Coma (OSCE)

Causes of Coma

• 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

Eye opening	Best Motor Response	Verbal Response
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

Function	Normal	Diencephalon	Midbrain	Pons
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