"improving intensive care in Scotland"

Neurological emergencies

Coma

Causes

These can be divided into systemic causes and primary neurological causes, table 2.

Systemic causes

Cerebral hypoxia; hypercapnea

* respiratory failure

Cerebral ischemia

* Cardiac arrest
* Hypotension

Metablic disturbance

* Diabetes (hypoglycemia, ketoacidosis, hyperosmolar coma)
* Hyponatremia
* Uremia
* Hepatic failure
* Hypothermia
* Drugs
* Sepsis
* Myxoedema coma

Primary neurological causes

Trauma

* Cerebral contusion
* Extradural haematoma
* Suddural haematoma
*Brain swelling

Infection

* Meningitis
* Encephalitis
* Cerebral abscess

Cerebrovascular disease

* Subarachnoid haemorrhage
* Intracerebral haemorrhage
* Brain stem infarction
* Cerebral venous sinus thrombosis

Epilepsy


 

Cerebral tumour

 

Hydrocephalus

 

Table 2. Causes of reduced level of consciousness.

Management

Manage ABCDEF as detailed in the assessment module.

Detailed history taking is crucial as vascular causes, in particular, require abrupt treatment. Get a history from GP, ambulance personnel, family, friends, observers.

If an overdose is possible think of specific intervention eg naloxone in opioid overdose. If meningitis is a possibility give intravenous antibiotics (after blood cultures): ceftriaxone 2grams. If the cause of coma is not immediately apparent further specialist investigations may be necessary:

  • CT scan brain (with a stable circulation and a secure airway)
  • Lumbar puncture (after excluding raised ICP)
  • Toxicology screen
  • EEG

Consult a Neurologist or Neurosurgeon and an Intensivist: they can advise and can take over patient care.

Page 5

Backwards Button Forward Button