Coma (OSCE)

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Causes of Coma[edit]

  • One Mnemonic is “GAMETIMES”:
  • G glucose (hyperosmolar or hypoglycemia)
  • A anoxia, acidosis, alcohol’s
  • M medications (one of the most common causes)
  • E electrolytes, “environment” (hypothermia)
  • T tumor, toxins, trauma
  • I infections (e.g. meningitis, encephalitis, sepsis)
  • M Metabolic, adrenal, renal, hepatic, (diabetes listed above)
  • E epilepsy
  • S stroke, (P)sychiatric pseudocoma

The Glasgow Coma Scale[edit]

Eye opening Best Motor Response Verbal Response
Spontaneous 4 Follows commands 6 Orientated 5
To speech 3 Localizes to painful stimuli 5 Confused conversation 4
To pain 2 Withdrawal from pain 4 Inappropriate words 3
No response 1 Flexion reflex response to pain 3 Incomprehensible sounds 2
Extension reflex response to pain 2 No response 1
No response 1

Neurological Exam[edit]

Function Normal Diencephalon Midbrain Pons
Respiration Normal Cheyne-Stokes Regular, hyperventilation Irregular, erratic
Pupil Size and Response to light Normal Small, Reactive Mid-position, fixed Pinpoint Reactive
Oculovestibular Reflex Suppressed Constant (tonic) deviation Dysconjugate gaze No response
Motor response to pain Appropriate Decorticate

(arms flexor response)

Decerebrate (all extensor response) No response

Other OSCE Modules[edit]