Element contents
Assessment of a Patient in Coma
Published online by Cambridge University Press: 21 August 2025
Summary
The authors start with definitions and classification of a depressed conscious state and proceed to detail practical tips in the initial assessment of patients with coma, focussing on the history and examination. They impress the number of non-neurological causes of coma, which may need to be considered. The assessment of pupillary responses, eye movement abnormalities and abnormal breathing patterns are described. They also explore the utility of basic initial investigations, including blood gases and briefly discuss specialist neuro-imaging and electroencephalography.
Information
- Type
- Element
- Information
- Online ISBN: 9781009485777Publisher: Cambridge University PressPrint publication: 18 September 2025
References
Teasdale, G, Jennett, B. Assessment of coma and impaired consciousness: A practical scale. Lancet. 1974;2(7872):81–84.CrossRefGoogle ScholarPubMed
McPherson, A, Rojas, L, Bauerschmidt, A, et al. Testing for minimal consciousness in complex partial and generalized tonic-clonic seizures. Epilepsia. October 2012;53(10):e180–e183.CrossRefGoogle ScholarPubMed
van Ommen, HJ, Thibaut, A, Vanhaudenhuyse, A, et al. Resistance to eye opening in patients with disorders of consciousness. J Neurol. June 2018;265(6):1376–1380.CrossRefGoogle ScholarPubMed
Chauhan, K, Pattharanitima, P, Patel, N, et al. Rate of correction of hypernatremia and health outcomes in critically ill patients. Clin J Am Soc Nephrol. 7 May 2019;14(5):656–663.CrossRefGoogle ScholarPubMed
Mehta, AN, Emmett, JB, Emmett, M. GOLD MARK: An anion gap mnemonic for the 21st century. Lancet. 13 September 2008;372(9642):892.CrossRefGoogle Scholar
Sandoval, Y, Jaffe, AS. Type 2 myocardial infarction: JACC review topic of the week. J Am Coll Cardiol. 16 April 2019;73(14):1846–1860.CrossRefGoogle ScholarPubMed
Baker, C, Muse, J, Taussky, P. Takotsubo syndrome in neurologic disease. World Neurosurg. May 2021;149:26–31.CrossRefGoogle ScholarPubMed
Brenner, RP. The interpretation of the EEG in stupor and coma. Neurologist. September 2005;11(5):271–284.CrossRefGoogle ScholarPubMed
Boulter, JH, Shields, MM, Meister, MR, et al. The expanding role of quantitative pupillometry in the evaluation and management of traumatic brain injury. Front Neurol. 2021;12:685313. Published 12 July. https://doi.org/10.3389/fneur.2021.685313.CrossRefGoogle ScholarPubMed
Accessibility standard: Inaccessible, or known limited accessibility
Why this information is here
This section outlines the accessibility features of this content - including support for screen readers, full keyboard navigation and high-contrast display options. This may not be relevant for you.Accessibility Information
The HTML of this element is known to have missing or limited accessibility features.
We may be reviewing its accessibility for future improvement, but final compliance is
not yet assured and may be subject to legal exceptions. If you have any questions,
please contact
accessibility@cambridge.org.
Content Navigation
Table of contents navigation
Allows you to navigate directly to chapters, sections, or non‐text items through a linked table of contents, reducing the need for extensive scrolling.
Allows you to navigate directly to chapters, sections, or non‐text items through a linked table of contents, reducing the need for extensive scrolling.
Index navigation
Provides an interactive index, letting you go straight to where a term or subject appears in the text without manual searching.
Provides an interactive index, letting you go straight to where a term or subject appears in the text without manual searching.
Reading Order & Textual Equivalents
Single logical reading order
You will encounter all content (including footnotes, captions, etc.) in a clear, sequential flow, making it easier to follow with assistive tools like screen readers.
You will encounter all content (including footnotes, captions, etc.) in a clear, sequential flow, making it easier to follow with assistive tools like screen readers.
Short alternative textual descriptions
You get concise descriptions (for images, charts, or media clips), ensuring you do not miss crucial information when visual or audio elements are not accessible.
You get concise descriptions (for images, charts, or media clips), ensuring you do not miss crucial information when visual or audio elements are not accessible.
Full alternative textual descriptions
You get more than just short alt text: you have comprehensive text equivalents, transcripts, captions, or audio descriptions for substantial non‐text content, which is especially helpful for complex visuals or multimedia.
You get more than just short alt text: you have comprehensive text equivalents, transcripts, captions, or audio descriptions for substantial non‐text content, which is especially helpful for complex visuals or multimedia.
Visual Accessibility
Use of colour is not sole means of conveying information
You will still understand key ideas or prompts without relying solely on colour, which is especially helpful if you have colour vision deficiencies.
You will still understand key ideas or prompts without relying solely on colour, which is especially helpful if you have colour vision deficiencies.
Structural and Technical Features
ARIA roles provided
You gain clarity from ARIA (Accessible Rich Internet Applications) roles and attributes, as they help assistive technologies interpret how each part of the content functions.
You gain clarity from ARIA (Accessible Rich Internet Applications) roles and attributes, as they help assistive technologies interpret how each part of the content functions.
- 2
- Cited by