      2. Purposeful movement (e.g. response to pain)
        1. Indicates intact Brainstem
        2. Indicates intact cortex
      3. Response to painful stimuli
        1. Abduction or adduction
        2. Posturing
          1. Decorticate Posturing
          2. Decerebrate Posturing
        3. Triple flexion response (spinal reflex)
        4. Asymmetric response
        5. Flaccid paralysis
  6. References
    1. Orman and Chang in Herbert (2017) EM:Rap 17(4): 8-9

You are currently viewing the original 'fpnotebook.com\legacy' version of this website. Internet Explorer 8.0 and older will automatically be redirected to this legacy version.

If you are using a modern web browser, you may instead navigate to the newer desktop version of fpnotebook. Another, mobile version is also available which should function on both newer and older web browsers.

Please Contact Me as you run across problems with any of these versions on the website.

Navigation Tree