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Coma Scales. The primary goal of the neurologic examination in an unresponsive patient is to localize the lesion and thereby narrow the differential diagnosis. The examination should proceed in a stepwise fashion and be familiar to the neurologist because of constant repetition.
Signs and symptoms. Dyspnea is the most common symptom, but it is very nonspecific. Patients may also complain of chest pain or discomfort, easy fatigability, cough, and orthopnea, or they may be completely asymptomatic. Signs include distant heart sounds, and pericardial friction rub. With cardiac tamponade, progressive heart failure occurs, with increased shortness of breath, cold sweats, confusion, hypotension, jugular venous distention, and pulsus paradoxus.