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FOCUSED SHIFT VIEW

Coma & Depressed LOC

Protect, correct the two reversible killers, image.

Open full pathway
Educational first-pass aid. Reassess the patient, confirm doses and use local protocols.

1 · First minutes

  1. Airway, glucose, oxygen — naloxone and thiamine as indicated (never delay dextrose).
  2. Pupils, breathing pattern, and brainstem reflexes localise structure vs toxin.
  3. Non-contrast CT for structural causes; EEG if non-convulsive status is possible.

2 · Escalate now if

  • Unequal or fixed-dilated pupils
  • Motor posturing or irregular breathing
  • Falling GCS, seizures, or hyperthermia
  • Hypoglycemia unresponsive to therapy; hypothermia
  • Meningeal signs with rapid progression
  • Anticoagulation with any trauma history

3 · Immediate workup

  • Glucose immediately; naloxone/thiamine as indicated
  • ECG; VBG/ABG; core temperature

4 · Don’t miss

  • Hypoglycemia
    Glucose every time — the most treatable cause of coma.
  • Opioid overdose
    Pinpoint pupils + hypoventilation — titrate naloxone to breathing.
  • Herniation (uncal / central)
    Blown or unilateral pupil, posturing, Cushing reflex — hypertonic saline/mannitol, neurosurgery.
  • Massive ICH / SAH / basilar occlusion
    Non-contrast CT immediately; basilar thrombosis can present as coma without lateralizing signs.
  • Non-convulsive status epilepticus
    Coma with subtle myoclonus — EEG; treat without waiting.

5 · Disposition lane

Admit (monitored)

Post-ictal or toxic with improving exam and a secured airway plan; correcting metabolic derangements.

ICU / neurosurgery

Undifferentiated coma, herniation signs, ICH/SAH, status epilepticus, need for airway protection.