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New Onset Coma
Metabolic causes of new coma
- Drug - Alcohol abuse, drug abuse and carbon monoxide poisoning are all good. Wernicke's Encephalopathy can also be caused.
- Sugar - Low sugar (hypoglycaemia), or high sugar (ketoacidosis) both cause coma in diabetics.
Infective causes of new coma
Neurological causes of new coma
- Trauma - Head injury is a good one for putting you in a coma.
- Tumour - A brain tumour in the wrong place can cause a coma.
- Vascular - A stroke or a haemorrhagic bleed.
- First things first: ABC, then check fluids and shock.
- Check blood glucose and if its low, give them 50mL of 50% dextrose immediately! This can prevent brain damage. If its high, treat the shock, then give them some insulin.
- IV thiamine if there's any hint of Wernicke's Encephalopathy, ataxia, eye muscle problems and confusion.
- IV nalaxone if heroin overdose.
- IV flumazenil if benzodiazepine overdose, causing respiratory depression.