Postgraduate medicine
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Postgraduate medicine · Feb 2002
ReviewEvaluating the comatose patient. Rapid neurologic assessment is key to appropriate management.
Coma is defined as a sleeplike state in which the patient is unresponsive to self and the environment. Coma should be distinguished from the persistent vegetative state and locked-in syndrome. ⋯ A pupil unreactive to light often points to a structural brain lesion and the need for urgent neurosurgical consultation. The prognosis for coma depends on the cause.
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Postgraduate medicine · Feb 2002
ReviewSedation and analgesia in intensive care. Medications attenuate stress response in critical illness.
The stress response to critical illness can have many deleterious effects. Appropriate use of sedation and analgesia can attenuate the stress response, alleviate pain and anxiety, and improve compliance with care. ⋯ In select cases, neuromuscular blocking agents are required, but they should not be used without concomitant sedation and analgesia. Use of agents needs to be tailored to the needs of individual patients; indications, anticipated length of need, and underlying organ system derangements are important considerations.