Answer: Vital signs often provide clues to the cause of coma. A core temperature must be obtained. An elevated temperature should lead you to investigate the possibility of meningitis, sepsis, heat-stroke, or hyperthyroidism. Hypothermia can result from environmental exposure, hypoglycemia, or, rarely, addisonian crisis. Do not assume that an abnormal temperature has a neurogenic cause [...]

Answer: A simple reproducible scoring system used in trauma patients to define the level of coma. It is useful for standardizing assessments among multiple observers and for monitoring changes in the degree of coma. The score is determined by eliciting the best response obtained from the patient in three categories. It is not sensitive enough [...]

Answer: The goal of the physical examination is to differentiate structural focal CNS problems from diffuse metabolic processes. Pay special attention to vital signs, general appearance, mental status, eye findings, and the motor examination. The general appearance should be noted before examining the patient. Are there signs of trauma? Is there symmetry of spontaneous movements? [...]

Answer: This seems like a stupid question because the patient with altered consciousness cannot give you a reliable history, and the comatose patient cannot give any history at all! You should question carefully prehospital personnel and attempt to contact the patient’s friends or family. Ask about the onset of symptoms (acute or/gradual), recent neurologic symptoms [...]

Answer: TIPS-Vowels–that is, TIPS-AEIOU. TIPS T Trauma, temperature I Infection (CNS and systemic) P Psychiatric S Space-occupying lesions, stroke, subarachnoid hemorrhage, shock VOWELS A Alcohol and other drugs E Endocrine, exocrine, electrolytes I Insulin (diabetes) O Oxygen (lack of), opiates U Uremia

Answer: Mental alertness is maintained by the cerebral hemispheres in conjunction with the reticular activating system. Coma can be produced by diffuse disease of both cerebral hemispheres (usually a metabolic problem), disease in the brainstem that damages the reticular activating system, or a structural central nervous system (CNS) lesion that compresses the reticular activating system.

Answer: What terms should be used to describe altered sensorium? A depressed mental state in which verbal and physical stimuli cannol elicit useful responses. Other terms, such as lethargic, stuporous, or obtunded, mean different things to different observers and should be avoided. It is best to describe the mental functions the patient can perform (e.g., [...]