Flashcards in Coma Deck (22)
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
What does consciousness depend on?
An intact ascending reticular activating system (arousal)
A functioning cerebral cortex of both hemispheres (environmental awareness)
What are some causes of decreased GCS?
Damage to reticular activating system
Causes of raised ICP
Sepsis/ hypoxia/ hypercapnia, hypotension
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
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
What are the causes of depressed respiration?
What are the causes of increased respiration?
What is a cause of fluctuating respiration?
What must be done during resuscitation?
Establish baseline BP, pulse, temp, IV access, stabilise neck
Examine for meningitis
What should be monitored during a coma?
Heart rate, BP, CVS
What is the neurological assessment of coma?
Glasgow coma scale
Motor function and reflexes
What are some causes of coma without focal or lateralising signs and without meningism?
Anoxic/ ischaemic conditions
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
What are the causes for a coma without focal or lateralising but with meningsm?
What are the investigations for a coma without focal or lateralising but with meningsm?
CT head scan
What are the causes of coma with focal brainstem or laterlising cerebral signs?
What are the investigations for a coma with focal brainstem or lateralising cerebral signs?
CT or MRI obligatory
What are the medical causes of coma lasting more than 5 hours?
Drug ingestion +/- alcohol
What factors can affect the prediction of outcome in coma?
Cause, depth and duration of coma
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
How should a head injury be managed?
Stabilise cervical spine
Intubation/ventilation if GCS <8
Treat raised ICP