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Assessment of a Patient in Coma

Published online by Cambridge University Press:  21 August 2025

Alexander Shah
Affiliation:
University Hospitals Plymouth NHS Trust
Holly Roy
Affiliation:
University of Plymouth

Summary

The authors start with definitions and classification of a depressed conscious state and proceed to detail practical tips in the initial assessment of patients with coma, focussing on the history and examination. They impress the number of non-neurological causes of coma, which may need to be considered. The assessment of pupillary responses, eye movement abnormalities and abnormal breathing patterns are described. They also explore the utility of basic initial investigations, including blood gases and briefly discuss specialist neuro-imaging and electroencephalography.
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Online ISBN: 9781009485777
Publisher: Cambridge University Press
Print publication: 18 September 2025

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References

Teasdale, G, Jennett, B. Assessment of coma and impaired consciousness: A practical scale. Lancet. 1974;2(7872):8184.CrossRefGoogle ScholarPubMed
McPherson, A, Rojas, L, Bauerschmidt, A, et al. Testing for minimal consciousness in complex partial and generalized tonic-clonic seizures. Epilepsia. October 2012;53(10):e180e183.CrossRefGoogle ScholarPubMed
van Ommen, HJ, Thibaut, A, Vanhaudenhuyse, A, et al. Resistance to eye opening in patients with disorders of consciousness. J Neurol. June 2018;265(6):13761380.CrossRefGoogle ScholarPubMed
Chauhan, K, Pattharanitima, P, Patel, N, et al. Rate of correction of hypernatremia and health outcomes in critically ill patients. Clin J Am Soc Nephrol. 7 May 2019;14(5):656663.CrossRefGoogle ScholarPubMed
Mehta, AN, Emmett, JB, Emmett, M. GOLD MARK: An anion gap mnemonic for the 21st century. Lancet. 13 September 2008;372(9642):892.CrossRefGoogle Scholar
Sandoval, Y, Jaffe, AS. Type 2 myocardial infarction: JACC review topic of the week. J Am Coll Cardiol. 16 April 2019;73(14):18461860.CrossRefGoogle ScholarPubMed
Baker, C, Muse, J, Taussky, P. Takotsubo syndrome in neurologic disease. World Neurosurg. May 2021;149:2631.CrossRefGoogle ScholarPubMed
Brenner, RP. The interpretation of the EEG in stupor and coma. Neurologist. September 2005;11(5):271284.CrossRefGoogle ScholarPubMed
Boulter, JH, Shields, MM, Meister, MR, et al. The expanding role of quantitative pupillometry in the evaluation and management of traumatic brain injury. Front Neurol. 2021;12:685313. Published 12 July. https://doi.org/10.3389/fneur.2021.685313.CrossRefGoogle ScholarPubMed

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Assessment of a Patient in Coma
  • Alexander Shah, University Hospitals Plymouth NHS Trust, Holly Roy, University of Plymouth
  • Online ISBN: 9781009485777
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Assessment of a Patient in Coma
  • Alexander Shah, University Hospitals Plymouth NHS Trust, Holly Roy, University of Plymouth
  • Online ISBN: 9781009485777
Available formats
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Assessment of a Patient in Coma
  • Alexander Shah, University Hospitals Plymouth NHS Trust, Holly Roy, University of Plymouth
  • Online ISBN: 9781009485777
Available formats
×