DESCRIBE INVESTIGATIONS

YOU WILL REQUEST FOR IN

AN UNCONSCIOUS PATIENT
INTRODUCTION
What is unconsciousness?
Requirements for one to be
awake.
Difference between coma and
sleep.
Abnormal drowsiness
Stupor
IMPORTANCE OF HISTORY
Give an idea as to the
investigations to be carried out
Taken from a witness or by
stander
Ascertain if onset was sudden or
gradual
Abnormal behavior prior to onset
Brief lucid interval?
CAUSES OF
UNCONSCIOUSNESS
Functional: lack of substrate
depression of
function
Abnormal function
Structural: diffuse
focal: supra or sub
tentoriol
INVESTIGATIONS
Imaging: X-RAY
MRI
CT-scan
Blood glucose
Electrolytes
LFTs
Blood gases & pH
Drug screen
Lumbar puncture
X-RAY
Skull fractures . Depressed?
Calcified pineal gland: midline
shift
CXR: cardiomegaly, tb
X-ray of bruised limbs &
suspected fractures
NB: In head trauma cases a c
spine x-ray should always be
sought.
CT & MRI
CT- scan is useful in the case
where SOL are suspected
Imaging of the skull where
images of higher definition than
x-ray are required
MRI may be used to view bleeds.
Hypo dense?Hyperdense?
BLOOD SUGAR
Must be done on every coma
patient
Normal fasting: 3.9-6.1mm0l/L
Hypoglycemia is the most
common cause of coma in
diabetics
Hyperglycemia causes
hyperosmolar state osmotic
diuresis with loss of sodium and
potassium ions.
May cause coma independent of
pH
Normal blood pH 7.35-7.45
Hypergycaemia,riased pH,kussmaul
breathing, and ketotic breath point
to diabetic ketoacidosis
Lactic acidosis may complicate
diabetic coma when tissue s
become hypoxic. Lactic acidosis
may itself cause coma.
1% of children with diabetic
ketoacidosis develop brain edema&
can cause coma. 25% mortality
BLOOD GASES
Important if there is brain
damage causing central pontine
hyperventilation.
Changes in respiratory pattern
provide important and relatively
objective evidence of
deterioration.
Normal blood gas levels:pO2 75-
100mmHg
pCO2
ELECTROLYTES
Monitoring of potassium is
important in management of
diabetic patients.
Total body potassium may be low
but plasma levels normal: ECF
volume is decreased due to polyuria
potassium moves from
cells to ECF when H+
conc. is high
lack of insulin induced k+
entry into cells
In severe acidosis NA+ is markedly
depleted.
LFTs&DRUG SCREEN
Lfts deranged in hepatic coma,
drug overdose
Elevated aminotransferase levels
Associated clinical findings e.g.
jaundice
*paracetamol OD may not cause
coma but other drugs taken at
that time may.
*alcohol level may be misleading
and other causes should be
LUMBAR PUNCTURE
Ensure intracranial pressure is
not raised
Levels of lymphocytes elevated
in tb meningitis(100-300)
normal(0-2) polymorphs 0-100,
colorless
In bacterial meningitis
polymorphs are 200-2000,
yellowish or turbid
Neoplastic
meningitis(infiltration)5-1000
BLOOD Ix
Hemoglobin can be used to asses
bs control 4-6 wks prior to the
test.
Raised WBC,*mantoux test
INR:hepatic coma,spotaneous
bleed
 OTHER Ix

Myxedema coma: Thyroid function

tests.
*loss of brain function as a result of
long standing low levels of thyroid
hormones.