Delirium & Coma Flashcards

1
Q

Ascending Reticular Activating System (RAS):

A

Begins: Reticular formation of paramedian tegmental region of pons and midbrain.
Ascends to: Bilateral Thalami
Ascends to: Bilateral Cortex

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2
Q

Electrolyte disturbances that cause delirium and lethargy:

A

Hypocalcemia: delirium.
Hypercalcemia: lethargy.
Hyponatremia.

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3
Q

Coma is almost always caused by structural lesions. What are exceptions to this.

A

Meds.
Status epilepticus.
Anesthetics agents.
Brain hypoxia.

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4
Q

Comatose =

A

No response too any stimulus

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5
Q

Stuporous =

A

Grimace only. Cannot arouse to verbal or negative stimulus.

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6
Q

Obtunded =

A

Sleepy, Awakened with verbal/negative stimulus.

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7
Q

Somnolent =

A

Sleepy, arouses with stimulus, able to maintain awake state.

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8
Q

Cushing triad = __. When is it seen?

A

HTN, Bradycardia, Respiratory change.

Seen in acute increased ICP and imminent cerebral herniation.

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9
Q

Roving eye movement?

A

Bilateral Hemisphere Injury

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10
Q

Gaze deviation?

A

Unilateral injury to gaze holding centers

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11
Q

Ocular bobbing=? Caused by?

A

Conjugate gaze with slow drift down and rapid jerk up.

Brainstem dysfunction

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12
Q

Unilateral dilated and unreactive eye caused by?

A

Compression of CNIII in subarachnoid space for aneurysm - until proven otherwise

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13
Q

Bilateral dilated and unreactive eyes caused by?

A

Compression of CNIII in subarachnoid space from herniation

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14
Q

Bilateral pinpoint pupils

A

Either pontine damage or opiates

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15
Q

Corneal exam assesses?

A

Ipsilateral CNV1, Bilateral CNVII

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16
Q

Threat response assesses?

A

visual fields

17
Q

Cheyne-Stokes

A

An abnormal pattern of breathing characterized by progressively deeper and sometimes faster breathing, followed by a gradual decrease that results in apnea.
Damage in Deep Hemisphere or Diencephalon.

18
Q

Rythmic Hyperventilation caused by?

A

Pulm/Metabolic problems.

Central Neurogenic - Midbrain, Upper pons.

19
Q

Apneusis

A

Sustained, gasping inhalation followed by short, inefficient exhalation, which can continue to the point of asphyxia.
Damage to Dorsomedial Medulla.

20
Q

Cluster breathing

A

A breathing pattern in which a closely grouped series of respirations is followed by apnea.
Damage to Low Pons, High Medulla.

21
Q

Ataxic breathing

A

Complete irregularity of breathing, with irregular pauses and increasing periods of apnea.
Damage to Dorsomedial Medulla

22
Q

If elevated ICP do:

A
  1. Elevate head of the bed
  2. Hyperventilate with pH goal 7.5. Arterial constriction and reduced blood volume.
  3. Hyperosmotic agent: Mannitol or Hypertonic Saline (reduce brain volume)
  4. Neuroanesthetics: propofol/BARBs. Reduce brain metabolism.
  5. External Ventricular Drainage (EVD). Reduce CSF. Do NOT do LP!-risk herniating
  6. Craniectomy