SCHOOL:SCHOOL OF MEDICINE AND CLINICAL SCIENCES
PROGRAME: CLINICAL MEDICINE GENERAL
NAME
: STEVEN BANDA
ID NUMBER :21O1O2009
LECTURER: DR C PHIRI
COURSE
:MEDICINE
QUESTION: Discuss How you will take the relevant history for the patient brought to your
consultation room in coma
INTRODUCTION
Medical history taking is a skill necessary form of examination which includes an injury
into patients’ medical history, social history, allergies, and medications the patient is taking
or may have recently stopped taking. History taking plays an important role for making an
accurate diagnosis. In a complete patient history, the following must be considered;
•
Presenting complaints
•
History of presenting complaints
•
Past medical history
•
Drug history
•
Family history
•
Social history
It is important to introduce yourself, identify your patient and gain a consent to speak with
them. However, taking history in a patient who is in a coma is a bit different from the patient
who is conscious. In this case a Glasgow coma scale is used to determine the levels of
consciousness.
COMA is defined as the state of prolonged unconsciousness with loss of reaction to
external stimuli.in this case I am going to discuss on how to take history in a patient who in
coma.
Causes of coma
Metabolic
Neurological
•
Drugs intoxication
Trauma
•
Poisoning (alcohol)
Meningitis
•
Hypoglycemia and hyperglycemia
Tumor
•
Hypoxia, (co2 increase)
vascular/ stroke
•
Septicemia
Epilepsy
If a patient has been present to your institution in the state of coma, the first thing you should
do is to check for the ABC.
A.
Airway
B.
Breaths
C.
Circulation
Protect the airway the airway is the most important in this patient consider intubation when
the Glasgow coma scale is less than 8. Intubation is the process of inserting a tube into the
mouth or nose and then into the airway to help move air in and out of the lung. GCS also to
assess the severity of coma in a patient and it will determine which types of acute medical
conditions and trauma is it .This scale will give a patient a score according to their verbal and
physical responses and how easily they can open their eyes. Therefore, Medical history
supposed to be done..
Medical history
Would ask friends, family, police, and witnesses some relevant questions:
•
The onset and time course of the problem (e.g., whether seizure, headache, vomiting,
head trauma, or drug ingestion was observed)
•
Baseline mental status
•
Recent infections and possible exposure to infections
•
Recent travel
•
Ingestions of unusual meals
•
Psychiatric problems and symptoms
•
Prescription drug history
•
Use of alcohol and other recreational drugs (e.g., anaesthetics, stimulants,
depressants)
•
Previous and concurrent systemic illnesses, including new-onset heart failure,
arrhythmias, respiratory disorders, infections, and metabolic, liver, or kidney disorders
•
The last time the patient was normal
•
Any hunches they may have about what might be the cause (e.g., possible occult
overdose, possible occult head trauma due to recent intoxication)
Medical records should be reviewed if available.
BRIEF COLLATERAL HISTORY
1.How was the patient found
2.When was the patient last seen to be okay
3. Was it abrupt or gradual onset
4 Is there any suggestion of trauma
5.Is there any history of flits when the patient become unconscious
6. Was there any recent complaints like headaches, fever, and depression
7. foreign travel or infection
8. Drugs or toxin exposure that the patient has taken
PHYSICAL EXAMINATION
Physical examination should be focused and efficient and should include thorough
examination of the head and face, skin, and extremities. Signs of head trauma, If unstable
injury and cervical spine damage have been excluded, passive neck flexion is done and
stiffness suggests subarachnoid haemorrhage or meningitis.
INVESTIGATIONS
1.
Labs
2.
Imaging
For labs do the Blood sugar, FBC, Urine Analysis etc.
For imaging do the CXR, CT SCAN, LUMBAR PUNCTURE, ECG etc.
DIAGNOSIS
•
History
•
General physical examination
•
Neurologic examination, including eye examination
•
Laboratory tests (e.g., pulse oximetry, bedside glucose measurement, blood and urine
tests)
•
Immediate neuroimaging
•
Sometimes measurement of ICP
•
If diagnosis is unclear, lumbar puncture or electroencephalography
MANAGEMENT
1.
Give oxygen therapy
2.
Give glucose if the patient is hypoglycemia
3.
Give narexone
4.
5.
Give iv thiamine
Septic specifics, give cefotoxine 2g bd
6.
Suspect malaria give artemethes, quinine
7.
Encephalitis; give acyclovir
CONCLUSION
All in all, Coma is produced by disorders that affects both cerebral hemispheres or the
brainstem reticular activiting system. The possible cause of coma is limited: Mass lesion,
metabolic encephalopathy, infection of the brain and its covering (meningitis) and sub
arachnoid hemorrhage and coma is a life-threatening condition.
REFFERENCE
1.
www.mayoclinic.org
2.
www.webmd.com
3.
www.healthline.com
4.
www.emedicinehealth.vic.gov.a