Flashcards in Coma Deck (22)
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1
Define coma
A state of unrousable psychological unresponsiveness in which the subjects lie with eyes closed and show no psychologically understandable response to external stimulus or inner need
2
What does consciousness depend on?
An intact ascending reticular activating system (arousal)
A functioning cerebral cortex of both hemispheres (environmental awareness)
3
What are some causes of decreased GCS?
Seizures
Damage to reticular activating system
Causes of raised ICP
Drug intoxication
Liver/renal failure
Sepsis/ hypoxia/ hypercapnia, hypotension
Hypoglycaemia, ketoacidosis
4
Define persistent vegetative state?
A state in which the brainstem recovers to an extent but there is no evidence of recovery cortical function. Arousal and wakefulness but no regain or purposeful behaviour
5
What is locked in syndrome?
Total paralysis below level of third nerve nuclei. Can open, elevate, depress eyes but no horizontal movement and no voluntary eye movements
6
What are the causes of depressed respiration?
Drug overdose
Metabolic disturbance
7
What are the causes of increased respiration?
Hypoxia
Hypercapnia
Acidosis
8
What is a cause of fluctuating respiration?
Brainstem lesion
9
What must be done during resuscitation?
Airway
Breathing
Circulation
Blood samples
Establish baseline BP, pulse, temp, IV access, stabilise neck
Examine for meningitis
10
What should be monitored during a coma?
Temperature
Heart rate, BP, CVS
Respiration
Skin, breath
Abdomen
Meningism
Fundal examination
11
What is the neurological assessment of coma?
Glasgow coma scale
Brainstem function
Motor function and reflexes
12
What are some causes of coma without focal or lateralising signs and without meningism?
Epilepsy
Intoxications
Hyper/hypothermia
Systemic infections
Metabolic disturbances
Anoxic/ ischaemic conditions
13
What investigations should be used coma without focal or laterlising signs and without meningism?
Toxicology screen incl alcohol level
Measure blood sugar and electrolytes
Acid-base hepatic and renal function
Measure blood pressure
Consider carbon monoxide poisoning
14
What are the causes for a coma without focal or lateralising but with meningsm?
Subarachnoid haemorrhage
Meningitis
Encephalitis
15
What are the investigations for a coma without focal or lateralising but with meningsm?
CT head scan
Lumbar puncture
16
What are the causes of coma with focal brainstem or laterlising cerebral signs?
Cerebral tumour
Cerebral haemorrhage
Cerebral infarction
Cerebral abscess
17
What are the investigations for a coma with focal brainstem or lateralising cerebral signs?
CT or MRI obligatory
Metabolic screens
Lumbar puncture
EEG
18
What are the medical causes of coma lasting more than 5 hours?
Drug ingestion +/- alcohol
Hypoxia
Haemorrhage/infarction
Metabolic
19
What factors can affect the prediction of outcome in coma?
Age
Cause, depth and duration of coma
20
What should be done to continue care for patients in coma?
Vital functions maintenance
Skincare (avoid pressure sores)
Bladder and bowel function attention
Control of seizures
Prophylaxis of DVT, peptic ulceration
Prevention of contractures
21
How should a head injury be managed?
Stabilise cervical spine
Airway/breathing/circulation
Intubation/ventilation if GCS <8
Treat raised ICP
Cranial imaging
22
