Medicina

Neurocrit Care (2012) 17:S54–S59
DOI 10.1007/s12028-012-9755-4

REVIEW ARTICLE

Emergency Neurological Life Support: Approach to the Patient
with Coma
J. Stephen Huff • Robert D. StevensScott D. Weingart • Wade S. Smith

•

Published online: 30 August 2012
Ó Neurocritical Care Society 2012

Abstract Coma is an acute failure of neuronal systems
governing arousal and awareness andrepresents a neurological emergency. When encountering a comatose patient,
the clinician must have an organized approach to detect
easily remedial causes, prevent ongoing neurologic injury,
anddetermine a hierarchy of diagnostic tests, treatments,
and neuromonitoring. Coma was chosen as an Emergency
Neurological Life Support (ENLS) protocol because timely
medical and surgical interventionscan be life-saving, and
the initial work-up of such patients is critical to establishing a correct diagnosis.
Keywords Coma Á Herniation Á Osmolar therapy Á
Mannitol Á Hypertonic saline

J. S.Huff (&)
Departments of Emergency Medicine and Neurology, University
of Virginia School of Medicine, Charlottesville, VA, USA
e-mail: jshuff505@me.com
R. D. Stevens
Departments of Anesthesiologyand Critical Care Medicine,
Neurology, Neurosurgery, and Radiology, Johns Hopkins
University School of Medicine, Baltimore, MD, USA
S. D. Weingart
Division of ED Critical Care, Mount Sinai School ofMedicine,
New York, NY, USA
W. S. Smith
Department of Neurology, University of California,
San Francisco, San Francisco, CA, USA
e-mail: spambin55@gmail.com

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Introduction
Coma ischaracterized by the absence of arousal (wakefulness, vigilance) and of awareness of self and environment [1]. Comatose patients have closed eyes, do not
speak, and do not arouse to verbal, tactile, ornoxious
stimulus. Some causes of coma are readily identified while
others may require extensive testing to discover an
etiology.
Diagnostic and therapeutic steps should occur simultaneously. An...