TY - CHAP M1 - Book, Section TI - Coma, Disorders of Consciousness, and Brain Death A1 - Goldenberg, Fernando D. A1 - Ammar, Faten El A1 - Dervishi, Ina A1 - Kramer, Christopher L. A2 - Schmidt, Gregory A. A2 - Kress, John P. A2 - Douglas, Ivor S. PY - 2023 T2 - Hall, Schmidt and Wood’s Principles of Critical Care, 5th Edition AB - KEY POINTSThe anatomical structures involved in the mechanisms of consciousness are the brainstem (pons and midbrain), bilateral thalamus, hypothalamus, and bilateral cerebral cortical structures.The initial emergent evaluation and management of a comatose patient include the ABC, general physical examination, and neurologic examination.The initial neurologic examination should include determination of the level of consciousness, pupillary size and function, eye movements, motor responses (spontaneous and to a painful stimulation), and respiratory patterns.Computed tomography (CT) scanning of the brain is the most valuable acute imaging test to rule out a structural cause of the coma.The Uniform Determination of Death Act (UDDA) 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 brainstem, is dead.” It also defines that “A determination of death must be made in accordance with accepted medical standards.”While the determination of Brain Death or Death by Neurologic Criteria is a clinical determination, there are certain circumstances that require an ancillary test to be performed in addition to the clinical examination and apnea testing. SN - PB - McGraw Hill CY - New York, NY Y2 - 2024/10/15 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=1201807721 ER -