In neurological issues, localizing indicators pointing to illness of components of the nervous system could also be current e.g, hemiplegia, cranial nerve palsies, focal seizures, and so forth. Meningitis and subarachnoid hemorrhage are related to indicators of meningeal irritation corresponding to neck rigidity, Kernig’s signal and Brudzinski’s indicators. In metabolic coma, localizing indicators could also be absent. In poisoning, different results of the poison might also be evident.
Investigations
1. Routine investigations to exclude systemic issues embody full urinalysis, estimation of blood sugar urea, electrolytes, blood gases and pH.
2. In suspected poisoning, the gastric supplies must be despatched for chemical examination for the poison.
3. Cerebrospinal fluid must be examined when meningitis, encephalitis, subarachnoid hemorrage, or meningeal leukemia are suspected.
4. Additional checks are determined by the scientific examination and progress of the case EEG, neuroradiology, CT scanning, NMR imaging and radioisotopic scanning could also be indicated in lots of circumstances.
Management
Normal Management: Comatose sufferers are very inclined to develop a number of problems because of lack of protecting reflexes and these must be prevented. Upkeep of the airway is of utmost significance. The neck must be stored prolonged to forestall “falling-back” of the tongue. If essential a affected person airway must be launched. Secretions must be eliminated by postural drainage and suction. In circumstances with respiratory despair synthetic air flow must be instituted early. Tracheostomy could also be required in some circumstances.
Upkeep of diet and fluid and electrolyte steadiness: Satisfactory diet (at the least 2000 cals/day and 2L of fluid) within the type of milk, sugar, eggs, cereals, salt and water are given via a nasogastric tube. Oral feeding carries the danger of aspiration into the respiratory tract and, subsequently, this must be prevented. Parenteral diet is began via the intravenous path to complement nasogastric feeding. The intravenous needle must be maintained aseptically. In extended sickness, the place of the needle must be modified each 36-48 hours to keep away from thrombophlebitis.
Care of the pores and skin: The sufferers develop bed sores attributable to steady pressure on localized areas. This threat is prevented by turning the affected person in bed each 2-4 hours and holding the pores and skin clean and dry. Satisfactory consumption of proteins helps in minimizing the danger of bed sores. When coma is prone to be extended, particular beds that are able to turning the sufferers, and which assist in avoiding pressure over localized areas could also be used with benefit 뇌출혈산재.
Bladder and bowels: The unconscious affected person voids his bladder and bowel robotically and this causes many issues in nursing. Establishment of a closed drainage system for the bladder helps in avoiding this soiling of the clothes and stop an infection. Bowels are moved by small enemas or suppositories at common intervals.
Positioning of the Limbs and physiotherapy: The Limbs must be maintained in optimum positions to keep away from mounted deformities. Common passive actions to the limbs assist in stopping venous thrombosis and subsequent pulmonary embolism.
Particular remedy: This relies upon the reason for the Coma. Anticonvulsant remedy is indicated if seizures happen. Intercurrent an infection (respiratory, urinary or cutaneous must be handled with antibiotics).
Mind demise
This downside has develop into necessary since removal of organs for transplantation is finished from sufferers who aren’t prone to recuperate. Sufferers who’re on supportive measures together with synthetic air flow could go right into a stage the place the cerebral and mind stem capabilities are irreversibly misplaced, nonetheless the affected person could proceed to have circulation on account of the supportive measures. Withdrawal of those helps will result in bodily demise. The choice to withdraw these helps is a medico-legal one. Due to this fact, mind demise must be identified with assistance from EEG. Deep Coma with none motion of reflexes for over 12 hours, absence of mind stem reflexes (Oculocephalic reflexes, light reflex and spontaneous respiration) and a flat EEG report point out irreversible mind damage-the mind demise. These standards aren’t legitimate if the coma is the results of overdose of poisons of hypothermia.