Management of the patient with diminished responsiveness

This article provides a comprehensive overview of the management of patients with coma. The article begins with a discussion of the emergency management of patients presenting with an acute alteration in the level of consciousness. It then reviews concepts on supportive care that are necessary to reduce secondary neurologic injury. A third section addresses management according to the underlying cause of coma, with emphasis on diagnoses that are frequently encountered. Issues related to the long-term management of patients in coma and outcome prediction are briefly discussed.