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The Intensive Care Manual - part 9

Chăm sóc cho một bệnh nhân hôn mê đòi hỏi một sự hiểu biết cơ bản của ý thức và các quá trình pathophysiologic dẫn đến làm hỏng của nó. Chương này thảo luận về định nghĩa hiện tại của hôn mê và các quốc gia liên quan của ý thức, cung cấp một phương pháp tiếp cận có hệ thống đánh giá của một | CHAPTER 13 Approach to Coma Curtis Benesch introduction DEFINITION OF consciousness Disorders of Arousal Anatomy of Consciousness DIAGNOSIS OF coma AND RELATED conditions Coma Vegetative State Minimally-conscious state conditions that Mimic coma causes of coma ASSESSMENT OF THE comatose patient General Examination Neurologic Examination diagnostic tests TREATMENT OF THE comatose patient Elevated intracranial Pressure causes of coma that Require Early Treatment PROGNOSIS Nontraumatic coma Traumatic coma Vegetative state DETERMINING DEATH according TO brain criteria SUMMARY 321 Copyright 2001 The McGraw-Hill Companies. Click Here for Terms of Use. 322 The Intensive Care Manual INTRODUCTION Caring for a comatose patient requires a basic understanding of consciousness and the pathophysiologic processes that lead to its derangement. This chapter discusses current definitions of coma and related states of consciousness provides a systematic approach to the evaluation of a patient in coma and describes current treatment recommendations for common causes of coma. DEFINITION OF CONSCIOUSNESS Consciousness can be defined broadly as the state of awareness of self and sur-roundings.1 More specific definitions of consciousness have included three distinct components wakefulness the capacity to detect and encode internal and external stimuli and the capacity to formulate goal-directed behavior.2 In this definition self-awareness is not a prerequisite for consciousness e.g. an individual with advanced dementia. In general disorders of consciousness are the result of impairment in either one or both of the critical elements of consciousness arousal and content.1 Disorders of arousal coma are the focus of this chapter. Disorders of content such as dementia or confusional states typically do not require intensive care and therefore are excluded from this discussion. Disorders of Arousal Disorders of arousal are often characterized by terms ranging from alert to comatose. Coma has .