Coma Education Elizabeth Aguirre MD CDAP Coach Coma

Coma Education Elizabeth Aguirre, MD CDAP Coach

Coma Definitions • Sleeplike state of unresponsiveness, with no purposeful response to stimuli • Impaired or unresponsive to external stimulation • Coma is a transient state of unresponsiveness. Patient’s recover, die or evolved into a more permanent state of impaired consciousness

Glasgow Coma Scale

Patient Can Have • Reflexic movements including blink to corneal stimulation • Muscle stretch reflexes • Posturing of UE and/or LE • Respirations • Pupil response, roving eye movements, gag to ET tube, etc… Clinical Documentation Accuracy Program (CDAP)

Patient Cannot Have • Withdrawal to noxious stimulus • Grimace • Spontaneous eye opening Clinical Documentation Accuracy Program (CDAP)

Glasgow Coma Scale GCS of 3 is clearly coma

Diabetic Coma • Diabetic coma – Reversible form of coma found in diabetics due to severe low blood sugar • Hyperosmolar nonketotic coma – Extremely high sugar leading to unconsciousness • Diabetic stupor (this is not coma) – Lowered level of consciousness but still responsive • Coma – Due to: sepsis, drug overdose, status epilepticus, etc

When documenting Coma • Please provide supporting documentation – Document the GCS score! Clinical Documentation Accuracy Program (CDAP)

Coma • Note: – There is no minimum amount of time for unresponsiveness • Ex: Diabetic pt unresponsive to all stimuli and found to have glucose of 15 – Glucose given, pt responding within a minute – This is still hypoglycemic coma Clinical Documentation Accuracy Program (CDAP)

Coma Examples • Postop pt given morphine. 30 min later found unresponsive. GCS 3. Narcan given and pt wakes up. – Dx: Coma due to accidental morphine overdose Clinical Documentation Accuracy Program (CDAP)

Coma Examples • 47 yo admitted w/ overdose and attempted suicide. Protected for airway protection. Glucose 15. GCS 3. – Dx: Coma due to intentional drug overdose or Hypoglycemic coma. Clinical Documentation Accuracy Program (CDAP)