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Medstudy Internal Medicine 14th Edition PDF ePub Mobi - Download Medstudy Internal Medicine 14th Edition (PDF, ePub, Mobi)Books Medstudy Internal. medstudy internal medicine 14th edition is available in our book collection an online Medstudy Internal Medicine Review Core Curriculum 14th Edition pdf. edition of medstudy internal medicine any of these books in exchange for the 2nd edition Medstudy Internal Medicine 14th Edition PDF ePub Mobi - Download.

Subsequently, it was hardly used in the known literature up to the middle of the 17th century. The term carus is also derived from Greek, where it can be found in the roots of several words meaning soporific or sleepy. Some examples are: [12] Traumatic brain injuries. Traumatic brain injuries , often caused by traffic collisions or acts of violence, are common causes of comas. Reduced or interrupted blood supply to the brain stroke , which may be caused by blocked arteries or a burst blood vessel, can result in a coma. Tumors in the brain or brainstem can cause a coma. In people with diabetes , blood sugar levels that become too high hyperglycemia or too low hypoglycemia can cause a coma.

Drugs and alcohol. Overdosing on drugs or alcohol can result in a coma.

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Medically induced comas. It may also be deliberately induced by pharmaceutical agents during major neurosurgery , to preserve higher brain functions following brain trauma , or to save the patient from extreme pain during healing of injuries or diseases.

Given that drug poisoning is the cause for a large portion of patients in a coma, hospitals first test all comatose patients by observing pupil size and eye movement, through the vestibular-ocular reflex. Oxygen deprivation in the brain , also known as hypoxia , causes sodium and calcium from outside of the neurons to decrease and intracellular calcium to increase, which harms neuron communication.

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Twenty percent of comatose states result from the side effects of a stroke. An ischemic stroke , brain hemorrhage , or tumor may cause restriction of blood flow.

Lack of blood to cells in the brain prevent oxygen from getting to the neurons, and consequently causes cells to become disrupted and die. As brain cells die, brain tissue continues to deteriorate, which may affect the functioning of the ARAS.

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Effect on cerebral cortex and reticular activating system[ edit ] Injury to either or both of the cerebral cortex or the Reticular Activating System RAS is sufficient to cause a patient to experience a coma.

The cerebral cortex is the outer layer of neural tissue of the cerebrum of the brain , in humans and other mammals. White matter is responsible for perception , relay of the sensory input via the thalamic pathway, and many other neurological functions, including complex thinking.

The RAS, on the other hand, is a more primitive structure in the brainstem which includes the reticular formation RF. The RAS has two tracts, the ascending and descending tract. The ascending track, or ascending reticular activating system ARAS , is made up of a system of acetylcholine-producing neurons, and works to arouse and wake up the brain.

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Arousal of the brain begins from the RF, through the thalamus , and then finally to the cerebral cortex. Mode of onset[ edit ] The severity and mode of onset of coma depends on the underlying cause. For instance, severe hypoglycemia low blood sugar or hypercapnia increased carbon dioxide levels in the blood initially cause mild agitation and confusion, but progress to obtundation , stupor, and finally, complete unconsciousness.

In contrast, coma resulting from a severe traumatic brain injury or subarachnoid hemorrhage can be instantaneous.

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The mode of onset may therefore be indicative of the underlying cause. As such, after gaining stabilization of the patient's airways, breathing and circulation the basic ABC s various diagnostic tests, such as physical examinations and imaging tools CAT scan , MRI , etc.

Overview of diagnostic steps[ edit ] When an unconscious patient enters a hospital, the hospital utilizes a series of diagnostic steps to identify the cause of unconsciousness.

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According to Young, [15] the following steps should be taken when dealing with a patient possibly in a coma: Perform a general examination and medical history check Make sure the patient is in an actual comatose state and is not in locked-in state or experiencing psychogenic unresponsiveness.

Patients with locked-in syndrome present with voluntary movement their eyes, whereas patients suffering from psychogenic comas , demonstrate active resistance to passive opening of the eyelids, with the eyelids closing abruptly and completely when the lifted upper eyelid is released rather than slowly, asymmetrically and incompletely as seen in comas due to organic causes. More elaborate scales, such as the Glasgow Coma Scale , quantify an individual's reactions such as eye opening, movement and verbal response in order to indicate their extent of brain injury.

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