Unconsciousness Coma Z. Rozkydal •Intracranial causes • •Vessels: head injury, bleeding • haematoma, anomalies, ischemia • •Infection – meningitis, encefalitis, abscesus • •Tumors • •Epilepsy • •Extracranial causes • •Poisoning (CO, alcohol, drugs) • •Metabolic diseases (DM, hypothyreosis) • •Systemis failure- liver, kidney • •Stop of breathing and circulation •- in 30 seconds •Level of consciousness • 1. Somnolence drowsiness 2. • •2. Sopor lower level of consciousness • reaction to pain • •3. Coma deep unconsciousness je neprobuditelný 1. •Level of consciousness • •A Alert, respond to questions • eyes are open • •V Voice, respond to voice, obey commands • •P Pain, respond to pain • •U Unresponsive to any stimulus • •First aid • •Seek the cause •Monitor vital signs •Opening the airways- tilt his head back • lift the chin •Checking breathing •Recovery position, injury- the same position •AED •CPR •Avoid aspiration, nothing orally •Transport FA rescue position •Recovery position •Faintness- syncope • •Short loss of consciousness • •Causes: bradycardia, arythmia • postural hypotensis • vasovagal faintness •First aid • •Horizontal position •Raising of legs •Fresh air •Fluids Extracranial unconsciousness •Diabetic coma • •DM- insufficient production of insulin •Hyperglycaemia, osmotic diuresis •Loss of fluids •Metabolic acidosis, aceton •Loss of potassium and natrium • •Brain is depedent on plasmatic glucose •Utilisation of glucose in brain •is not controlled by insulin •Signs • •Polyuria, polydypsia •Dry, warm skin, dehydration •Rapid pulse and breathing •Excessive thirst •Deep breath •Fruity sweet breath- aceton in the breath •Nausea and vomiting •Unconsciousness • •Mortality 50 % • •Hypoglycaemia – coma • •Causes: insulin- sugar balance is incorrect • high doses of insulin, alcohol • •Signs: •Weakness, faintness, confusion •Sweating with cold clammy skin •Rapid pulse, muscle tremor •Deteriotating level of response •Feels hungry • •First aid in both- sugar, glucose fluids • •Hepatal coma • •Renal coma (uraemia) • •Hyperthyreosis • •Hypothyreosis •Death of brain • •History of brain lesion •Areflexia, apnoe from the brain stem •No reaction of pupils •No reaction to pain •No breathing for 10 minutes • after stopping of ventilation with oxygen •EEG – ½ hour isoelectric line •Brain angiography – no vascularisation • above the base •Signs of death • •Patches (6-12 hours) • •Cold body (1˚C / hour) • •Stiffness (after 6-12 hours) • •Decomposed body (after 2 days)