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MANAGEMENT OF MANAGEMENT OF COMA COMA By By Dr. G.Srinivas Dr. G.Srinivas Associate Professor of Associate Professor of Medicine Medicine
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MANAGEMENT OF COMA By Dr. G.Srinivas Associate Professor of Medicine.

Jan 19, 2018

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Amberly Wilson

KNOWN CASE OF EPILEPSY KNOWN CASE OF EPILEPSY 1. LEVELS OF ANTICONVULSANTS. 1. LEVELS OF ANTICONVULSANTS. 2. EEG 2. EEG  URINE ANALYSIS FOR GLUCOSE, KETONEBODIES, PROTEIN
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Page 1: MANAGEMENT OF COMA By Dr. G.Srinivas Associate Professor of Medicine.

MANAGEMENT MANAGEMENT OF COMAOF COMA

By By Dr. G.SrinivasDr. G.Srinivas

Associate Professor of Associate Professor of MedicineMedicine

Page 2: MANAGEMENT OF COMA By Dr. G.Srinivas Associate Professor of Medicine.

INVESTIGATIONS INVESTIGATIONS

GUIDED BY HISTORY AND GUIDED BY HISTORY AND EXAMINATIONEXAMINATION

PTS WITH RAISED ICT – LP PTS WITH RAISED ICT – LP CT SCAN CT SCAN MRI MRI

Page 3: MANAGEMENT OF COMA By Dr. G.Srinivas Associate Professor of Medicine.

KNOWN CASE OF EPILEPSYKNOWN CASE OF EPILEPSY 1. LEVELS OF 1. LEVELS OF

ANTICONVULSANTS.ANTICONVULSANTS. 2. EEG2. EEG

URINE ANALYSIS FOR GLUCOSE, URINE ANALYSIS FOR GLUCOSE, KETONEBODIES, KETONEBODIES, PROTEIN PROTEIN

Page 4: MANAGEMENT OF COMA By Dr. G.Srinivas Associate Professor of Medicine.

PS FOR LEUCOCYTOSIS, MPPS FOR LEUCOCYTOSIS, MP

BLOOD FOR RBS,UREA,AMMONIABLOOD FOR RBS,UREA,AMMONIA

SERUM CREATININE,ELECTROLYTESSERUM CREATININE,ELECTROLYTES

SERUM CALCIUMSERUM CALCIUM

SGOTSGOT

Page 5: MANAGEMENT OF COMA By Dr. G.Srinivas Associate Professor of Medicine.

SUSPECTED POISONINGSSUSPECTED POISONINGS

11. ASPIRATION AND ANALYSIS OF . ASPIRATION AND ANALYSIS OF GASTRICCONTENTSGASTRICCONTENTS

2. CHROMATOGRAPHIC ANALYSIS 2. CHROMATOGRAPHIC ANALYSIS OF BLOOD & URINEOF BLOOD & URINE

Page 6: MANAGEMENT OF COMA By Dr. G.Srinivas Associate Professor of Medicine.

MANAGEMENTMANAGEMENT INTIALLY BY TAKING CARE OF INTIALLY BY TAKING CARE OF

1. AIRWAY1. AIRWAY

2. BREATHING 2. BREATHING

3. CIRCULATION3. CIRCULATION

Page 7: MANAGEMENT OF COMA By Dr. G.Srinivas Associate Professor of Medicine.

MONITORING MONITORING HAEMODYNAMIC MONITORINGHAEMODYNAMIC MONITORING

PULMONARY MONITORINGPULMONARY MONITORING

NEUROLOGIC MONITORINGNEUROLOGIC MONITORING

Page 8: MANAGEMENT OF COMA By Dr. G.Srinivas Associate Professor of Medicine.

HAEMODYNAMIC HAEMODYNAMIC MONITORINGMONITORING

HEART RATE HEART RATE

BLOOD PRESSUREBLOOD PRESSURE

CVPCVP

PULMONARY CAP.WEDGE PULMONARY CAP.WEDGE PRESSUREPRESSURE

Page 9: MANAGEMENT OF COMA By Dr. G.Srinivas Associate Professor of Medicine.

PULMONARY PULMONARY MONITORINGMONITORING

ABGABG

END TIDAL CAPNOGRAPHYEND TIDAL CAPNOGRAPHY

PULSE OXIMETRYPULSE OXIMETRY

Page 10: MANAGEMENT OF COMA By Dr. G.Srinivas Associate Professor of Medicine.

NEUROLOGIC NEUROLOGIC MONITORINGMONITORING

EEGEEG EVOKED POTENTIALSEVOKED POTENTIALS INFRARED SPECTROSCOPYINFRARED SPECTROSCOPY BISPECTRAL INDEXBISPECTRAL INDEX INVASIVE NEUROLOGIC INVASIVE NEUROLOGIC

MONITORINGMONITORING JUGULARBULB MONITORINGJUGULARBULB MONITORING

Page 11: MANAGEMENT OF COMA By Dr. G.Srinivas Associate Professor of Medicine.

TREATMENTTREATMENT MENINGITIS / ENCEPHALITISMENINGITIS / ENCEPHALITIS 1. DEFINITIVE1. DEFINITIVE 2. SYMPTOMATIC2. SYMPTOMATIC 3. SUPPORTIVE3. SUPPORTIVE

SUBDURAL EFFUSION/EMPYEMA – SUBDURAL EFFUSION/EMPYEMA – DRAINAGE OF PUS DRAINAGE OF PUS

Page 12: MANAGEMENT OF COMA By Dr. G.Srinivas Associate Professor of Medicine.

DKA-CORRECT DEHYDRATIONDKA-CORRECT DEHYDRATION INSULIN DRIPINSULIN DRIP MAINTAINENCE FLUIDSMAINTAINENCE FLUIDS

HYPOGLYCEMIA-DEXTROSE HYPOGLYCEMIA-DEXTROSE BOLUS & MAINTAINENCEBOLUS & MAINTAINENCE

Page 13: MANAGEMENT OF COMA By Dr. G.Srinivas Associate Professor of Medicine.

HEPATIC COMAHEPATIC COMA

1. LACTULOSE 1. LACTULOSE

2. 10% DEXTROSE WITH MVI2. 10% DEXTROSE WITH MVI

3. SUPPORTIVE3. SUPPORTIVE

Page 14: MANAGEMENT OF COMA By Dr. G.Srinivas Associate Professor of Medicine.

POISONINGSPOISONINGS

1. STOMACH WASH1. STOMACH WASH

2. ANTIDOTE2. ANTIDOTE

3. SUPPORTIVE3. SUPPORTIVE

Page 15: MANAGEMENT OF COMA By Dr. G.Srinivas Associate Professor of Medicine.

OPIOD POISONING – NALAXONE 0.01mg/kgOPIOD POISONING – NALAXONE 0.01mg/kg

BENZODIAZEPINES – FLUMAZENILBENZODIAZEPINES – FLUMAZENIL

SALICYLATE SALICYLATE – 1. – 1. STOMACHWASH WITH STOMACHWASH WITH CHARCOAL CHARCOAL 2. REHYDRATION2. REHYDRATION

3. INCREASE URINARY PH-3. INCREASE URINARY PH- IV NAHCO3IV NAHCO3

4. SEVERE CASES-DIALYSIS4. SEVERE CASES-DIALYSIS

Page 16: MANAGEMENT OF COMA By Dr. G.Srinivas Associate Professor of Medicine.

CEREBRAL MALARIA-QUININE IVCEREBRAL MALARIA-QUININE IV

SUPPORTIVESUPPORTIVE

ENTERIC ENCEPHALOPATHYENTERIC ENCEPHALOPATHY 1. ANTIBIOTICS1. ANTIBIOTICS 2. 2.

DEXAMETHASONEDEXAMETHASONE

Page 17: MANAGEMENT OF COMA By Dr. G.Srinivas Associate Professor of Medicine.

DYSELECTROLYTEMIASDYSELECTROLYTEMIAS HYPONATREMIA-REDUCE LOSSHYPONATREMIA-REDUCE LOSS MAINT. DEFICITMAINT. DEFICIT 3% NACL 1-3ml/kg3% NACL 1-3ml/kg HYPERNATREMIA-RESTICT Na INTAKEHYPERNATREMIA-RESTICT Na INTAKE 1/2 NS1/2 NS HYPERKALEMIA-CAL.GLUCONATEHYPERKALEMIA-CAL.GLUCONATE INSULIN DRIPINSULIN DRIP K+BINDING RESINSK+BINDING RESINS

Page 18: MANAGEMENT OF COMA By Dr. G.Srinivas Associate Professor of Medicine.

General measuresGeneral measures

Monitoring VitalsMonitoring Vitals Maintaining fluid & electrolyte Maintaining fluid & electrolyte

balancebalance Input & outputInput & output Temp. controlTemp. control Bladder , bowel , back careBladder , bowel , back care Eye careEye care NutritionNutrition

Page 19: MANAGEMENT OF COMA By Dr. G.Srinivas Associate Professor of Medicine.

Prognosis Prognosis Depends on Etiology ,Depends on Etiology , Duration &Duration & Depth of ComaDepth of Coma

Page 20: MANAGEMENT OF COMA By Dr. G.Srinivas Associate Professor of Medicine.

PrognosisPrognosis Etiology Etiology

Postictal coma – recovery goodPostictal coma – recovery good Anoxic coma – poor outcomeAnoxic coma – poor outcome Infections – mortality 40 %Infections – mortality 40 %

Page 21: MANAGEMENT OF COMA By Dr. G.Srinivas Associate Professor of Medicine.

PrognosisPrognosis DurationDuration

Longer the duration poorer the outcomeLonger the duration poorer the outcome

Page 22: MANAGEMENT OF COMA By Dr. G.Srinivas Associate Professor of Medicine.

PrognosisPrognosis Depth Depth

Glasgow coma scale 5 or <5Glasgow coma scale 5 or <5 Fixed dilated pupils for > 2 hrsFixed dilated pupils for > 2 hrs Decerebration Decerebration Cardiorespiratory arrest Cardiorespiratory arrest

ass . With poor outcomeass . With poor outcome

Page 23: MANAGEMENT OF COMA By Dr. G.Srinivas Associate Professor of Medicine.

THANK UTHANK U