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A coma is a deep state of prolonged unconsciousness in which a person cannot be awakened, fails to respond normally to painful stimuli, light, or sound, lacks a normal wake-sleep cycle and does not initiate voluntary actions. Coma patients exhibit a complete absence of wakefulness and are unable to consciously feel, speak or move. Comas can be derived by natural causes, or can be medically induced.
In medicine, triage is a practice invoked when acute care cannot be provided for lack of resources. The process rations care towards those who are most in need of immediate care, and who benefit most from it. More generally it refers to prioritisation of medical care as a whole. In its acute form it is most often required on the battlefield, during a pandemic, or at peacetime when an accident results in a mass casualty which swamps nearby healthcare facilities' capacity.
A head injury is any injury that results in trauma to the skull or brain. The terms traumatic brain injury and head injury are often used interchangeably in the medical literature. Because head injuries cover such a broad scope of injuries, there are many causes—including accidents, falls, physical assault, or traffic accidents—that can cause head injuries.
The Glasgow Coma Scale (GCS) is a clinical scale used to reliably measure a person's level of consciousness after a brain injury.
Neurotrauma, brain damage or brain injury (BI) is the destruction or degeneration of brain cells. Brain injuries occur due to a wide range of internal and external factors. In general, brain damage refers to significant, undiscriminating trauma-induced damage.
Major trauma is any injury that has the potential to cause prolonged disability or death. There are many causes of major trauma, blunt and penetrating, including falls, motor vehicle collisions, stabbing wounds, and gunshot wounds. Depending on the severity of injury, quickness of management, and transportation to an appropriate medical facility may be necessary to prevent loss of life or limb. The initial assessment is critical, and involves a physical evaluation and also may include the use of imaging tools to determine the types of injuries accurately and to formulate a course of treatment.
The Paediatric Glasgow Coma Scale or the Pediatric Glasgow Coma Score or simply PGCS is the equivalent of the Glasgow Coma Scale (GCS) used to assess the level of consciousness of child patients. As many of the assessments for an adult patient would not be appropriate for infants, the Glasgow Coma Scale was modified slightly to form the PGCS. As with the GCS, the PGCS comprises three tests: eye, verbal and motor responses. The three values separately as well as their sum are considered. The lowest possible PGCS is 3 whilst the highest is 15. The pediatric GCS is commonly used in emergency medical services.
Epidural hematoma is when bleeding occurs between the tough outer membrane covering the brain and the skull. Often there is loss of consciousness following a head injury, a brief regaining of consciousness, and then loss of consciousness again. Other symptoms may include headache, confusion, vomiting, and an inability to move parts of the body. Complications may include seizures.
A traumatic brain injury (TBI), also known as an intracranial injury, is an injury to the brain caused by an external force. TBI can be classified based on severity, mechanism, or other features. Head injury is a broader category that may involve damage to other structures such as the scalp and skull. TBI can result in physical, cognitive, social, emotional and behavioral symptoms, and outcomes can range from complete recovery to permanent disability or death.
The AVPU scale is a system by which a health care professional can measure and record a patient's level of consciousness. It is mostly used in emergency medicine protocols, and within first aid.
Abnormal posturing is an involuntary flexion or extension of the arms and legs, indicating severe brain injury. It occurs when one set of muscles becomes incapacitated while the opposing set is not, and an external stimulus such as pain causes the working set of muscles to contract. The posturing may also occur without a stimulus. Since posturing is an important indicator of the amount of damage that has occurred to the brain, it is used by medical professionals to measure the severity of a coma with the Glasgow Coma Scale and the Pediatric Glasgow Coma Scale.
The Revised Trauma Score (RTS) is a physiologic scoring system based on the initial vital signs of a patient. A lower score indicates a higher severity of injury.
A coma scale is a system to assess the severity of coma. There are several such systems:
The following outline is provided as an overview of and topical guide to emergency medicine:
The fencing response is an unnatural position of the arms following a concussion. Immediately after moderate forces have been applied to the brainstem, the forearms are held flexed or extended for a period lasting up to several seconds after the impact. The fencing response is often observed during athletic competition involving contact, such as combat sports, American football, Ice hockey, rugby union, rugby league and Australian rules football. It is used as an overt indicator of injury force magnitude and midbrain localization to aid in injury identification and classification for events including on-field and/or bystander observations of sports-related head injuries.
An altered level of consciousness is any measure of arousal other than normal. Level of consciousness (LOC) is a measurement of a person's arousability and responsiveness to stimuli from the environment. A mildly depressed level of consciousness or alertness may be classed as lethargy; someone in this state can be aroused with little difficulty. People who are obtunded have a more depressed level of consciousness and cannot be fully aroused. Those who are not able to be aroused from a sleep-like state are said to be stuporous. Coma is the inability to make any purposeful response. Scales such as the Glasgow coma scale have been designed to measure the level of consciousness.
Trauma in children, also known as pediatric trauma, refers to a traumatic injury that happens to an infant, child or adolescent. Because of anatomical and physiological differences between children and adults the care and management of this population differs.
The FOUR Score is a clinical grading scale designed for use by medical professionals in the assessment of patients with impaired level of consciousness. It was developed by Dr. Eelco F.M. Wijdicks and colleagues in Neurocritical care at the Mayo Clinic in Rochester, Minnesota. "FOUR" in this context is an acronym for "Full Outline of UnResponsiveness".
Pain stimulus is a technique used by medical personnel for assessing the consciousness level of a person who is not responding to normal interaction, voice commands or gentle physical stimuli. It forms one part of a number of neurological assessments, including the first aid based AVPU scale and the more medically based Glasgow Coma Scale.
A pediatric concussion, also known as pediatric mild traumatic brain injury (mTBI), is a head trauma that impacts the brain capacity. The concussion can affect the patient on multiple factors such as functional, emotional, cognitive and physical, that occurs in infant, adolescent and child patients. Symptoms following after the concussion include confusion, disorientation, lightheadedness, nausea, vomiting, blurred vision, loss of consciousness (LOC) and environment sensitivity, but these clinical manifestations may vary on the type, severity and location of the trauma. These indications potentially appear immediately, while others may arise multiple days following the injury leading to a concussion and can be diagnosed through various methods by health professionals to estimate the recovery. The majority of pediatric patients recover from the symptoms within one to three months subsequently following the injury but few patients risk delayed recovery or symptoms that persist.
References
- ↑ Green, Steven M. (2011). "Cheerio, Laddie! Bidding Farewell to the Glasgow Coma Scale". Annals of Emergency Medicine. 58 (5): 427–30. doi:10.1016/j.annemergmed.2011.06.009. PMID 21803447.
- ↑ Green, Steven M. (2011). "Cheerio, Laddie! Bidding Farewell to the Glasgow Coma Scale". annemergmed.com. 58 (5): 427–430. doi:10.1016/j.annemergmed.2011.06.009. PMID 21803447 . Retrieved 2022-09-26.
- ↑ "Simplified Motor Score (SMS)". mdcalc.com. Retrieved 2022-09-26.
- ↑ "Simplified Motor Scales". onlinecprcertification.net. Retrieved 2022-09-26.
- ↑ Haukoos, Jason S.; Gill, Michelle R.; Rabon, Rick E.; Gravitz, Craig S.; Green, Steven M. (2007). "Validation of the Simplified Motor Score for the Prediction of Brain Injury Outcomes After Trauma". sciencedirect.com. 50 (1): 18–24. doi:10.1016/j.annemergmed.2006.10.004 . Retrieved 2022-09-26.
- ↑ Caterino, J. M.; Raubenolt, A. (2012). "The prehospital simplified motor score is as accurate as the prehospital Glasgow coma scale: analysis of a statewide trauma registry". Pubmed.ncbi.NLM.nih.gov. 29 (6): 492–496. doi:10.1136/emj.2010.110437. PMID 21795294. S2CID 6983244 . Retrieved 2022-09-26.
- ↑ "Validation of the Simplified Motor Score in patients with traumatic brain injury at a major trauma centre in South Africa". researchgate.net. Retrieved 2022-09-26.