OF THE acute situations in clinical medicine, there is none more difficult than the treatment of the comatose patient. The difficulty exists in part because coma is a symptom, representing failure of cerebral metabolism, rather than a specific disease entity. Coma may be a symptom of diseases as diverse as hypoglycemia on the one hand or brain tumor on the other. Because there are so many potential causes of coma, and because the time the physician has in which to make the appropriate diagnostic and therapeutic judgments is often very brief before irreversible brain damage ensues, a systematic approach to differential diagnosis and treatment is necessary.
A detailed description of the pathophysiology of coma,1 its specific causes, and management are beyond the scope of this article, but certain general principles concerning the approach to and treatment of the comatose patient encountered in a hospital emergency room are outlined here.