Medical Management of Unconscious or Comatose Patient

Definition of Coma or Comatose Patient:

In medicine, coma is a state of unconsciousness in which a person: cannot be awakened, fails to respond normally too painful stimuli, light, or sound; lacks a normal wake-sleep cycle; and does not initiate voluntary actions.

Medical management of unconscious or comatose patient
Fig: Medical management of unconscious or comatose patient

How Will You Assess The Comatose Patient?

A. Immediate assessment of the patient:

a). Level of consciousness by Glasgow coma scale,

b). Airway,

c). Pulse,

d). Pupil (fixed, dilated),

e). Respiration,

f). Temperature,

g). Presence of trauma.

B. Further assessment:

a) History from attendance of-

  • Duration of un-consciousness,
  • Fever,
  • Vomiting / Diarrhoea,
  • Blood transfusion,
  • Travelling history,
  • Drug history of DM taken immediate after meal,
  • Trauma,
  • HTN,
  • DM,
  • Epilepsy,
  • Poisoning,
  • Jaundice.

b) Examination:

1. General examination:

  • Pulse,
  • BP,
  • Temperature,
  • Skin color texture & presence of injection bites,
  • Smell of breath, vomiting,
  • Hiccup, respiration rate, depth & type.

2. Neurological examination:

  • Signs of head injury – local bruising, fractures, wounds, bleeding.
  • Pupillary size, shape, and reaction to light.
  • Fundi, ocular movement, reflexes.
  • Limbs movement.
  • Signs of meningeal irritation- neck rigidity, kernig’s sign.

3. CVS examinations:

  • To see presence of HTN,
  • Rheumatic heart diseases,
  • Infective endocarditis.

4. Respiratory system:

  • To see presence of HTN,
  • Rheumatic heart diseases,
  • Infective endocarditis.

5. Urinary system:

  • To see presence of urinary retention.

Medical Management of Unconscious or Comatose Patient:

Sign and Symptoms of Coma:

  • Loss of consciousness is qualitative,
  • Projectile vomiting,
  • Asymmetric pupils,
  • GCS less than 13,
  • Severe headache,
  • Papilledema,
  • Pupillary reaction to light slow down or negative,
  • Fever,
  • Restless,
  • Seizures,
  • Retention of mucus / sputum in the throat,
  • Retention or urinary incontinence,
  • Hypertension or hypotension ,
  • Tachycardia or bradycardia,
  • Tachypnoea or dyspnea,
  • Local edema or anasarka,
  • Cyanosis, pallor.


a) Routine investigations:

  • Blood for TC, DC, ESR, Hb%, platelets, BT, CT
  • Blood sugar level
  • electrolytes
  • Urine RME
  • Chest X-ray
  • ECG

b) To detect the risk factor:

  • Blood sugar (2 hours after 75 gm of glucose)
  • lipid profile.

c) To find out the level of lesion:

  • CT scan (for haemor rhagic stroke),
  • MRI (for infarctive -stroke),
  • Cerebral angiography,
  • Doppler USG of carotid artery.

Immediate Management:

  1. Maintenance of airway: clear airway (oropharyngeal suction) if necessary.
  2. Maintenance of breathing:
  • Only neck extended & lateral position if respiration is ok.
  • Mouth to mouth breathing, 02 inhalation, intubation, tracheostomy if necessary.
  1. Maintenance of circulation: Cardiac pulmonary resuscitation, secure IV channel & start normal saline if appropriate.
  2. If dehydration by vomiting -Cholera saline.
  3. If overhydrated -diuretics
  4. Maintain intake output chart.
  5. BP, if SBP > 240 mm of Hg & DBP >120 mm of Hg then reduce BP, otherwise not necessary, if BP does not comes to normal even after 1stweek then start antihypertensive agents.
  6. Blood glucose maintaining: > 11.l mmol/l it reduces by insulin (Increased blood glucose- Increased infarction).

General Treatment:

  1. First pay attention to airway, breathing, circulation.
  2. Maintenance of nutrition Give the patient ryles tube feeding 2hourly. Liquid diet is given the help of 50cc syringe adequate carbohydrate and high protein should be present in diet.
  3. Care of skin – Change the posture of the patient 2 hourly. Keep the skin dry and clean.
  4. Care of mouth – Antifungal agent is used to prevent candida infection.
  5. Care of eye – Chloramphenicol eye drop to prevent exposure keratitis.
  6. Care of bowel- Bed pan is used to prevent soiling of cloth.
  7. Care of bladder Catheterization is done.
  8. Control of infection by antibiotic.

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