Approach to the comatose patient

Robert D. Stevens, Anish Bhardwaj

Research output: Contribution to journalArticle

84 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)31-41
Number of pages11
JournalCritical care medicine
Volume34
Issue number1
DOIs
StatePublished - Jan 2006
Externally publishedYes

Keywords

  • Coma
  • Hypoxic-ischemic encephalopathy
  • Neurologic diagnosis
  • Outcome prediction
  • Traumatic brain injury
  • Vegetative state

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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