Coma - Revision history

Danbot: Add verified PubMed references (PMIDs 24767707, 33218655)

2026-03-22T10:42:55Z

Add verified PubMed references (PMIDs 24767707, 33218655)

← Revisión anterior		Revisión del 10:42 22 mar 2026
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	==Background==		==Background==
	*Coma is a state of unresponsiveness from which the patient cannot be aroused, even with vigorous stimuli		*Coma is a state of unresponsiveness from which the patient cannot be aroused, even with vigorous stimuli<ref>Edlow JA, et al. Diagnosis of reversible causes of coma. Lancet. 2014;384(9959):2064-76. PMID 24767707</ref>
	*Defined as GCS ≤8 or inability to follow commands, speak, or open eyes		*Defined as GCS ≤8 or inability to follow commands, speak, or open eyes<ref>Karpenko A, Keegan J. Diagnosis of Coma. Emerg Med Clin North Am. 2021;39(1):155-172. PMID 33218655</ref>
	*Requires dysfunction of both cerebral hemispheres or the reticular activating system (brainstem)		*Requires dysfunction of both cerebral hemispheres or the reticular activating system (brainstem)
	*Coma is a medical emergency — rapid assessment and stabilization take priority while pursuing diagnosis		*Coma is a medical emergency — rapid assessment and stabilization take priority while pursuing diagnosis

Danbot: Strip excess bold

2026-03-22T09:26:10Z

Strip excess bold

← Revisión anterior		Revisión del 09:26 22 mar 2026
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	*Coma is a state of unresponsiveness from which the patient cannot be aroused, even with vigorous stimuli		*Coma is a state of unresponsiveness from which the patient cannot be aroused, even with vigorous stimuli
	*Defined as GCS ≤8 or inability to follow commands, speak, or open eyes		*Defined as GCS ≤8 or inability to follow commands, speak, or open eyes
	*Requires dysfunction of ~~'''~~both cerebral hemispheres~~'''~~ or the ~~'''~~reticular activating system~~'''~~ (brainstem)		*Requires dysfunction of both cerebral hemispheres or the reticular activating system (brainstem)
	*Coma is a medical emergency — rapid assessment and stabilization take priority while pursuing diagnosis		*Coma is a medical emergency — rapid assessment and stabilization take priority while pursuing diagnosis
	*The mnemonic ~~'''~~AEIOU-TIPS~~'''~~ helps recall the differential:		*The mnemonic AEIOU-TIPS helps recall the differential:
	**~~'''~~A~~'''~~ — Alcohol, Acidosis		**A — Alcohol, Acidosis
	**~~'''~~E~~'''~~ — Endocrine, Electrolytes, Encephalopathy		**E — Endocrine, Electrolytes, Encephalopathy
	**~~'''~~I~~'''~~ — Insulin (hypoglycemia, DKA, HHS)		**I — Insulin (hypoglycemia, DKA, HHS)
	**~~'''~~O~~'''~~ — Opiates, Overdose, Oxygen (hypoxia)		**O — Opiates, Overdose, Oxygen (hypoxia)
	**~~'''~~U~~'''~~ — Uremia		**U — Uremia
	**~~'''~~T~~'''~~ — Trauma, Temperature		**T — Trauma, Temperature
	**~~'''~~I~~'''~~ — Infection (meningitis, encephalitis, sepsis)		**I — Infection (meningitis, encephalitis, sepsis)
	**~~'''~~P~~'''~~ — Psychiatric (rare, diagnosis of exclusion), Poisoning		**P — Psychiatric (rare, diagnosis of exclusion), Poisoning
	**'''S''' — Stroke, Seizure (nonconvulsive status), Shock		**'''S''' — Stroke, Seizure (nonconvulsive status), Shock

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	*No eye opening, verbal response, or motor response to command		*No eye opening, verbal response, or motor response to command
	*Key exam components:		*Key exam components:
	**~~'''~~Pupils:~~'''~~ Bilateral fixed/dilated (anoxic brain injury, sympathomimetic), bilateral pinpoint (opioids, pontine lesion), unilateral fixed/dilated (uncal herniation, CN III compression)		**Pupils: Bilateral fixed/dilated (anoxic brain injury, sympathomimetic), bilateral pinpoint (opioids, pontine lesion), unilateral fixed/dilated (uncal herniation, CN III compression)
	**~~'''~~Eye movements:~~'''~~ Oculocephalic reflex (doll's eyes), oculovestibular reflex (cold calorics); absent = brainstem dysfunction		**Eye movements: Oculocephalic reflex (doll's eyes), oculovestibular reflex (cold calorics); absent = brainstem dysfunction
	**~~'''~~Motor response:~~'''~~ Purposeful withdrawal, flexion posturing (decorticate), extension posturing (decerebrate), flaccid		**Motor response: Purposeful withdrawal, flexion posturing (decorticate), extension posturing (decerebrate), flaccid
	**~~'''~~Breathing pattern:~~'''~~ Cheyne-Stokes (bilateral hemispheric or early transtentorial), central hyperventilation (midbrain), ataxic/apneustic (medulla/pons)		**Breathing pattern: Cheyne-Stokes (bilateral hemispheric or early transtentorial), central hyperventilation (midbrain), ataxic/apneustic (medulla/pons)
	**~~'''~~Signs of trauma:~~'''~~ Battle sign, raccoon eyes, hemotympanum, scalp lacerations		**Signs of trauma: Battle sign, raccoon eyes, hemotympanum, scalp lacerations

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Evaluation==		==Evaluation==
	*~~'''~~Immediate:~~'''~~		*Immediate:
	**ABCs — secure airway if GCS ≤8 (intubate)		**ABCs — secure airway if GCS ≤8 (intubate)
	**[[Finger stick glucose]] — treat [[hypoglycemia]] immediately		**[[Finger stick glucose]] — treat [[hypoglycemia]] immediately
	**Rapid vitals including temperature		**Rapid vitals including temperature
	*~~'''~~Focused workup:~~'''~~		*Focused workup:
	**CBC, BMP, LFTs, ammonia, lactate, VBG/ABG		**CBC, BMP, LFTs, ammonia, lactate, VBG/ABG
	**Toxicology screen (urine drug screen, serum ethanol, salicylate, acetaminophen levels)		**Toxicology screen (urine drug screen, serum ethanol, salicylate, acetaminophen levels)
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	**Coagulation studies (PT/INR) if bleeding or liver disease suspected		**Coagulation studies (PT/INR) if bleeding or liver disease suspected
	**Thyroid function (TSH) if no clear cause identified		**Thyroid function (TSH) if no clear cause identified
	*~~'''~~Imaging:~~'''~~		*Imaging:
	**~~'''~~CT head without contrast~~'''~~ — first-line; rules out hemorrhage, mass, hydrocephalus, herniation		**CT head without contrast — first-line; rules out hemorrhage, mass, hydrocephalus, herniation
	**Consider CTA head/neck if large vessel occlusion or vascular dissection suspected		**Consider CTA head/neck if large vessel occlusion or vascular dissection suspected
	**MRI if CT negative and structural cause still suspected		**MRI if CT negative and structural cause still suspected
	*~~'''~~Other:~~'''~~		*Other:
	**[[Lumbar puncture]] if meningitis/encephalitis suspected (after CT, if safe)		**[[Lumbar puncture]] if meningitis/encephalitis suspected (after CT, if safe)
	**[[EEG]] for suspected nonconvulsive status epilepticus		**[[EEG]] for suspected nonconvulsive status epilepticus
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	==Management==		==Management==
	*~~'''~~Stabilize first:~~'''~~		*Stabilize first:
	**Airway protection — intubate if GCS ≤8 or unable to protect airway		**Airway protection — intubate if GCS ≤8 or unable to protect airway
	**IV access, continuous monitoring		**IV access, continuous monitoring
	**Treat [[hypoglycemia]] immediately with dextrose		**Treat [[hypoglycemia]] immediately with dextrose
	*~~'''~~Empiric interventions ("coma cocktail"):~~'''~~		*Empiric interventions ("coma cocktail"):
	**[[Dextrose]] (D50) if glucose unknown or low		**[[Dextrose]] (D50) if glucose unknown or low
	**[[Thiamine]] 100 mg IV (give before or with glucose to prevent [[Wernicke encephalopathy]])		**[[Thiamine]] 100 mg IV (give before or with glucose to prevent [[Wernicke encephalopathy]])
	**[[Naloxone]] 0.4-2 mg IV if opioid overdose suspected (pinpoint pupils, respiratory depression)		**[[Naloxone]] 0.4-2 mg IV if opioid overdose suspected (pinpoint pupils, respiratory depression)
	**[[Flumazenil]] — generally ~~'''~~avoided~~'''~~ in undifferentiated coma (risk of seizures in benzodiazepine-dependent patients)		**[[Flumazenil]] — generally avoided in undifferentiated coma (risk of seizures in benzodiazepine-dependent patients)
	*~~'''~~Treat underlying cause~~'''~~ once identified		*Treat underlying cause once identified
	*~~'''~~Herniation management~~'''~~ if signs present (unilateral dilated pupil, posturing):		*Herniation management if signs present (unilateral dilated pupil, posturing):
	**Head of bed 30°		**Head of bed 30°
	**[[Mannitol]] or [[hypertonic saline]]		**[[Mannitol]] or [[hypertonic saline]]

Danbot: Comprehensive expansion: EM-focused approach with AEIOU-TIPS, structured DDx, key exam findings, coma cocktail, and herniation management

2026-03-20T23:00:39Z

Comprehensive expansion: EM-focused approach with AEIOU-TIPS, structured DDx, key exam findings, coma cocktail, and herniation management

@@ Línea 1: / Línea 1: @@
-==Definition==
+==Background==
-*State of reduced alertness and responsiveness from which the patient cannot be aroused
+*Coma is a state of unresponsiveness from which the patient cannot be aroused, even with vigorous stimuli
 ==See Also==
-*[[Altered Mental Status]]
+*[[Altered mental status]]
-*[[Persistent Vegetative State]]
+*[[Altered mental status (peds)]]
 [[Category:Neurology]]
 [[Category:Symptoms]]

ClaireLewis at 00:38, 3 October 2019

2019-10-03T00:38:27Z

← Revisión anterior		Revisión del 00:38 3 oct 2019
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	[[Category:Neurology]]		[[Category:Neurology]]
			[[Category:Symptoms]]

Neil.m.young: Text replacement - " pt " to " patient "

2016-07-02T12:09:32Z

Text replacement - " pt " to " patient "

← Revisión anterior		Revisión del 12:09 2 jul 2016
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	==Definition==		==Definition==
	*State of reduced alertness and responsiveness from which the pt cannot be aroused		*State of reduced alertness and responsiveness from which the patient cannot be aroused

	==See Also==		==See Also==

Ostermayer: Text replacement - "Category:Neuro" to "Category:Neurology"

2016-03-22T14:14:29Z

Text replacement - "Category:Neuro" to "Category:Neurology"

← Revisión anterior		Revisión del 14:14 22 mar 2016
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	*[[Persistent Vegetative State]]		*[[Persistent Vegetative State]]

	[[Category:~~Neuro~~]]		[[Category:Neurology]]

Rossdonaldson1 at 01:27, 20 December 2013

2013-12-20T01:27:32Z

← Revisión anterior		Revisión del 01:27 20 dic 2013
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	See:		==Definition==
			*State of reduced alertness and responsiveness from which the pt cannot be aroused

			==See Also==
	*[[Altered Mental Status]]		*[[Altered Mental Status]]
	*[[Persistent Vegetative State]]		*[[Persistent Vegetative State]]

	[[Category:Neuro]]		[[Category:Neuro]]

Rossdonaldson1: Replaced content with "See: Altered Mental Status Persistent Vegetative State Category:Neuro"

2013-12-20T01:24:45Z

Replaced content with "See: *Altered Mental Status *Persistent Vegetative State Category:Neuro"

@@ Línea 1: / Línea 1: @@
-==Background==
+See:
 *[[Altered Mental Status]]
+*[[Persistent Vegetative State]]
 [[Category:Neuro]]

Rossdonaldson1: /* See Also */

2013-12-20T01:15:23Z

Jswartz at 07:07, 20 December 2011

2011-12-20T07:07:53Z

← Revisión anterior		Revisión del 07:07 20 dic 2011
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	*Depends on cause		*Depends on cause
	**Diffuse brain dysfunction - lack of focal findings		**Diffuse brain dysfunction - lack of focal findings
	***Focal brain dysfunction - hemiparesis, loss of motor tone, loss of ocular reflexes		**Focal brain dysfunction - hemiparesis, loss of motor tone, loss of ocular reflexes

	==DDX==		==DDX==

← Revisión anterior		Revisión del 01:15 20 dic 2013
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	*[[AVPU Scale]]		*[[AVPU Scale]]
	*[[Brain Death]]		*[[Brain Death]]
			*[[Altered Mental Status]]

	==Source==		==Source==