Page 256 - PJ MED OPS Handbook 8th Ed

Causes of Coma/Decreased Level of Consciousness:
A – Alcohol (and other drugs), Acidosis (hyperglycemic coma/DKA)
E – Electrolyte abnormality, Endocrine problem, Epilepsy
I – Insulin (diabetes/hypoglycemic shock)
O – Oxygen (Hypoxia), Overdose (or poisoning)
U – Uremia (renal failure/insufficiency)
T – Trauma; Temperature (hypothermia, heat stroke)
I – Infection (e.g., meningitis, encephalitis, sepsis)
P – Psychogenic (“hysterical coma”)
S – Stroke or Space-occupying lesions in the cranium; Seizure; Shock
Coma Assessment:
D – Depth of coma (responds to verbal or painful stimulus, unresponsive)
E – Eyes (PERRLA)
R – Respiration (rate and rhythm)
M – Motor (posturing; loss of movement/sensation)

Level of Consciousness:
A – Patient is Alert and Oriented to person/place/date/time
V – Patient responds properly to verbal stimuli
P – Patient responds to painful stimuli (withdraws from stimulus)
U – Patient is unresponsive to all stimuli

Pupil Reaction:
P – Pupils
E – Equal
R – Round
R – Reactive to
L – Light
Distal Limb Assessment:
Pulse: Does the patient have distal pulses? Capillary blanch in finger in and toes?
Motor: Patient moves fingers and toes? Arms? Legs? Equal, bilateral muscle strength?
Sensory: Does the patient feel touch of fingers and toes? Does the unconscious patient respond
when pinching his/her fingers and toes?

Oxygen Toxicity Symptoms:
V – Visual (Tunnel vision or blurred vision)
E – Ear symptoms (Tinnitus)
N – Nausea and/or vomiting
T – Twitching (Generally involves facial muscles, but can involve arms/legs)
I – Irritability (Change in diver’s mental status)
D – Disability (Sudden neurological deficit to include clumsiness, fatigue)
C – Convulsions (Often a first sign)

254 n Pararescue Medical Operations Handbook / 8th Edition