General anaesthesia Coma and management of unconscious patients

General anaesthesia Coma and management of unconscious patients

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General anaesthesia Coma and management of unconscious patients This is a state in which a patient is totally unaware of both self and external surroundings, and unable to respond meaningfully to external stimuli. Coma results from gross impairment of both cerebral hemispheres, and/or the ascending reticular activating system. There are many causes of coma and these may be classified as either focal or diffuse brain dysfunction. Focal brain dysfunction: focal head injury vascular events (CVA) demyelination infection, such as cerebral abcess brain tumour Diffuse brain dysfunction: Drugs, poisoning and overdoses (including alcohol) Diffuse head injury Epilepsy Infection, such as meningitis or encephalitis Hypoxia and hypercarbia Metabolic/endocrine causes, such as diabetic coma, hepatic or renal failure, hypothyroidism, severe electrolyte disturbances Hypotension, or hypertensive crisis Subarachnoid haemorrhage Hypothermia, hyperthermia Sometimes, people just pretend! Management of the unconscious patient: First of all, make sure quickly that they are unconscious, and not just asleep. Often, someone else has already done this for you. Next, the primary care is EXACTLY the same as Basic Life Support – AIRWAY, BREATHING, CIRCULATION.
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A patient who is unconscious is at a very high risk of compounding their problems by adding to them by asphyxia, leading to death. When consciousness is lost, the tongue usually falls back in the pharynx and obstructs the airway. The cough reflex is lost, and blood or regurgitated stomach contents are often aspirated into the lungs. Therefore, the unconscious patient must have their airway supported by tilting the head and lifting the chin (sometimes with the help of an oral or nasal airway), and by placing them into
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General anaesthesia Coma and management of unconscious patients

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