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Coma Exam

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1. Coma Exam

Coma Exam Coma Exam Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Coma Exam Coma Exam Aka: Coma Exam II. Background: Key goal (...) of Coma Exam is distinguish cause Toxic or metabolic cause Structural cause III. Exam: Vitals Consider underlying or Abnormal IV. Exam: General Breath (also see ) Fruity breath ( ) Almonds ( toxicity) s ( Toxicity) signs Hemotympanum CSF leakage from nares or ear canal Neck Meningismus Thyromegaly Cardiopulmonary exam Pulmonary Rales or s Scars Cardiac Murmurs Irregular rhythm ( ) Breathing pattern (e.g. ) sounds or ( ) Skin Needle Tracks ( ) Skin Hydration V. Exam: Neurologic Reflexes ( ) ( ) Normal

2018 FP Notebook

2. FOUR Score Coma Exam

FOUR Score Coma Exam FOUR Score Coma Exam Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 FOUR Score Coma Exam FOUR Score Coma Exam (...) Aka: FOUR Score Coma Exam , Full Outline of Unresponsiveness , FOUR Score II. Criteria: Calculate total points (4 scores totaling 16 points) Eye Response Score 4: s open or opened, tracks and blinks to command Score 3: s open but are not tracking Score 2: s close but open with loud voice Score 1: s closed but open to pain Score 0: s remain closed despite painful stimuli Motor Response Score 4: Makes thumbs up, fist or peace sign Score 3: Localizes to pain Score 2: Flexion in response to pain Score

2018 FP Notebook

3. FOUR Score Coma Exam

FOUR Score Coma Exam FOUR Score Coma Exam Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 FOUR Score Coma Exam FOUR Score Coma Exam (...) Aka: FOUR Score Coma Exam , Full Outline of Unresponsiveness , FOUR Score II. Criteria: Calculate total points (4 scores totaling 16 points) Eye Response Score 4: s open or opened, tracks and blinks to command Score 3: s open but are not tracking Score 2: s close but open with loud voice Score 1: s closed but open to pain Score 0: s remain closed despite painful stimuli Motor Response Score 4: Makes thumbs up, fist or peace sign Score 3: Localizes to pain Score 2: Flexion in response to pain Score

2017 FP Notebook

4. Post-anoxic quantitative MRI changes may predict emergence from coma and functional outcomes at discharge. (Full text)

days of arrest and used a semi-automated algorithm to perform quantitative volumetric analysis of apparent diffusion coefficient (ADC) sequences at various thresholds. Area under receiver operating characteristic curves (ROC-AUC) were estimated to compare predictive values of quantitative MRI with pupillary exam at days 3, 5 and 7 post-arrest, for persistence of coma and functional outcomes at discharge. Cerebral Performance Category scores of 3-4 were considered poor outcome.Excluding patients (...) Post-anoxic quantitative MRI changes may predict emergence from coma and functional outcomes at discharge. Traditional predictors of neurological prognosis after cardiac arrest are unreliable after targeted temperature management. Absence of pupillary reflexes remains a reliable predictor of poor outcome. Diffusion-weighted imaging has emerged as a potential predictor of recovery, and here we compare imaging characteristics to pupillary exam.We identified 69 patients who had MRIs within seven

2017 Resuscitation PubMed

5. Coma Exam

Coma Exam Coma Exam Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Coma Exam Coma Exam Aka: Coma Exam II. Background: Key goal (...) of Coma Exam is distinguish cause Toxic or metabolic cause Structural cause III. Exam: Vitals Consider underlying or Abnormal IV. Exam: General Breath (also see ) Fruity breath ( ) Almonds ( toxicity) s ( Toxicity) signs Hemotympanum CSF leakage from nares or ear canal Neck Meningismus Thyromegaly Cardiopulmonary exam Pulmonary Rales or s Scars Cardiac Murmurs Irregular rhythm ( ) Breathing pattern (e.g. ) sounds or ( ) Skin Needle Tracks ( ) Skin Hydration V. Exam: Neurologic Reflexes ( ) ( ) Normal

2015 FP Notebook

6. Critical Care Observation of Motor Activity (COMA) and SICU Outcomes

): Matthias Eikermann, Massachusetts General Hospital Study Details Study Description Go to Brief Summary: In the surgical intensive care unit (SICU), goals of critical care are often discussed in long-term ventilated patients around the time of extubation. Muscle weakness predicts extubation failure but formal muscle strength assessment by the Medical Research Council scale is time-consuming and not part of the daily clinical exam. In this observational study, we hypothesize that COMA measurement (...) Critical Care Observation of Motor Activity (COMA) and SICU Outcomes Critical Care Observation of Motor Activity (COMA) and SICU Outcomes - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Critical Care

2016 Clinical Trials

7. Coma

of dysfunction of awareness and arousal III. Pathophysiology Bilateral cortical disease Unilateral disease does not cause coma Metabolic and toxic derangements most common Focal Neurologic signs absent except in Suppression of Reticular Activating System (RAS) Supratentorial pressure Infratentorial pressure Cerebellar Posterior fossa tumor Intrinsic lesion tic pontine Hypertensive pontine Neurologic degenerative diseases tumor Torque on from sudden head blow IV. Exam See V. Differential Diagnosis See See (...) Psychogenic Coma (EEG) Amytal interview VI. Evaluation See Step 0: Review History, Exam, Labs Physiologic Coma with Nonfocal exam may suggest metabolic cause Step 1: Obtain and If Abnormal: : Supportive care , Tumor or tion Neurosurgical stat Decadron Mannitol No tion Supportive care Neurosurgical Step 2: Obtain and If Abnormal Antibiotics Neurosurgical Step 3: Unclear etiology (above testing normal) Etiologies infarct Drug Complex partial Evaluation (EEG) Management Supportive Care VII. Management See

2018 FP Notebook

8. Prediction of blunt traumatic injuries and hospital admission based on history and physical exam (Full text)

and for appropriate admission triage decisions.Using only their history and physical exam, and prior to any imaging studies, three (3) experienced trauma surgeons, with a combined Level 1 trauma experience of over 50 years, predicted injuries in patients with an initial GCS (Glasgow Coma Score) of 14-15. Additionally, ED disposition (ICU, floor, discharge to home) was also predicted. These predictions were compared to actual patient dispositions and to blunt injuries documented at discharge.A total of 101 (...) Prediction of blunt traumatic injuries and hospital admission based on history and physical exam We evaluated the ability of experienced trauma surgeons to accurately predict specific blunt injuries, as well as patient disposition from the emergency department (ED), based only on the initial clinical evaluation and prior to any imaging studies. It would be hypothesized that experienced trauma surgeons' initial clinical evaluation is accurate for excluding life-threatening blunt injuries

2016 World journal of emergency surgery : WJES PubMed

9. Automated Pupillometry for Coma Prognostication After Cardiac Arrest

Automated Pupillometry for Coma Prognostication After Cardiac Arrest Automated Pupillometry for Coma Prognostication After Cardiac Arrest - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Automated (...) Pupillometry for Coma Prognostication After Cardiac Arrest The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT02607878 Recruitment Status : Completed First Posted : November 18, 2015 Last Update Posted : April 2, 2018 Sponsor: Centre Hospitalier Universitaire Vaudois Collaborators: Erasme University Hospital

2015 Clinical Trials

10. Vagal Nerve Stimulation in Coma Patients

stimulation and a second one after 3 months of stimulation. ] Investigators will use the radioligand Fluorodesoxyglucose [18F-FDG] to assess brain consumption of glucose. This measure is complementary to the one provided by fMRI and has already been used in coma patients. Moreover, thanks to a hybrid MRI/PET scanner, investigators will perform the two exams simultaneously to correlate these two measures in real time. Monitoring heart rate variability [ Time Frame: First assessment one week before (...) Vagal Nerve Stimulation in Coma Patients Vagal Nerve Stimulation in Coma Patients - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Vagal Nerve Stimulation in Coma Patients (SNV) The safety and scientific

2015 Clinical Trials

11. Hyperosmolar Coma (Treatment)

Hyperosmolar Coma (Treatment) Hyperosmolar Hyperglycemic State Treatment & Management: Approach Considerations, Standard Care for Dehydration and Altered Mental Status, Insulin Therapy for Correction of Hyperglycemia Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache (...) management, IV access, crystalloid fluid replacement, and administration of any medications routinely given to coma patients. Airway management Protection of the airway is mandatory in patients presenting with mental status changes, obtundation, or unconsciousness. Patients may present with respiratory failure and circulatory collapse and must be ventilated mechanically. If patients are presenting with metabolic acidosis, take care to hyperventilate them when mechanical ventilation is instituted

2014 eMedicine.com

12. Hyperosmolar Coma (Follow-up)

Hyperosmolar Coma (Follow-up) Hyperosmolar Hyperglycemic State Treatment & Management: Approach Considerations, Standard Care for Dehydration and Altered Mental Status, Insulin Therapy for Correction of Hyperglycemia Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache (...) management, IV access, crystalloid fluid replacement, and administration of any medications routinely given to coma patients. Airway management Protection of the airway is mandatory in patients presenting with mental status changes, obtundation, or unconsciousness. Patients may present with respiratory failure and circulatory collapse and must be ventilated mechanically. If patients are presenting with metabolic acidosis, take care to hyperventilate them when mechanical ventilation is instituted

2014 eMedicine.com

13. Coma Algorithm

, Approach to Coma From Related Chapters II. Approach: Psychogenic Coma (EEG) Amytal interview III. Approach: Physiologic Coma with Nonfocal exam Evaluate laboratory data and correct abnormalities If labs Normal then evaluate as with Focal exam below IV. Approach: Physiologic Coma with Focal exam Step 1: Obtain , If Abnormal: : Supportive care , Tumor or tion Neurosurgical stat Decadron Mannitol No tion Supportive care Neurosurgical Step 2: Obtain , If Abnormal Antibiotics Neurosurgical Step 3: Unclear (...) Coma Algorithm Coma Algorithm Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Coma Algorithm Coma Algorithm Aka: Coma Algorithm

2015 FP Notebook

14. Coma

of dysfunction of awareness and arousal III. Pathophysiology Bilateral cortical disease Unilateral disease does not cause coma Metabolic and toxic derangements most common Focal Neurologic signs absent except in Suppression of Reticular Activating System (RAS) Supratentorial pressure Infratentorial pressure Cerebellar Posterior fossa tumor Intrinsic lesion tic pontine Hypertensive pontine Neurologic degenerative diseases tumor Torque on from sudden head blow IV. Exam See V. Differential Diagnosis See See (...) Psychogenic Coma (EEG) Amytal interview VI. Evaluation See Step 0: Review History, Exam, Labs Physiologic Coma with Nonfocal exam may suggest metabolic cause Step 1: Obtain and If Abnormal: : Supportive care , Tumor or tion Neurosurgical stat Decadron Mannitol No tion Supportive care Neurosurgical Step 2: Obtain and If Abnormal Antibiotics Neurosurgical Step 3: Unclear etiology (above testing normal) Etiologies infarct Drug Complex partial Evaluation (EEG) Management Supportive Care VII. Management See

2015 FP Notebook

15. Overview of Coma and Impaired Consciousness

the American... 3D Model Herniated Nucleus Pulposus Video How to do a 4-Minute Neurologic Exam SOCIAL MEDIA Add to Any Platform Loading , MD, National Heart, Lung, and Blood Institute Click here for Patient Education NOTE: This is the Professional Version. CONSUMERS: Topic Resources Coma is unresponsiveness from which the patient cannot be aroused. Impaired consciousness refers to similar, less severe disturbances of consciousness; these disturbances are not considered coma. The mechanism for coma (...) Overview of Coma and Impaired Consciousness Overview of Coma and Impaired Consciousness - Neurologic Disorders - MSD Manual Professional Edition Brought to you by The trusted provider of medical information since 1899 SEARCH SEARCH MEDICAL TOPICS Common Health Topics Resources QUIZZES & CASES Quizzes Cases The trusted provider of medical information since 1899 SEARCH SEARCH MEDICAL TOPICS Common Health Topics Resources QUIZZES & CASES Quizzes Cases / / / / IN THIS TOPIC OTHER TOPICS

2013 Merck Manual (19th Edition)

16. Coma (Full text)

Coma Coma - Wikipedia Coma From Wikipedia, the free encyclopedia For other uses, see and . Not to be confused with . State of unconsciousness Coma , A coma is a deep state of prolonged in which a person cannot be awakened; fails to respond normally to painful stimuli, light, or sound; lacks a normal wake-sleep cycle; and does not initiate voluntary actions. Coma patients exhibit a complete absence of wakefulness and are unable to consciously feel, speak or move. Comas can be derived by natural (...) causes, or can be . Clinically, a coma can be defined as the inability to consistently follow a one-step command. It can also be defined as a score of ≤ 8 on the (GCS) lasting ≥ 6 hours. For a patient to maintain consciousness, the components of wakefulness and awareness must be maintained. describes the quantitative degree of , whereas relates to the qualitative aspects of the functions mediated by the cortex, including cognitive abilities such as attention, sensory perception, explicit memory

2012 Wikipedia PubMed

17. Lassa fever

and death. History and exam presence of risk factors fever ≥37.5°C elevated respiratory rate low systolic blood pressure malaise nausea/vomiting headache sore throat/pharyngitis conjunctivitis chest pain/cough myalgia deafness (sensorineural) facial oedema bleeding abdominal pain diarrhoea confusion and altered Glasgow Coma Scale or seizures effusions occupational exposure living/working in, or arrival from, endemic area contact with infected body fluids butchering and/or eating rodent meat bioterrorism

2019 BMJ Best Practice

18. Hyponatraemia

of hyponatraemia.) This topic principally focuses on hypotonic (hypo-osmolar) hyponatraemia, the most common type of hyponatraemia. History and exam presence of risk factors high fluid intake fluid losses history of diabetes mellitus history of cirrhosis, nephrosis, congestive heart failure nausea/vomiting mild cognitive symptoms altered mental status, seizures, coma low urine output weight changes orthostatic hypotension abnormal jugular venous pressure poor skin turgor dry mucous membranes absence

2019 BMJ Best Practice

19. Guidelines for diagnosing and managing pediatric concussion

5.4a(v) Refer the child/adolescent to a pediatric sleep specialist if sleep has not improved. C 5.4b(i) Take a history of any headaches. B 5.4b(ii) Establish the degree and duration of the disability that the headaches cause. B 5.4b(iii) Perform a neurological exam and a head/neck exam. C 5.4b(iv) Consider non-pharmacological, complementary and/or alternative medicine therapies for headache. C 5.4b(v) Consider treating migraine headaches with prescription medication. B Chapter: Tipsheet Guidelines (...) the following tools as appropriate. o Tool 2.1: Management of Acute Symptoms Algorithm. o Tool 2.2: Acute Concussion Evaluation (ACE). o Tool 0.2: ChildSCAT3 Sport Concussion Assessment Tool for Children aged 5-12 (symptom evaluation). o Tool 1.1: SCAT3 Sport Concussion Assessment Tool for Athletes aged 13+ (symptom evaluation). o Tool 2.4: Neurologic and Musculoskeletal Exam. • Consider signs and symptoms in context with the child/adolescent’s normal performance, especially for those with learning

2019 CPG Infobase

20. West Nile virus

. No vaccine or specific antiviral treatment is available. Definition An infection caused by West Nile virus (WNV), a flavivirus of the family Flaviviridae, that is transmitted to humans by mosquito bites or through contact with infected blood. The majority of cases are asymptomatic, but infection can cause a self-limited influenza-like illness (West Nile fever or WNF) or, rarely, West Nile neuroinvasive disease (WNND). Kunjin virus is a subtype of West Nile virus endemic to Oceania. History and exam fever (...) of sudden onset malaise myalgia arthralgia pharyngitis anorexia abdominal pain visual disturbances headache rash lymphadenopathy conjunctival injection multi-focal chorioretinal lesions chorioretinitis and inflammatory vitritis seizures respiratory distress jaundice epigastric tenderness mild confusion disorientation stupor/coma neck stiffness Kernig's sign Brudzinski's sign muscle paralysis parkinsonism ataxia myoclonus tremors nausea/vomiting generalised muscle weakness splenomegaly retinal

2018 BMJ Best Practice

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