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An approach to critically ill patients in coma 12016243 2002 07 10 2018 11 13 0093-0415 176 3 2002 May The Western journal of medicine West. J. Med. An approach to critically ill patients in coma. 184-7 Liao Y Joyce YJ Department of Neurology and Neurosciences, Room A343, Mail Code 5235, Stanford University Medical Center, CA 94305-5235, USA. So Yuen T YT eng Journal Article Review United States West J Med 0410504 0093-0415 AIM IM Coma diagnosis etiology therapy Critical Illness Glasgow Coma (...) Scale Humans Physical Examination methods Prognosis 10 2002 5 23 10 0 2002 7 12 10 1 2002 5 23 10 0 ppublish 12016243 PMC1071711 Neurol Clin. 2001 May;19(2):347-69 11358748 Ann Intern Med. 1981 Mar;94(3):293-301 7224376 JAMA. 1985 Mar 8;253(10):1420-6 3968772 Emerg Med Clin North Am. 1998 Nov;16(4):701-15, v 9889736 Neurol Clin. 1998 May;16(2):237-56 9537961 Crit Care Clin. 1998 Jul;14(3):497-511 9700444 Lancet. 1998 Dec 5;352(9143):1808-12 9851380 Arch Neurol. 1990 Nov;47(11):1181-4 2241614
Coma Scale (GCS). The results of clinical and EP testing were examined in the light of the patient's outcome 10 months later: 1) fatal outcome was predicted by a GCS of three (38% of cases, p less than or equal to 0.05, Fisher's exact test), abolished brainstem- or papillary reflexes (38%, p less than or equal to 0.05), the combination of these clinical signs (54%, p less than or equal to 0.01), bilateral abolition of elMEPs (38%, p less than or equal to 0.05), magMEPs (38%, p less than or equal (...) Motor and somatosensory evoked potentials in coma: analysis and relation to clinical status and outcome. Central sensory and motor conduction were studied in 23 comatose and three brain-dead patients. Motor evoked potentials (MEPs) to transcranial magnetic (magMEP) and electrical (elMEP) stimulation were recorded from the hypothenar muscle, and somatosensory evoked potentials (SEPs) were recorded after median nerve stimulation. Comparison of clinical with evoked potential (EP) findings revealed
Suppression of brainstem reflexes in barbiturate coma. Brainstem reflexes were examined in 23 children treated with thiopentone infusion and correlated with serum thiopentone concentrations. The results suggest that if all brainstem reflexes are lost with a serum thiopentone concentration less than 40 mg/l, it is unlikely to be due to the thiopentone alone. Other causes including brain death need to be considered.
Don't throw in the towel! A case of reversible coma A young woman with pre-eclampsia became unresponsive shortly after delivery. Examination revealed extensive brain stem dysfunction with absent pupillary light reflexes and decerebrate posturing. Computed tomography showed hypodensity throughout the brain stem, and it was initially thought that she had suffered catastrophic brain stem infarction. However, magnetic resonance diffusion imaging and apparent diffusion coefficient mapping showed
light reflexes in the presence of deep coma with decerebrate posturing should alert the clinician to a possible metabolic cause for the coma, including alcohol. Nevertheless, a diagnosis of alcoholic coma should not be made unless the blood alcohol concentration is grossly elevated and other causes of coma have been excluded by careful physical examination, blood glucose and electrolyte measurement, skull radiography and, in the absence of a rapid improvement, computerized tomography. (...) Decerebrate posturing in alcoholic coma. Two cases of alcoholic coma are presented where extensor responses to noxious stimuli are demonstrated. Decerebrate posturing normally indicates severe structural or functional depression of midbrain function but can be caused by depressant drugs. Blood alcohol measurements are a vital test in the comatose patient as the clinical picture may be caused, or temporarily significantly worsened, by severe alcohol intoxication. The preservation of pupillary
Epidemiologic characteristics of mortality from diabetes with acidosis or coma, United States, 1970-78. Deaths due to diabetes with acidosis or coma (DAC) in the United States from 1970 through 1978 were analyzed to determine epidemiologic characteristics associated with mortality likely to be due to diabetic ketoacidosis (DKA), a complication of diabetes mellitus considered largely preventable. Annual age-adjusted rates for DAC deaths decreased during the study period, and the secular trend (...) was significant in all regional, race, and sex groups examined. General population-based mortality rates increased linearly with age, were higher in non-Whites than in Whites among persons aged greater than 14, were higher in females, and increased significantly with age in both races and both sexes. By region, rates were lowest in the West. DAC mortality rates specific to estimated diabetic populations decreased annually from 1970 to 1978 in all race and sex groups, and were highest at age greater than
Use of abbreviated mental status examination in the initial assessment of overdose patients. Application of formal mental status testing in the emergency department (ED) to assess cognitive function has been hampered by the lack of a rapidly applied instrument. An Abbreviated Mental Status Examination (AMSE) with 10 test items that can be administered within five minutes by nursing personnel is described. Evaluation of the instrument on 296 ambulatory ED patients with grossly normal neurologic (...) function showed that 93% of patients had a total score of seven or more correct answers and 83% of patients had eight or more correct answers. Application of the AMSE to 375 acute drug overdose patients at the same hospital showed a significant correlation with Glasgow Coma Scale (GCS) score. An AMSE score of seven or less was found to be more sensitive than a GCS score of 13 or less for admission to the intensive care unit (ICU) and complications in the ICU (P less than 0.001). The AMSE score may
Comparison of indices of TBI severity: Glasgow coma scale, length of coma, post-traumatic amnesia. Classification of traumatic brain injury (TBI) severity guides management and contributes to determination of prognosis. Common indicators of TBI severity include Glasgow Coma Scale (GCS) scores, length of coma (LOC) and duration of post-traumatic amnesia (PTA).To compare GCS, LOC and PTA by examining distributions and intercorrelations and develop multivariable linear regression models