TY - CHAP M1 - Book, Section TI - Coma, Persistent Vegetative State, and Brain Death A1 - Mangat, Halinder S. A1 - Rosengart, Axel A2 - Hall, Jesse B. A2 - Schmidt, Gregory A. A2 - Kress, John P. Y1 - 2015 N1 - T2 - Principles of Critical Care, 4e AB - The neuroanatomy of coma can be divided into three major categories: diffuse brain dysfunction or bithalamic injury, primary brain stem disorders, and secondary brain stem compression from supratentorial and infratentorial mass lesions.Most cases of coma are due to metabolic disorders or exogenous drug intoxication.Patient evaluation must follow an orderly sequence, beginning with vital signs, general physical examination, and neurologic examination.The neurologic examination of the patient in coma is brief and focuses on (1) level of consciousness, (2) pupils, (3) eye movements, (4) motor responses, and (5) respiratory pattern.Computed tomographic (CT) scanning of the brain is the most valuable acute test to rule out structural causes of coma.Hypoxic-ischemic encephalopathy after cardiopulmonary arrest may be ameliorated by targeted hypothermia and supportive measures.Serial neurologic examination over the first 72 hours is most helpful to determine the prognosis for patients with atraumatic coma; for anoxic brain injury, failure to recover pupillary responses or corneal reflexes in the first 72 hours is a poor prognostic sign.As therapies aimed at cerebral resuscitation and preservation following acute injury are developed and proved efficacious, prior guidelines for determining prognosis will require redefinition and reconfirmation.The Uniform Determination of Death Act states that, “An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead.”The determination of death by brain criteria is based on clinical examination, and in most cases does not require confirmatory tests. However, the cause of coma must be known, and the cause must be sufficient to explain irreversible cessation of whole brain function. The new AAN guidelines recommend a single clinical neurological examination. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=1107722516 ER -