Coma

Abstract

The acute presentation of an unconscious individual is a common scenario and it indicates a severe pathological insult. Aetiology may not be apparent at initial assessment and maximal use of available resources should be made to identify the cause. Initial management should be directed towards resuscitation and stabilisation of the individual, followed by further clinical assessment. The prevention of secondary brain injury is essential and so respiratory, circulatory and metabolic abnormalities should be treated aggressively. Early involvement of critical care physicians may be required. Detailed aspects of acute management and specific care of head injured, intoxicated and post-cardiac arrest patients is discussed.