Coma (OSCE)

Causes of Coma

One Mnemonic is “GAMETIMES”:

G glucose (hyperosmolar or hypoglycemia)
A anoxia, acidosis, alcohol’s
M medications (one of the most common causes)
E electrolytes, “environment” (hypothermia)
T tumor, toxins, trauma
I infections (e.g. meningitis, encephalitis, sepsis)
M Metabolic, adrenal, renal, hepatic, (diabetes listed above)
E epilepsy
S stroke, (P)sychiatric pseudocoma

The Glasgow Coma Scale

Eye opening	Best Motor Response	Verbal Response
Spontaneous 4	Follows commands 6	Orientated 5
To speech 3	Localizes to painful stimuli 5	Confused conversation 4
To pain 2	Withdrawal from pain 4	Inappropriate words 3
No response 1	Flexion reflex response to pain 3	Incomprehensible sounds 2
	Extension reflex response to pain 2	No response 1
	No response 1

Neurological Exam

Function	Normal	Diencephalon	Midbrain	Pons
Respiration	Normal	Cheyne-Stokes	Regular, hyperventilation	Irregular, erratic
Pupil Size and Response to light	Normal	Small, Reactive	Mid-position, fixed	Pinpoint Reactive
Oculovestibular Reflex	Suppressed	Constant (tonic) deviation	Dysconjugate gaze	No response
Motor response to pain	Appropriate	Decorticate (arms flexor response)	Decerebrate (all extensor response)	No response

Other OSCE Modules

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