La Revue du praticien
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The clinical examination of a comatose patient may be divided into neurological ang general. The neurological examination aims at determining all that is proper to the state of coma, its complication, whatever they origin (mostly cerebral oedema and herniation) and its focal signs. As for the coma itself, one may distinguish between disorders of consciousness or perceptivity and disorders of wakefulness. ⋯ Vegetative symptoms, including respiration, cardiovascular system, temperature, trophicity, sphincteral function, must be studies in all comas. The classification of comas into stages of severety and the relevant scores (Glasgow, Liège) must be known with their advantages and limitations. The general clinical evaluation, including past history and associated signs, may suggest an aetiological diagnosis and point to the necessary paraclinical explorations.
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The outcome of anoxic coma following cardiac arrest depends on the aetiological circumstances, on pre-existing visceral deficiencies and on the duration of inefficient circulation. Outside the extreme cases of prompt return to consciousness or early death, in many patients this course is marked by neurological sequelae of varying severity which may result in a persistent vegetative state. Initially, there is nothing that can predict the quality of survival, but within 72 hours the neurological examination usually makes it possible to foresee irreversible situations with permanent loss of consciousness. The decisional problems that ensue are discussed.