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The coma profile

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Abstract

The comatose patient presents an urgent and challenging diagnostic and therapeutic problem for the clinician. From our experience, a cooperative effort between the clinical laboratory staff and the physician has evolved a diagnostic protocol which minimizes many of the pitfalls in the management of a patient in unexplained coma.

After examining the comatose patient, the physician requests the attending nurse to order a “coma profile” in which a large series of tests are performed on a “stat” basis. The physician fills in the coma profile form (Table 1) while samples of blood, urine, gastric contents, and spinal fluid (when indicated) are promptly drawn. One medical technologist is responsible for distributing samples and gathering data, thus minimizing the chance of losing samples and misplacing results. During the analyses, any abnormal findings are telephoned to the nurse-in-charge. The entire coma profile is returned to the chart within 1½ hours.

Our selection of tests which comprise the “coma profile” is by no means complete and can be easily modified. The SMA-12 provides rapid determinations of serum cholesterol, calcium, phosphorus, bilirubin, albumin, total protein, uric acid, BUN, glucose, LDH, alkaline phosphatase, and SGOT. Determinations of serum electrolytes (potassium, sodium, chloride, CO2) and creatinine are also done on an autoanalyzer. Blood gases, serum acetone, Cortisol, T-4, salicylate, and alcohol levels are often key factors in determining appropriate therapy. Spinal fluid testing should include both routine analysis and cytologic examination for atypical cells compatible with malignancy. Routine urinalysis is performed, and blood and urine specimens and . . .


 

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