Causes of coma

1. Diseases that cause no focal or lateralizing neuro signs, usually with normal brain stem function.
Ct scan and CSF are normal.
A] intoxication: alchohol,sedative,drugs,opiates
B]metabolic disturbances: hyponatremia,hypernatremia,hypercalcemia,diabetic acidosis, hypoglycaemia, nonketotic hyperosmolar hyperglycaemia,uraemia, hepatic coma,hypercarbia,addisonian crisis,hypo and hyperthyroid states,profound nutritional deficiency.
C]severe systemic infection:pneumonia,septicemia,typhoid fever,malaria,Waterhouse Friderichsen syndrome.
D]shock from any causes
E] post seizure,status epilepticus
F]hypothermia,hyperthermia
G]Hypertensive encephalopathy,eclampsia
H]concussion
I]acute hydrocephalus

2. Diseases causes meningeal irritation with or without fever, snd with excess WBC or RBc in CSF. CT no mass lesion
a]subarachnoid hemorrhage
b]bacterial meningitis
c]encephalits
d]fat embolism,cholesterol embolism

3.Diseases that cause focal neuro signs. CT abnormal
a]hemispheral hemorrhages
b]brainstem infarction due to basal artery thrombosis or embolism
c]brain abscess
d]subdural haemorrhages
e]cerebellar and pontine hemorrhages
f]brain tumour
g]traumatic brain injury
i]miscellanous:cortical vein thrombosis,herpes simplex encephalitis,acute disseminated encephalomyelitis,TTP,pit apoplexy.

Pneumothorax

Pneumothorax as everyone know is the medical emergency especially when patient 's respiration is compromised.
Pneumothorax means air in the plural space.
Pneumothorax can be divided in primary or secondary causes.
Symptom for it is tachypnoeic,dyspnoeic and chest discomfort.
Primary pneumothorax usually happens in healthy patient without any lung pathology.
Usually happens in tall and thin patient.
secondary pneumothorax usually happens in patient with underlying pathology.
For example COAD(chronic obstrutive airway disease),cystic fibrosis,status asthmaticus
Infective lung disease such asPCP,necrotising pneumonia.interstitial lund disease such as sarcoidosis,tuberous sclerosis, idiopathic pul fibrosis.
connective tissue:Ankylosis spondylitis,polymyositis
Ca of lung,sarcoma
Treatment of choice is observation if pneumothorax is small
If it is big, insert chest tube
if small pneumothorax with severe resp distress, chest tube also need to be inserted.
pneumothorax resolve by 1.25% each day without intervention

contrast nephropathy

Everyone who got cronic renal failure presented with unstable angina or severe chest pain and require angioplasty intervention are warned about possible contrast nephropathy .
What the hell is that?
I will give you some brief account about that.
Cotrast nephropathy is impairment of renal function occured within 3 days of IV contrast.
Recovers in few days,Rarely irreversible.
Contrast nephropathy is peaked at 4-5 days and returns to baseline within 7-10 days. Renal function can persists up to 3 weeks.

Patient with impaired renal funtion.Iodinated contrast is nephrotoxic causing renal vasoconstiction and direct toxic effects upon renal tubules.
Is anyone with normal renal function carries the risk.
Risk factor for contrast nephropathy are
A:renal insufficiency
60% of pt develop contrast nephropathy had preexisting renal insufficiency.
The greater the impairment the greater the risk.
B:Diabetis mellitus(DM)
Pt with DM and preexisting renal insufficiency carries higher risk compare to nondiabetis with renal insufficiency develop contrart nephropathy.
But DM with normal renal function carries same risk as non diabetic pt.
C:Volume of contrast
The higher the amount the higher the risk
D:multiple myeloma
McCarthy found that is no increase incidence for nephropathy but previously they say yes.
How to prevent it
The main stay is hydration
Hydration with normal saline.
How about N acetyl cysteine?
Some evidence said benefit some say not.