management of coma by dr. g.srinivas associate professor of medicine
DESCRIPTION
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, PROTEINTRANSCRIPT
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MANAGEMENT MANAGEMENT OF COMAOF COMA
By By Dr. G.SrinivasDr. G.Srinivas
Associate Professor of Associate Professor of MedicineMedicine
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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
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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
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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
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SUSPECTED POISONINGSSUSPECTED POISONINGS
11. ASPIRATION AND ANALYSIS OF . ASPIRATION AND ANALYSIS OF GASTRICCONTENTSGASTRICCONTENTS
2. CHROMATOGRAPHIC ANALYSIS 2. CHROMATOGRAPHIC ANALYSIS OF BLOOD & URINEOF BLOOD & URINE
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MANAGEMENTMANAGEMENT INTIALLY BY TAKING CARE OF INTIALLY BY TAKING CARE OF
1. AIRWAY1. AIRWAY
2. BREATHING 2. BREATHING
3. CIRCULATION3. CIRCULATION
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MONITORING MONITORING HAEMODYNAMIC MONITORINGHAEMODYNAMIC MONITORING
PULMONARY MONITORINGPULMONARY MONITORING
NEUROLOGIC MONITORINGNEUROLOGIC MONITORING
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HAEMODYNAMIC HAEMODYNAMIC MONITORINGMONITORING
HEART RATE HEART RATE
BLOOD PRESSUREBLOOD PRESSURE
CVPCVP
PULMONARY CAP.WEDGE PULMONARY CAP.WEDGE PRESSUREPRESSURE
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PULMONARY PULMONARY MONITORINGMONITORING
ABGABG
END TIDAL CAPNOGRAPHYEND TIDAL CAPNOGRAPHY
PULSE OXIMETRYPULSE OXIMETRY
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NEUROLOGIC NEUROLOGIC MONITORINGMONITORING
EEGEEG EVOKED POTENTIALSEVOKED POTENTIALS INFRARED SPECTROSCOPYINFRARED SPECTROSCOPY BISPECTRAL INDEXBISPECTRAL INDEX INVASIVE NEUROLOGIC INVASIVE NEUROLOGIC
MONITORINGMONITORING JUGULARBULB MONITORINGJUGULARBULB MONITORING
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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
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DKA-CORRECT DEHYDRATIONDKA-CORRECT DEHYDRATION INSULIN DRIPINSULIN DRIP MAINTAINENCE FLUIDSMAINTAINENCE FLUIDS
HYPOGLYCEMIA-DEXTROSE HYPOGLYCEMIA-DEXTROSE BOLUS & MAINTAINENCEBOLUS & MAINTAINENCE
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HEPATIC COMAHEPATIC COMA
1. LACTULOSE 1. LACTULOSE
2. 10% DEXTROSE WITH MVI2. 10% DEXTROSE WITH MVI
3. SUPPORTIVE3. SUPPORTIVE
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POISONINGSPOISONINGS
1. STOMACH WASH1. STOMACH WASH
2. ANTIDOTE2. ANTIDOTE
3. SUPPORTIVE3. SUPPORTIVE
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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
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CEREBRAL MALARIA-QUININE IVCEREBRAL MALARIA-QUININE IV
SUPPORTIVESUPPORTIVE
ENTERIC ENCEPHALOPATHYENTERIC ENCEPHALOPATHY 1. ANTIBIOTICS1. ANTIBIOTICS 2. 2.
DEXAMETHASONEDEXAMETHASONE
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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
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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
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Prognosis Prognosis Depends on Etiology ,Depends on Etiology , Duration &Duration & Depth of ComaDepth of Coma
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PrognosisPrognosis Etiology Etiology
Postictal coma – recovery goodPostictal coma – recovery good Anoxic coma – poor outcomeAnoxic coma – poor outcome Infections – mortality 40 %Infections – mortality 40 %
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PrognosisPrognosis DurationDuration
Longer the duration poorer the outcomeLonger the duration poorer the outcome
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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
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THANK UTHANK U