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PCM > Alterations in consciousness and Coma > Flashcards

Alterations in consciousness and Coma Flashcards

1
Q

Define Consciousness

A

Altert + Content

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2
Q

Define Alert

A

Eyes are open

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3
Q

Define Content

A

awareness in a cognitive sense

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4
Q

define Coma

A

impairment or absence of awareness

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5
Q

define Dementia

A

Issue of Content not awareness

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6
Q

define delirium

A

Mostly issue of content but also an issue of awareness

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7
Q

Define obtundation

A

external stimuli is needed to wake someone up but they only stay awake briefly

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8
Q

Define stupor

A

external stimulus is consistently required to keep someone awake

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9
Q

Is sleep a consciences state

A

NO- b/c there is no arousal BUT body maintains the ability to return to a consciences state.
body responds to external stimuli

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10
Q

Anatomy and function of the reticular activating formation in the brainstem- what provides the input and output for the brainstem

A

Brainstem: pons and mesencephalon
Input: spinal cords gets info from the periphery, cortex provides higher level input, and the cerebellum provides coordination
Output is to the spinal cord

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11
Q

anatomy and physiology of the reticular activating formation in the supratentorial areas

A

Cortex and diencephalon (thalamus) describe the content and awareness at a higher level

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12
Q

What brain structures need to be working for conscience

A

One hemisphere
Brainstem
Connection between the two

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13
Q

What are the two types of posture

A

Decorticate and Decerebrate

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14
Q

what is decorticate posture?

where is the lesion

A

The lesion is superior to the red nucleus
UE flexion, LE extension
= mummy baby

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15
Q

What is Decererate posturing

where is the lesion

A

Lesion is inferior to the red nucleus in the mid collicular region
extensor posturing of UES and LES

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16
Q

Which posture has a worse prognosis- Decorticate or Decerebrate?

A

Decerebrate

17
Q

What condition often causes Decerebrate posturing

A

Pontine Strokes

18
Q

What can cause stupor or coma?

A

anything that messes with the requirements of consciencenes:
hypoxia
Hypo or hyperglycemia
organ dysfunction of liver, kidney, or adrenal
toxin or poison
metabolic dz ie thymus
infection
structural dz- tumor, infarct, herniation
trauma

19
Q

What is the Glasgow Coma scale
What are the max and min scores
what do they mean
What is the cutoff for serious brain injury

A

way to score severity of a coma
min score is 3 which is very bad
max score is 15
cutoff for serious brain injury is 8

20
Q

what tests are used to judge the coma or locate a lesion

A

galsgow coma scale
spontaneous eye reflex
oculovestibular or caloric testing
oculocephalic dolls eye test

21
Q

What part of the brain is responsible for the spontaneous eye reflex
What is normal
what happens when there is a lesion
what happens when there is a seizure

A

Frontal gaze centers in the cortex
normally causes eyes to move spontaneous in the oposite direction they were moving
when there is a lesion they will move in the same direction
when there is a seizure, so there is hyperactivity, the eyes will deviate to the opposite side

22
Q

What is caloric testing

what reflex is it measuring

A

Caloric testing is when cold or hot air or water is placed into a comatose patients ear and watch the nystagmus of the eye
Tests Oculocephalic reflex
COWS
Cold water- nystagmus Opposite side
Warm water- nystagmus Same side
If there is no nystagmus the reflex is not intact, if there is no movement at all it means its really bad

23
Q

what does the doll’s eye test- test
what is normal
what is pathological
what does it mean

A

test the oculocephalic reflex
Normally pt should be able to keep their eyes fixed if you turn the head quickly
It is pathological if the eyes simply turn with the head
indicates a low brain stem lesion

24
Q

Definition of brain death

A

cessation of brain function

25
Q

what are the components of brain death

A

No response to deep pain
No CN responses- corneal (5,7), gag (9,10)
No oculocephalic or oculovestibular reflexes
Apnea
Vitals are ok- temp >90, SBP>90
Spinal reflexes may be intact

PCM (12 decks)

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