title: Approach to the comatose patient.
abstract: BACKGROUND
  Coma is a medical emergency and may constitute a diagnostic and therapeutic challenge for the intensivist.
  
  
  OBJECTIVE
  To review currently available data on the etiology, diagnosis, and outcome of coma. To propose an evidence-based approach for the clinical management of the comatose patient.
  
  
  METHODS
  Search of Medline and Cochrane databases; manual review of bibliographies from selected articles and monographs.
  
  
  CONCLUSIONS
  Coma and other states of impaired consciousness are signs of extensive dysfunction or injury involving the brainstem, diencephalon, or cerebral cortex and are associated with a substantial risk of death and disability. Management of impaired consciousness includes prompt stabilization of vital physiologic functions to prevent secondary neurologic injury, etiological diagnosis, and the institution of brain-directed therapeutic or preventive measures. Neurologic prognosis is determined by the underlying etiology and may be predicted by the combination of clinical signs and electrophysiological tests.
authors.affiliation: Division of Neurosciences Critical Care, Department of Anesthesiology/Critical Care Medicine, Neurology and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Stevens
authors.forename: Anish
authors.initials: A
authors.lastname: Bhardwaj
mesh_terms: D001926:Brain Death; D001930:Brain Injuries / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D003128:Coma / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D003131:Combined Modality Therapy; D018450:Disease Progression; D004502:Education, Medical, Continuing; D004594:Electrophysiology; D019317:Evidence-Based Medicine; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D018458:Persistent Vegetative State / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome