MANAGEMENT OF COMA By Dr. G.Srinivas Associate Professor of Medicine.
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Transcript of MANAGEMENT OF COMA By Dr. G.Srinivas Associate Professor of Medicine.
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MANAGEMENT MANAGEMENT OF COMAOF COMA
By By Dr. G.SrinivasDr. G.Srinivas
Associate Professor of Associate Professor of MedicineMedicine
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INVESTIGATIONS INVESTIGATIONS
GUIDED BY HISTORY AND GUIDED BY HISTORY AND EXAMINATIONEXAMINATION
PTS WITH RAISED ICT – LP PTS WITH RAISED ICT – LP CT SCAN CT SCAN MRI MRI
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KNOWN CASE OF EPILEPSYKNOWN CASE OF EPILEPSY 1. LEVELS OF 1. LEVELS OF
ANTICONVULSANTS.ANTICONVULSANTS. 2. EEG2. EEG
URINE ANALYSIS FOR GLUCOSE, URINE ANALYSIS FOR GLUCOSE, KETONEBODIES, KETONEBODIES, PROTEIN PROTEIN
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PS FOR LEUCOCYTOSIS, MPPS FOR LEUCOCYTOSIS, MP
BLOOD FOR RBS,UREA,AMMONIABLOOD FOR RBS,UREA,AMMONIA
SERUM CREATININE,ELECTROLYTESSERUM CREATININE,ELECTROLYTES
SERUM CALCIUMSERUM CALCIUM
SGOTSGOT
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SUSPECTED POISONINGSSUSPECTED POISONINGS
11. ASPIRATION AND ANALYSIS OF . ASPIRATION AND ANALYSIS OF GASTRICCONTENTSGASTRICCONTENTS
2. CHROMATOGRAPHIC ANALYSIS 2. CHROMATOGRAPHIC ANALYSIS OF BLOOD & URINEOF BLOOD & URINE
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MANAGEMENTMANAGEMENT INTIALLY BY TAKING CARE OF INTIALLY BY TAKING CARE OF
1. AIRWAY1. AIRWAY
2. BREATHING 2. BREATHING
3. CIRCULATION3. CIRCULATION
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MONITORING MONITORING HAEMODYNAMIC MONITORINGHAEMODYNAMIC MONITORING
PULMONARY MONITORINGPULMONARY MONITORING
NEUROLOGIC MONITORINGNEUROLOGIC MONITORING
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HAEMODYNAMIC HAEMODYNAMIC MONITORINGMONITORING
HEART RATE HEART RATE
BLOOD PRESSUREBLOOD PRESSURE
CVPCVP
PULMONARY CAP.WEDGE PULMONARY CAP.WEDGE PRESSUREPRESSURE
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PULMONARY PULMONARY MONITORINGMONITORING
ABGABG
END TIDAL CAPNOGRAPHYEND TIDAL CAPNOGRAPHY
PULSE OXIMETRYPULSE OXIMETRY
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NEUROLOGIC NEUROLOGIC MONITORINGMONITORING
EEGEEG EVOKED POTENTIALSEVOKED POTENTIALS INFRARED SPECTROSCOPYINFRARED SPECTROSCOPY BISPECTRAL INDEXBISPECTRAL INDEX INVASIVE NEUROLOGIC INVASIVE NEUROLOGIC
MONITORINGMONITORING JUGULARBULB MONITORINGJUGULARBULB MONITORING
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TREATMENTTREATMENT MENINGITIS / ENCEPHALITISMENINGITIS / ENCEPHALITIS 1. DEFINITIVE1. DEFINITIVE 2. SYMPTOMATIC2. SYMPTOMATIC 3. SUPPORTIVE3. SUPPORTIVE
SUBDURAL EFFUSION/EMPYEMA – SUBDURAL EFFUSION/EMPYEMA – DRAINAGE OF PUS DRAINAGE OF PUS
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DKA-CORRECT DEHYDRATIONDKA-CORRECT DEHYDRATION INSULIN DRIPINSULIN DRIP MAINTAINENCE FLUIDSMAINTAINENCE FLUIDS
HYPOGLYCEMIA-DEXTROSE HYPOGLYCEMIA-DEXTROSE BOLUS & MAINTAINENCEBOLUS & MAINTAINENCE
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HEPATIC COMAHEPATIC COMA
1. LACTULOSE 1. LACTULOSE
2. 10% DEXTROSE WITH MVI2. 10% DEXTROSE WITH MVI
3. SUPPORTIVE3. SUPPORTIVE
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POISONINGSPOISONINGS
1. STOMACH WASH1. STOMACH WASH
2. ANTIDOTE2. ANTIDOTE
3. SUPPORTIVE3. SUPPORTIVE
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OPIOD POISONING – NALAXONE 0.01mg/kgOPIOD POISONING – NALAXONE 0.01mg/kg
BENZODIAZEPINES – FLUMAZENILBENZODIAZEPINES – FLUMAZENIL
SALICYLATE SALICYLATE – 1. – 1. STOMACHWASH WITH STOMACHWASH WITH CHARCOAL CHARCOAL 2. REHYDRATION2. REHYDRATION
3. INCREASE URINARY PH-3. INCREASE URINARY PH- IV NAHCO3IV NAHCO3
4. SEVERE CASES-DIALYSIS4. SEVERE CASES-DIALYSIS
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CEREBRAL MALARIA-QUININE IVCEREBRAL MALARIA-QUININE IV
SUPPORTIVESUPPORTIVE
ENTERIC ENCEPHALOPATHYENTERIC ENCEPHALOPATHY 1. ANTIBIOTICS1. ANTIBIOTICS 2. 2.
DEXAMETHASONEDEXAMETHASONE
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DYSELECTROLYTEMIASDYSELECTROLYTEMIAS HYPONATREMIA-REDUCE LOSSHYPONATREMIA-REDUCE LOSS MAINT. DEFICITMAINT. DEFICIT 3% NACL 1-3ml/kg3% NACL 1-3ml/kg HYPERNATREMIA-RESTICT Na INTAKEHYPERNATREMIA-RESTICT Na INTAKE 1/2 NS1/2 NS HYPERKALEMIA-CAL.GLUCONATEHYPERKALEMIA-CAL.GLUCONATE INSULIN DRIPINSULIN DRIP K+BINDING RESINSK+BINDING RESINS
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General measuresGeneral measures
Monitoring VitalsMonitoring Vitals Maintaining fluid & electrolyte Maintaining fluid & electrolyte
balancebalance Input & outputInput & output Temp. controlTemp. control Bladder , bowel , back careBladder , bowel , back care Eye careEye care NutritionNutrition
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Prognosis Prognosis Depends on Etiology ,Depends on Etiology , Duration &Duration & Depth of ComaDepth of Coma
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PrognosisPrognosis Etiology Etiology
Postictal coma – recovery goodPostictal coma – recovery good Anoxic coma – poor outcomeAnoxic coma – poor outcome Infections – mortality 40 %Infections – mortality 40 %
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PrognosisPrognosis DurationDuration
Longer the duration poorer the outcomeLonger the duration poorer the outcome
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PrognosisPrognosis Depth Depth
Glasgow coma scale 5 or <5Glasgow coma scale 5 or <5 Fixed dilated pupils for > 2 hrsFixed dilated pupils for > 2 hrs Decerebration Decerebration Cardiorespiratory arrest Cardiorespiratory arrest
ass . With poor outcomeass . With poor outcome
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THANK UTHANK U