Coma

 

 

 

 

     Mag men bij een comateuse patiënt glucose toedienen als men geen perifere glycemiemeter voorhanden heeft en bij vermoed van een eventuele hypoglycemie?

 

                    ->  verslechtert uitcome niet (in USA dient men bij coma soms een standaard "coma pack" toe, bestaande uit glucose, anexaat en naloxone.

                    ->  Bij een bewusteloze patiënt zonder duidelijke oorzaak heeft men meer kans op hypoglycemie dan CVA

                    ->  Men kan de diagnose van hyperglycemisch coma hierdoor eventueel wel verdoezelen.

 

 

De behandeling dient te gebeuren in functie van de onderliggende oorzaak. In geval van intoxicatie zal men in veel gevallen de luchtweg vrijwaren en afbraak door het lichaam van de toxische stoffen afwachten.

Wel dient men de patiënt vaak goed te monitoren omdat vele toxische stoffen eveneens ritmestoornissen of metabole afwijkingen kunnen geven.

Bij hypoglycemie is het toedienen van glucose vaak afdoende om het bewustzijn te herstellen. Wel dient men te voorkomen dat de patiënt terug in hypoglycemie gaat door toedienen van voedsel en suikerrijke dranken en door goede monitoring.

Behandeling van de andere oorzaken van coma worden in de desbetreffende hoofdstukken besproken:

epidurale bloeding

subdurale bloeding

subarachnoidale bloeding

traumatische subarachnoidale bloeding

 

 

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