In all cases of coma when first seen examine the head for signs of injury, note the odour of the breath, observe the state of the pupils and their reactions, examine the limbs for paralysis, count the pulse and note its character, and the state of the arteries, note the size of the heart and auscultate it at each area. Count and note the character of the respirations, take the temperature, examine the urine, take note of the person‘s age, and inquire into the previous history.
SUDDEN DEATH
Sudden death may proceed from natural or violent causes. From the former, death may occur unexpectedly and very rapidly, but as a rule the period of time occupied by the phenomena of “dying” is measurable, though inconstant. Should such period of time be immeasurable, death may be considered as instantaneous.
Apart from sudden death resulting from violence or poisoning, the common causes are as follows:—
1. Diseases of the heart: angina pectoris, valvular diseases with failure of compensation, especially aortic regurgitation, degeneration of the heart muscle, rupture of the heart, heart failure from diphtheria or toxic diseases.
2. Diseases of the blood-vessels: rupture of aneurysms or varicose veins, thrombosis, embolism.
3. Cerebral hæmorrhage, especially when in the region of the pons Varolii or cerebellum.
4. Lesions of the respiratory system: œdema or spasm of the glottis, membranous deposit or foreign bodies in the larynx or trachea, foreign bodies in the pharynx, tumours, whooping-cough, asthma, embolism of the pulmonary artery, air embolism, fat embolism, rupture of a vessel or aneurysm into the air-passages, as in phthisical cavities, pneumothorax, hæmothorax, pleuritic effusion, and in acute pneumonia.
5. Rupture of a gastric ulcer or ulcer of some other part of the alimentary tract.
6. Sudden hæmorrhage into the peritoneal cavity from ruptured uterus, ectopic gestation, &c.