Coma (OSCE)

## Causes of Coma

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* 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

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Eye opening | Best Motor Response | Verbal Response

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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

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Function | Normal | Diencephalon | Midbrain | Pons

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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

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* v
* t
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Objective structured clinical examination

Acute Confusion \- Acute Coronary Syndrome Orders \- Anemia \- Arterial Blood Gasses \- Asthma \- Blood Pressure \- Chest pain \- Chest XRay \- CHF \- Coma \- COPD \- Cranial Nerves \- Diabetic History \- Diabetic Foot \- Dysphagia \- EKGs \- Gallbladder and Liver \- Liver Disease \- Gait and Balance \- Headache \- Hematemesis \- Hypertension \- Jugular Venous Pulses \- Knee Exam \- Lymph Nodes \- Community Acquired Pneumonia \- Parkinson Disease \- Peripheral Arterial Insufficiency \- Pneumonia Examination \- Precordial Exam \- STD's \- Spleen \- Swollen Leg Exam \- Thyroid Exam \- Upper vs Lower Motor Neuron Lesions \- Urinary Incontinence
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