Background: Coma is a medical emergency and may constitute a diagnostic and therapeutic challenge for the intensivist.
Objective: To review currently available data on the etiology, diagnosis, and outcome of coma. To propose an evidence-based approach for the clinical management of the comatose patient.
Data Source: Search of Medline and Cochrane databases; manual review of bibliographies from selected articles and monographs.
Data Synthesis and Conclusions: Coma and other states of impaired consciousness are signs of extensive dysfunction or injury involving the brainstem, diencephalon, or cerebral cortex and are associated with a substantial risk of death and disability. Management of impaired consciousness includes prompt stabilization of vital physiologic functions to prevent secondary neurologic injury, etiological diagnosis, and the institution of brain-directed therapeutic or preventive measures. Neurologic prognosis is determined by the underlying etiology and may be predicted by the combination of clinical signs and electrophysiological tests.
LEARNING OBJECTIVES: On completion of this article, the reader should be able to:
1. Describe changes in the level of consciousness.
2. Identify the indicators of prognosis in comatose patients.
3. Use this information in a clinical setting.
Dr. Stevens has disclosed that he is the recipient of direct grant/research funds from the National Institutes of Health, Public Health Service; Dr. Bhardwaj has disclosed that he was the recipient of direct grant/research funds from the American Heart Association and that he is/was the recipient of grant/research funds from the National Institutes of Health, Public Health Service.
Wolters Kluwer Health has identified and resolved all faculty conflicts of interests regarding this educational activity.
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