Coma

This is where one is in a deep state of prolonged, un-arousable unconsciousness in which they fail to respond normally to painful stimuli/light/sound, lack a normal wake-sleep cycle, and does not initiate voluntary actions. It's assessed with the GCS.

The most common cause of it is Drug poisoning. Other causes include:

• Hypoxia

• Hypoglycaemia

• Stroke

• Trauma

• Hypothermia

• Infection e.g. meningitis

Clinical Features

• GCS ≤ 8 lasting 6+ hrs

• Inability to voluntarily open the eyes

• Non-existent sleep-wake cycle

• Lack of response to painful/verbal stimuli

• Pupils not responding to light

• Irregular breathing

Investigations

• A-E - Including GCS, and if PEARL

• Basic obs and general examination, checking for potential indicators of a cause e.g. needle marks, alcohol smell, meningism, trauma

• Collaterall hx if possible

• Bloods - FBC, U&E, CRP, LFT, Ethanol, Drug screen, VBG

• Urine toxicology

• Imaging - CXR, CT Head

Management

• Correct any hypoglycaemia

• IV Pabrinex if alcohol withdrawal

• IV Naloxone if opioid OD

• IV Flumazenil for benzo OD