====== Response to Painful Stimuli ======

Profound sedation in the presence of a reasonable blood pressure suggests [[:wikitox:2.1.11.9.2.1_tricyclic_antidepressants|TCA]]s, [[:wikitox:2.1.11.9.3_antipsychotics|neuroleptics]], [[:wikitox:2.1.11.2_anticonvulsants|anticonvulsants]] (e.g. carbamazepine, phenytoin), [[:wikitox:2.1.1.3_opioids|opioids]] or [[:wikitox:barbiturates|]].

It is unusual for [[:wikitox:benzodiazepines|]] or alcohol alone to lead to deep coma (grades 2-4). More serious toxins such as TCAs and anticonvulsants are more likely.

|**Alert** |no signs of CNS depression|
|**Drowsy** |all patients between alert & stuporous|
|**Stuporous** |responds to verbal or tactile stimuli|
|**Coma 1** |responds to painful stimuli only, normal BP & Respiration|
|**Coma 2** |no response to painful stimuli, normal BP & Respiration|
|**Coma 3** |no response to painful stimuli, abnormal respiratory pattern &/or low but adequate BP|
|**Coma 4** |no response to painful stimuli, apnoea or inadequate respiration &/or inadequate BP|

Plum F, Posner JB. The diagnosis of stupor and coma. //Contemp Neurol Ser// 1972;10:1-286 [[http://www.ncbi.nlm.nih.gov/pubmed/4664014|PMID4664014]]

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