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 |
Other OSCE Modules
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