ALTERED CONSCIOUSNESS Flashcards
Explain GCS score?
Eye opening:
4. Open spontaneously
3. Open to sound
2. Open to pain
1. No response
Verbal response:
5. Orientated response
4. Confused conversation
3. Inappropriate words
2. Incomprehensible sounds
1. No response
Motor response:
6. Obeys commands
5. Localises to pain
4. Withdraws to pain
3. Abnormal flexion response to pain - decorticate posturing where adduction and internal rotation of arms, flexion of elbows, pronation of forearms and wrist flexion. Can indicate damage to cerebral hemispheres, internal capsule and thalamus. If progressive can indicate uncal or tonsilar brain herniation
2. Abnormal extension response to pain - decerebrate posturing where head, arms and legs are extended and internally rotated and pt appears rigid with clenched teeth. Can indicate brain stem damage. If progressive can indicate uncal or tonsilar brain herniation
1. No response
Outline the AVPU scoring system?
Alert
Confusion that is new
Verbal
Pain
Unresponsive
Highest and lowest possible score for GCS?
Highest 15
Lowest 3
At what GCS score should we be intubating?
8 or less
Causes of alterations of conscious level?
Collapse secondary to cardiovascular disease Hypoxaemia and/or hypercarbia due to respiratory failure
Shock due to any cause (e.g. sepsis, hypovolaemia, anaphylaxis)
Diabetic emergencies (Diabetic ketoacidosis, hyperosmolar hyperglycaemic state, hypoglycaemia)
Endocrine emergencies
Hypothermia
Hepatic encephalopathy
Uraemic encephalopathy
Poisoning and overdose
Seizures and epilepsy including eclampsia
Head injury e.g. diffuse axonal injury
Acute stroke
Cerebral tumour e,g, glioblastoma or infection e,g, meningitis
Intracranial bleeds
Poisoning
Alcohol or substance misuse
Mental health conditions
Infections e.g. pneumonia or UTI in elderly women
Electrolyte abnormalities - most commonly hyponatraemia, hyperkalaemia or hypernatraemia
Exogenous toxins
Drug withdrawal states - alcohol and benzos
