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