Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MBBS 2: Head and Neck Clinical Correlations > Approach To Child With Coma > Flashcards

Approach To Child With Coma Flashcards

1
Q

What is Coma?

A

Coma is an alteration in the level of consciousness in which the person appears to be asleep, cannot be aroused and shows no awareness of the environment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Levels of consciousness are regulated in what areas?

A

Regulated in two areas
1. Cerebral hemispheres
2. ARAS
Note: altered LOC Can affects one or both or communication between the two

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is ARAS?

A

Ascending reticular activating system
1. ARAS modulates arousal in response to external stimuli
- has targets in thalamus, hypothalamus and cerebral cortex
- healthy projections between the two areas are essential
2. located in the brainstem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the states of consciousness between normal levels of consciousness and coma?
i.e. spectrum

A
  1. Confusion
  2. Delirium
  3. Lethargy
  4. Obtundation
  5. Stupor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What questions do you ask in getting a history from a coma patient?

A
  1. Onset
    - Acute vs gradual
  2. Associated symptoms
    - Fever, headache, rash, irritability, trauma, seizure
  3. Reccurent episodes
  4. Family history
  5. Developmental delays
  6. Birth history
  7. Immunological state
  8. Events surrounding
  9. History of trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do you assess a child with coma?

A
  1. State of consciousness
  2. Pattern of respiration
  3. Pupillary reactions
  4. Eye movements
  5. Motor function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe a coma score?

A

AVPU
1. awake - patient is awake
2. verbal - patient responds to a verbal stimulus
3. pain - patient responds to a pain stimulus
4. unresponsive - patient is unresponsive to stimulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe pupillary reactions in a child with coma?

A
  1. Dolls eye movement (oculocephalic)
    - when head is turned eyes move in the opposite direction
  2. Caloric stimulation (Oculovestibular)
    - ice water in the ear canal causes eyes to move in the direction of that ear
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why are pupillary reactions used in assessing consciousness?

A
  1. The area of the brain stem controlling consciousness and those controlling pupillary reactions are anatomically adjacent the pupils are a usefull guide in assessing consciousness
  2. The pupillary pathways are also relatively resistant to metabolic insults
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the pattern of respiration in a healthy child?

A

Follow a Cephalo caudal progression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the changes in pattern of respiration in a child with coma?

A
  1. Post hyperventilation apnoea
  2. Cheyne stokes respirations
  3. Central neurogenic hyperventilation
  4. Apneustic breathing
  5. Ataxic breathing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is seen upon inspection during motor exam in a child with coma?

A
  1. Fasciculations
  2. Wasting
  3. Posturing
  4. Gait
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What do you test for during the motor exam of a child with coma?

A
  1. power
    - Maximum effort a patient can exert from an individual/muscle groups
  2. Reflexes
    - Assess integrity of sensory and motor neuron circuit
  3. tone
  4. sensory function
  5. Coordination
    - Finger to nose test
    - Heel shin test
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Name causes of coma that causes no focal neurology / CSF abnormalities?

A
  1. Infection
  2. Shock
  3. Epilepsy
  4. Intoxication
  5. Metabolic
  6. Epilepsy
  7. Hypertensive encephalopathy
  8. Hyper/hypothermia
  9. Concussion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Name causes of coma that causes meningeal irritation with RBC/WBC in CSF?

A
  1. Subarachnoid heamorrhage
  2. Bacterial meningitis
  3. Viral encphelalitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Name causes of coma that causes focal neurology without CSF abnormalities?

A
  1. Brain heamorrhage
  2. Cerebral infarction
  3. Brain abscess/ empyema
  4. Subdural/epidural heamorrhage
  5. Brain tumour
17
Q

What is raised intracranial pressure?

A

Increase in volume of one or more of the intracranial compartments
1. CSF
2. Brain tissue
3. Blood

18
Q

Consequences of raised intracranial pressure?

A

Raised ICP interferes with cerebral circulation resulting in hypoxia and ischaemia
Cerebral blood flow less than 20ml/kg/min results in ischaemic damage
CPP= MBP-ICP

19
Q

Investigations?

A

RBG
FBC
Acute phase reactants
Urea+ Electrolytes
Blood culture
ABG
LFTs
Toxicology screen
Urinalysis

20
Q

Neuroimaging?

A

CT scan
- Indicated in trauma, focal neurology, unclear etiology

21
Q

What is the primary assessment and resuscitation in management of coma?

A

Airway - is it secure?
Breathing - is respiratory effort sufficient?
Circulation - treat shock
Disability - check blood glucose
- AVPU or Glasgow Coma Scale
Exposure - e.g. look for meningococcal purpuric rash

22
Q

What is the secondary assessment and emergency treatment in management of coma?

A
  1. Examination
    - Is there raised intracranial pressure - abnormal breathing, posture, pupils?
    - Bradycardia and hypertension suggest impending brain stem herniation
  2. Treat the treatable
    - hypoglycaemia
    - poisoning
    - diabetes mellitus
    - septicaemia/meningitis
    - herpes simplex encephalitis
    Note: Intubate and ventilate if necessary, transfer to paediatric/neurosurgical intensive care unit
23
Q

Management?

A
  1. Infection
  2. Seizure control
  3. Detect and treat raised ICP
  4. Maintain microcirculation
  5. Maintain homeostasis
    Note: Address rapidly reversible causes, initiate protective measure and begin time sensitive management steps

MBBS 2: Head and Neck Clinical Correlations (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions