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Treatment of impaired consciousness
Last reviewed: 20.11.2021
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Treatment of impaired consciousness
Regardless of the cause of coma, the first activities are the evaluation of vital functions, the elimination and prevention of their disorders. The following actions are required.
- Provision of oxygenation (release of the respiratory tract, intubation, if necessary - tracheostomy, ventilation).
- Normalization and stabilization of blood circulation (administration of antihypertensive drugs or vasopressors, antiarrhythmics, maintenance of cardiac activity, normalization of circulating blood volume).
- Administration of large doses of thiamine when suspected of alcohol abuse.
- Introduction anticonvulsants in the presence of seizures.
- The introduction of glucose (the risk of hypoglycemic damage to the brain is higher than the worsening of encephalopathy in hyperglycemia) with subsequent correction after receiving the assays.
- Introduction of sedative drugs in the presence of psychomotor agitation.
- Normalization of water-electrolyte disturbances and acid-base balance.
- Normalization of body temperature.
- The introduction of antibiotics (TBI, a suspicion of a neuroinfection or the presence of signs of a bacterial infection).
- Gastric lavage if suspected of drug or food poisoning.
Further treatment depends on the results of the examination and the determination of the cause of coma and includes detoxification (including specific) in poisoning, the administration of naloxone in case of drug overdose, hemodialysis in renal failure, the use of large doses of thiamine in alcohol poisoning, etc. It should be remembered about neurosurgical care volume lesions of the brain, when procrastination can cost a patient's life (epi- and subdural hematomas, acute occlusion of cerebrospinal fluid pathways, etc.).
Forecast
The outcome in patients with impaired consciousness, especially those in a state of coma, depends on so many factors. The accuracy of the prognosis is due primarily to the etiology of the lesion and the degree of depression of consciousness, so it is advisable to discuss the prognosis and outcome of the disease only in connection with the specific condition of the patient. In general, besides the cause of coma development, the age of the patient, the speed and volume of medical care are of great importance.
A patient with a violation of consciousness, especially in a coma, requires quick decisions, since with a timely diagnosis and adequate therapy, coma can be reversible, and delay in some cases can be fatal.