In neurological disorders, the location of signs pointing to parts of the nervous system disease can be for example present, hemiplegia, palsies of cranial nerves, focal seizures, etc. Meningitis and subarachnoid haemorrhage associated with signs of meningeal irritation such as neck stiffness, Kernig sign and Brudzinski signs. In metabolic coma, location of signs may be absent. In poisoning, other effects of the poison can also be evident.
Research
1. Investigations of routine to exclude systemic disorders include a thorough analysis of urine, estimation of arterial blood gases, electrolytes, pH, blood sugar urea.
2. In the alleged poisoning, gastric chemical examination for poison materials shall be submitted.
3. The cerebrospinal fluid should be considered suspected meningitis, encephalitis, hemorrage subarachnoid or meningeal leukemia.
4 Evidence decided by clinical examination and the progress of the EEG, neurorradiologia, CT case analysis, NMR imaging and radioisotope scanning may indicate in many cases.
Management
Directorate-General: Comatose patients are very sensitive to develop several complications as a result of the loss of reflexes protectors and these must be avoided. Maintenance of the respiratory tract is paramount.The neck has to maintain extended to avoid "fall-back of the tongue. If necessary, you must enter a patient airway. Secretions must eliminate postural drainage and aspiration in cases with depression respiratory artificial ventilation must be established early.In some cases, may be necessary to tracheostomy.
Maintenance of nutrition and fluid and electrolyte balance: adequate nutrition (at least 2000 cals per day and 2 L of fluid) in the form of milk, sugar, eggs, cereals, salt and water are given on a probe nasogastric. food by mouth carries the risk of aspiration in airway and, therefore, should be avoided.Parenteral nutrition starts through intravenous route to complement the nasogastric tube feeding. Intravenous needle must maintain prolonged aseptico.Enfermedad, the position of the needle must be changed every 36 to 48 hours to avoid thrombophlebitis.
Skin care: patients develop sores due to continuous pressure on localized areas. This risk is to avoid activating the patient in bed every two to four hours and keep skin clean and dry.An adequate intake of protein helps to minimize the risk of ulcers of the cama.Cuando coma is likely to extend, special beds which are capable of converting to patients, and help to avoid pressure on localized areas can be used with advantage.
Bladder and bowel: the patient unconscious voids your bladder and bowel automatically and this causes many problems in nursing.Institution of a closed for bladder drainage system helps to avoid this clothing dirt and prevent infection.Bowels moved by small enemas or suppositories at regular intervals.
Positioning of limbs and physiotherapy: members should be kept positions best to avoid fixed deformities.Regular passive movements to limbs help in the prevention of venous thrombosis and pulmonary embolism later.
Specific therapy: this depends on the cause of the comma.Anticonvulsant medication indicated if seizures occur.Intercurrent infection (urinary or cutaneous has to be treated with antibiotics, breathing).
Brain death
This issue has gained importance from the removal of organs for transplantation is performed from patients who have no chance of recuperarse.Los patients undergoing support including artificial ventilation measures can happen in a stage where brain functions and the brain stem is irretrievably lost, the patient can continue have circulation of these housings apoyo.Retirada measures will lead to the death fisica.La decision to withdraw these housings is doctor-legales.Por therefore, brain death must have been diagnosed with the help of deep without any movement reflexes for more than 12 hours, EEG.Coma lack of brain stem (Oculocephalic reflexes, reflection of light and spontaneous breathing) reflexes and a flat EEG record indicates irreversible death cerebral.estos brain damage criteria are not valid if the comma is the result of hypothermia poisons overdose.
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