Approach to Coma Flashcards
What parts of the brain must be affected in order for a coma to be the diagnosis?
- BILATERAL cerebral hemispheres
- Brainstem
- or both!
What parts of the brain must be affected in order for a coma to be the diagnosis?
- BILATERAL cerebral hemispheres
- Brainstem
- or both!
What 3 things make up the brainstem?
Pons
Midbrain
Cerebellum
Total awareness of self and environment
Consciousness
What 2 things are required for consciousness?
- Arousal
2. Awareness
What system in the brainstem is vital for consciousness?
ARAS
What are you trying to determine in the neuro examination with a possible coma patient?
Location/anatomic level of brain involvement that is causing the impaired consciousness
With an Uncal Transtentorial Herniation, what cranial nerve is compressed?
CN3
With an Uncal Transtentorial Herniation, CN3 is compressed. What are the signs?
IPSILATERAL eye is down and out, with an enlarged pupil and possibly ptosis (droopy eyelid)
CN3 is a dysfunction of which autonomic system?
Parasympathetic – enlarged pupil on one side
If the right eye’s pupil is enlarged, the eye is down and out and there is a droopy eyelid, which side of the brain herniated?
Right side
What 3 items are needed to declare brain death?
- Irreversible
- NO brain function
- Persistent
Can spontaneous breaths be seen with Brain Death?
NO
What is the gold standard test for Brain Death?
Apnea test
What usually is in the history with a patient who has meningitis?
Previous ear/sinus infection
