Assessing patients in coma Flashcards
What is coma?
A state of unrousable psychologicalunresponsiveness in which subjects lie with eyes closed and show no psychologically understandable response to external response or internal need
What GCS score indicates coma?
8 or less in total
Eye opening 2 or less
Verbal response 2 or less
Motor response 2 or less
What are the 2 components of consciousness?
Arousal (Reticular activating system)
Awareness (Cerbral hemispheres)
What effects of toxic metabolic states may lead to a decreased GCS?
Hypoxia
Hypercapnia
Sepsis
Hypotension
What effects of raised ICP may cause a decrease in GCS?
Tumour Stroke EDH SDH SAH Hydrocephalus
What are some other causes of decreased GCS?
Seizures
Damage to reticular activating system
What may fluctuating respiration indicate?
Brainstem lesion
What may depressed respiration indicate?
Drug overdose
Metabolic disturbance
What may increased respiration indicate?
Hypoxia
Hypercapnia
Acidosis
What are some important tests in coma?
Blood Glc Blood gases BP LP Pulse Temperature Toxicology CT head scan
What functions may be tested to assess brainstem function?
Pupillary response Spontaneous eye movements Corneal response Oculocephalic response Oculovestibular response Respiratory pattern
What is “locked-in” syndrome?
Total paralysis below third nerve nuclei
Can open eyes but no voluntary movement
Diagnosis depends on patient being able to open eyes and signal numerically by eye closure
What pathologies may a head injury lead to?
Contusion
Diffuse axonal injury
Intracerebral haematoma
Extracerebral haematoma
What are the priorities when treating a head injury?
Stabilise C-spine
Treat raised intracranial pressure
Intubation
Ventilation
What is the Rosier score?
Recognition Of Stroke In Emergency Room
Score of greater than 0 predicts stroke
