الفهرس 
Physiology of ConsciousnessOnly 14 pages are availabe for public view
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Abstract
Coma is a state of extreme unresponsiveness, in which an individual exhibits no voluntary movement or behavior. Furthermore, in a deep coma, even painful stimuli are unable to affect any response, and normal reflexes may be lost.
Comatose cases are at high risk for morbidity and mortality. A rapid and systematic diagnostic work up to evaluate and potentially treat the underlying etiology is mandatory. In patients presenting to the emergency department with impaired consciousness, poisoning has been shown to be the most common underlying cause. Numerous substances are capable of producing coma and they can be classified into two groups:
1. Agents that produce coma through a direct effect on brain cells as sedative-hypnotics, opioids, and organophosphate.
2. Agents that produce coma through an indirect result of derangements involving other organ systems as oral hypoglycemic drugs.
The aim of this work is to assess the frequency, causes, mechanisms, clinical presentation, management techniques, outcome and mortality rates of hospitalized cases of coma who were admitted to ICU department in Poison Control Center (PCC), Ain Shams University hospitals during one-year period from January to December 2015. Data were collected and statistically analyzed in an attempt to figure out the pattern of toxic coma for better orientation in diagnosis and management.
Four hundred cases were presented with toxic coma during one year.
The outcomes of this study can be summarized in the following points:
Most of the patients aged between 18-34 years old (50.25%) and the majority of them were males (54.75%), the mortality rate increased in older age.
The suicidal manner considered the highest frequency among the studied cases (54.00%) followed by an overdose of illicit drugs (24.00%).
It was found that the oral route was the commonest (88.25%) followed by inhalation (5.50%).
Tramadol was the most common toxic agent (19.75%) followed by Antipsychotic drugs (17.00%), while C.N.S. drugs were the most common group (34.00%) followed by the following groups in descending order of frequency; illicit drugs (33.50%), unknown agents (12.75%), other agents (10.75%), pesticides (6.00%), hypoglycemic drugs (1.75%) and household agents (1.25%).
Majority of cases didn’t receive treatment before arrival to PCC (82.25%) and presented within 2-6 hours after toxin intake (76.25%), while 13.75% had a delay more than 6 hours.
Most of the cases (67.75%) spent less than three days, the mean duration of hospital stay was 3.025±3.577 days with range (1-32 days) with increased mortality in those staying longer duration in the hospital.
Regarding Reed’s coma scale in the studied cases, it was found that most of the cases presented by coma grade II (43.00%) followed by grade I in 32.00% of cases, grade III was 13.00% while grade IV was found in 11.50% of cases. The highest mortality rate was found among those presented with grade IV (54.55%).
Toxicological screening was done in most cases (64.75%) according to the suspected toxins.
Oxygen supplementation and I.V. fluids were given to all patients. Gastrointestinal decontamination was done to only 9.75%. Specific antidotes were administered to 36.50%, while 22.75% of cases were intubated and 21.75% of them required mechanical ventilation.
The mortality rate in this study was (13.75%), the highest mortality rate was seen in illicit drugs (32.73%), other agents were (21.82%) while CNS drugs and pesticides were (16.36% for each). 11.00% of all cases discharged against medical advice, most of them presented by illicit drugs intake (34.09%) followed by CNS drugs (31.82%).