10-15 L2 Coma

Question 1

Coma

Answer 1

a state of sustained unconciousness from which the pt can not be easily awakened.

Question 2

Brain death

Answer 2

the complete and irreversible cessation of all brain and brainstem functions

Question 3

PVS (Persistent vegetative state)

Answer 3

• surviving state of coma due to w_idespread cerebral injury_ where a sleep-wake cycle returns, normal circulation and breathing are maintained but the pt lacks evidence of inner or outer awarenees
• these pts may have their eyes moving around the room but they don’t attend or track anyone or anything.
  
  • They dont respond to pain with coordinated withdrawal or facial grimacing. They don’t follow commands, they don’t eat food or swallow liquids.

Question 4

Neurologically devastated pts

Answer 4

• somewhere above PVS (pts we commmonly see)
  
  • can’t comprehend words, talk, walk or feed themselves
• Causes: This can follow from cardia arests, head injury or be an end-stage of Alzheimer’s disease.

Question 5

Locked in syndrome

Answer 5

• produces a picture that looks like a deep coma because the pt is paralyzed but is able to open eyes and has preserved vertical gaze.
• cause: most often this is caused by infarcts of the ventral pons by central pontine myelinolysis

Question 6

Pseduocoma

Answer 6

• Non-responsive state in which there is no neurological injury
• sometimes there is a resistence of eye opening all reflexes are normal as is the EEG

Question 7

Delirium

Answer 7

• a clinical state where the pt is c_onfused and usually drowsy_ to some degree
• Neuologist use this term delirium when a pt is confused, hyperactive and encephalopathy when the patient is confused and drowsy.

Question 8

What is cushing’s triad?

Answer 8

• HTN
• Bradycardia
• Irregular respirations

Question 9

What cranial nerves are involved in pupillary light reflex?

Answer 9

CN II & III (midbrain)

CN 2,3

Question 10

What cranial nerves are involved in corneal reflex?

Answer 10

CN V & VII (pons)

CN 5,7

Question 11

What cranial nerves are invovled in oculocephalic reflex?

Answer 11

• CN II/IV/VI & VIII (lower pons to midbrain)
• 3,4,6,8

Question 12

What are the cause of Coma?

(VITaMIN CD)

Answer 12

• Vascular
  
  • cardiac areest (followed by resuscitation, subarachnoid hemorrhage, rarities)
• Infections
  
  • Bacterial meningitis, encephalitis
• Trauma
  
  • Sever closed head injury usually obvious,, subdural hematomas in teh elderly can be sneaky
• Metabolic
  
  • Diabets, hypoxia, uremina, liver failiur, wernicke’s encephalopathy
• Iatrogenic
  
  • prescipiton drugs (errors & overdose), drugs of abuse (legal and illegal)
• Neoplastic
  
  • Focal history and exam with slow progression, headache
• **Congenital **
• Degenerative

Question 13

Wernicke’s encephalopathy

Answer 13

impaired consciousness, eye movements and gait

Question 14

If a pt has cardiac arrest that leads to coma what do you do?

What are some common treatments for coma?

Answer 14

• _Hypothermia protocol for cardiac arres_t
  
  • (control raised IC pressure)
  • Elevate head to 30 degress
  • Intubate and hyperventilate
  • Dexamethasone for cerebral edema
• Treatment of coma:
  
  • Naloxone, thiamine and dextrose