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The diagnostic workup of the comatose patient must proceed concomitantly with management Supportive therapy for respiration or blood pressure is initiated; in hypothermia, all vital signs may be absent and all such patients should be rewarmed before the prognosis is assessed The patient can be positioned on one side with the neck partly extended, dentures removed, and secretions cleared by suction; if necessary, the patency of the airways is maintained with an oropharyngeal airway Blood is drawn for serum glucose, electrolyte, and calcium levels; arterial blood gases; liver and renal function tests; and toxicologic studies as indicated Dextrose 50% (25 g), naloxone (04 12 mg), and thiamine (50 mg) are given intravenously Further details are then obtained from attendants of the patient s medical history, the circumstances surrounding the onset of coma, and the time course of subsequent events Abrupt onset of coma suggests subarachnoid hemorrhage, brainstem stroke, or intracerebral hemorrhage, whereas a slower onset and progression occur with other structural or mass lesions A metabolic cause is likely with a preceding intoxicated state or agitated delirium On examination, attention is paid to the behavioral response to painful stimuli, the pupils and their response to light, the position of the eyes and their movement in response to passive movement of the head and ice-water caloric stimulation, and the respiratory pattern

Example A-62. The solution to Exercise 21-1 (continued)

Purposive limb withdrawal from painful stimuli implies that sensory pathways from and motor pathways to the stimulated limb are functionally intact Unilateral absence of responses despite application of stimuli to both sides of the body in turn implies a corticospinal lesion; bilateral absence of responsiveness suggests brainstem involvement, bilateral pyramidal tract lesions, or psychogenic unresponsiveness Inappropriate responses may also occur Decorticate posturing may occur with lesions of the internal capsule and rostral cerebral peduncle, decerebrate posturing with dysfunction or destruction of the midbrain and rostral pons, and decerebrate postur-

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Diseases causing coma may lead to respiratory abnormalities Cheyne-Stokes respiration may occur with bihemispheric or diencephalic disease or in metabolic disorders Central neurogenic hyperventilation occurs with lesions of the brainstem tegmentum; apneustic breathing (in which there are prominent end-inspiratory pauses) suggests damage at the pontine level (eg, due to basilar artery occlusion); and atactic breathing (a completely irregular pattern of breathing with deep and shallow breaths occurring randomly) is associated with lesions of the lower pontine tegmentum and medulla

when scripting a Mac OS X application. As you gain more experience, the dictionary will make more sense, enabling you to use it directly as you would an API. You will notice iTunes menu bar, which contains an AppleScript menu. Many Mac OS X applications offer this service, which lets users run scripts directly from within an application. To install scripts into iTunes, open the Library folder in your home directory (~/Library), create a folder called Scripts, and add your AppleScripts to this folder. When you relaunch iTunes, the AppleScript menu will appear and display the scripts in the Scripts folder. As I mentioned earlier, Apple provides many useful scripts that you can download and use. Writing a script Now that you understand the basics, let s move on to creating your own script that you can use within iTunes. You will use parts of the Make Playlist By Artist script as the basis of a new script that creates playlists for all artists or albums in your iTunes library. Before continuing, copy the new script (located on the chapter07 folder of the source distribution), called Make Playlist, to the iTunes script folder (~/Library/iTunes), and relaunch iTunes. Here s how this version works:

responses, the development of spontaneous eye movements (roving, conjugate, or better), and extensor, flexor, or withdrawal responses to pain at this early stage imply a relatively good prognosis Treatment of metabolic encephalopathy is of the underlying disturbance and is considered in other chapters If the cause of the encephalopathy is obscure, all drugs except essential ones may have to be withdrawn in case they are responsible for the altered mental status

Stevens RD et al Approach to the comatose patient Crit Care Med 2006 Jan;34(1):31 41 [PMID: 16374153] Wijdicks EF et al Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology Neurology 2006 Jul 25;67(2):203 10 [PMID: 16864809]

Console.WriteLine("{0}x{1}x{2}", Length, Width, Height); } } class Program { static void Main(string[] args) { List<Box> boxList = new List<Box> { new Box { Length = 4, Width = 6, Height = 2 }, new Box { Length = 3, Width = 1, Height = 4 }, new Box { Length = 5, Width = 12, Height = 3 }, new Box { Length = 4, Width = 7, Height = 5 }, new Box { Length = 3, Width = 7, Height = 1 } }; IEnumerable<Box> resultList = from myBox in boxList where myBox.Length > 3 && myBox.Width > 3 select myBox; Console.WriteLine("Boxes greater than 3 units in length or width:"); foreach (Box b in resultList) { b.DisplayBox( ); } } } }

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