CuraRN

Head Injury/Coma

Student study notes from paramedic coursework (2023 to 2024), not medical advice. Verify clinical values against current references and your local protocols.

EMS etiologies

Setting: ER

Head injuries can result from trauma, such as falls, car accidents, or assaults, leading to brain damage or coma. A coma is a deep state of prolonged unconsciousness in which a person cannot be awakened and does not respond to stimuli such as pain, light, or sound. Coma patients lack a normal sleep-wake cycle, cannot initiate voluntary actions, and are unable to speak, move, or consciously feel. Comas can result from natural causes or be medically induced. Individuals in a coma often require intensive medical care to maintain bodily functions and prevent complications such as pneumonia or blood clots.

Consciousness is maintained by the interaction of the cerebral cortex and the reticular activating system (RAS) in the brainstem, which governs wakefulness and awareness. Disruption of these systems leads to the comatose state. Comas can result from various causes, including:

• Drug poisoning
• Trauma, such as head injuries that damage brain tissue.
• Stroke, which can deprive the brain of oxygen.
• Infections, such as encephalitis or meningitis, that inflame brain tissue.
• Metabolic imbalances, including severe hypoglycemia or hyperglycemia, electrolyte imbalances, or liver/kidney failure.
• Severe hypoxia due to cardiac arrest or respiratory failure.

Clinical Presentation:

• Loss of consciousness
• Confusion, disorientation
• Headache, vomiting
• Seizures, coma

Clinically, a coma is defined by an inability to follow simple commands and a score of 8 or less on the Glasgow Coma Scale for at least six hours.

Treatment Modalities:

• Stabilization and monitoring
• Surgical intervention if needed
• Supportive care (ventilation, fluids)