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Coma, definition and measurement

shane heinzman

on 6 March 2012

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Transcript of Coma

Coma Definition & Measurement Shane Heinzman Clinical Neuropsychology
Spring 2012 A state of unawareness to the world at large, with the exception of eye opening in response to pain, but with an absence of eye tracking or fixation and the only motor activity is limb withdrawal in response to pain (Wijdicks, 2009) Coma: Early assessment of coma Glascow Coma Scale (GCS)
Bozza-Marrubini coma scale
Full Outline UnResponsiveness (FOUR) Score Eyes open Glascow Coma Scale (GCS) 4 - Spontaneously
3 - To speech
2 - To pain
1 - None Verbal response 5 - Oriented x 3
4 - Confused
3 - Inappropriate words
2 - Incomprehensible sounds
1 - None Motor response 5 - Obey commands
4 - Localizes pain
3 - Flexion to pain (decorticate)
2 - Extension to pain (decerebrate )
1 - None Coma: A state of total unawareness where the individual is not responsive to external stimuli (Bordini, Luiz, Fernandes, Arruda, & Teive, 2010)

Glascow Coma Scale Is particularly useful in assessing the severity of changes of consciousness in patients with TBI.
Most commonly used coma assessment scale Satisfies three requirements: Bozza Marrubini Scale 1) Common language which overcomes barriers of time, space, and speciality
2) Good for assessing a series of patients
3) Is predictive of clinical outcome Level/reactivity
reflexes Bozza-Marrubini Scale Reactivity to
voice Reactivity to
pain Brain stem
reflexes 1 2 3 4 5 6 7 Answers Obeys No response No response No response No response No response Localizes Localizes Localizes Flexion Extension Any type or
no response None Present
Both absent OR VOR disconjugate only Both absent Seperates organic brain damage into 7 categories Also composed of brainstem reflexes which makes it more sensitive than the GCS in assessing conditions such as locked-in syndrome, and the vegetative state
Provides more neurologic detail than the GCS Full Outline UnResponsiveness (FOUR) Score (E)ye response FOUR Score 4 - Eyelids open & tracking or blinking to command
3 - Eyelids open but not tracking
2 - Eyelids closed but open to loud voice
1 - Eyelids closed but open to pain
0 - Eyelids remain closed with pain (M)otor response 4 - Makes sign (thumbs-up, fist, peace sign)
3 - Localizing to pain
2 - Flexion response to pain
1 - Extension response to pain
0 - No response to pain or generalized myoclonus status (cont.) FOUR Score (cont.) (B)rainstem reflexes 4 - Pupil and corneal reflexes present
3 - One pupil wide and one fixed
2 - Pupil or corneal reflexes absent
1 - Pupil and corneal reflexes absent
0 - Absent pupil, corneal, and cough reflex (R)espiration 4 - Not intubated, regular breathing pattern
3 - Not intubated, cheyne-stokes breathing pattern
2 - Not intubated, irregular breathing
1 - Breathes above ventilator rate
0 - Breathes at ventilator rate or apnea References Bordini, A. L., Luiz, T. F., Fernandes, M., Arruda, W. O., & Teive, H. (2010). Coma scales: A historial review. "Arquivos De Neuro-Psiquiatria", 68(6), 930-937. doi:10.1590/S0004-282X2010000600019
Servadei, F. (2006). Coma scales. "The Lancent", 367(9510), 548-549. doi: 10.1016/S0140-6736(06)68197-X
Wijdicks, F.M. (2009). The Bare Essentials: Coma. "Practical Neurology", 2010(10), 51-60. doi: 10.1136/jnnp.2009.200097
Zuercher (2009). The use of Glasgow Coma Scale in injury assessment: A critical review. "Brain injury" (0269-9052), 23 (5), p. 371-384
Coma Brain death PVS Conscious Absence of brain
stem reflexes One month - one year period of being in a vegetative state of partial arousal MCS Unlike individuals in PVS, those in MCS maintain a partial awareness with the world around them Disability Good recovery (Wijdicks, 2009)
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