BMB 2 - Altered Mental Status; Coma Flashcards
What mnemonic is useful in remembering the differential for altered mental status?
‘HE STOPS for TIPS on VOWELS’
Using the mnemonic ‘HE STOPS for TIPS on VOWELS,’ state some of the general causes of altered mental status using the ‘HE STOPS’ portion.
Hepatic
Electrolytes
Stroke
Temperature abnormality
Oxygen desaturation
Psychiatric disturbance
Sepsis
Using the mnemonic ‘HE STOPS for TIPS on VOWELS,’ state some of the general causes of altered mental status using the ‘TIPS’ portion.
Trauma
Infection
Porphyria
Seizure
Using the mnemonic ‘HE STOPS for TIPS on VOWELS,’ state some of the general causes of altered mental status using the ‘AEIOU’ portion.
Alcohol
Endocrine
Intoxication
Opiates
Uremia
What is consciousness?
An awareness of oneself and one’s surrounding
What is arousal (in terms of being awake)?
The level of consciousness
What are the four levels of arousal in terms of consciousness?
Alert
Lethargic
Stupor
Coma
True/False.
Arousal is one’s level of consciousness; awareness is the content of that consciousness.
True.
A patient is awake and shows normal consciousness. This patient is _______ (level of arousal).
A patient is awake and shows normal consciousness. This patient is alert.
A patient is arousable by voice and can respond verbally. This patient is _______ (level of arousal).
A patient is arousable by voice and can respond verbally. This patient is lethargic.
A patient is unresponsive and requires repeated vigorous stimuli to arouse. This patient is _______ (level of arousal).
A patient is unresponsive and requires repeated vigorous stimuli to arouse. This patient is in a stupor.
A patient is completely unresponsive to stimuli. This patient is _______ (level of arousal).
A patient is completely unresponsive to stimuli. This patient is in a coma.
A patient presents with altered mental status. What are some of the first steps of work-up?
- Assess vitals
- Take thorough medical history
- Check medications
Define delerium.
Acute change with impaired, fluctuating consciousness
(usually has an underlying cause)
Define dementia.
Slow, progressing, consistent cognitive impairment
(think memory loss, agnosia, apraxia, aphasia, etc.)
True/False.
Most causes of altered mental status are due to some loss of homeostasis.
True.
What sorts of labs are useful in working up a case of altered mental status?
CBC,
glucose,
BUN,
LFTs,
toxicology,
urinalysis,
TSH,
B12
What sorts of imaging are useful in working up a case of altered mental status?
CXR,
CT (head and/or C-spine)
True/False.
Comas often arise due to causes that affect the cortex globally and bilaterally.
True.
Comas often arise due to damage to which specific portions of the brain?
The reticular activating system;
bilateral thalamic lesions
Occlusion of which artery is especially associated with bilateral thalamic infarction and resultant coma?
The artery of Percheron
A patient presents with constricted pupils and a low respiratory rate. What category of substances do you expect is the proximal cause?
Narcotics
A patient is unresponsive after ingesting tricyclic medications.
What will their pupil state be?
Dilated
The Glascow coma scale follows a range of ____ - ____.
The Glascow coma scale follows a range of 3** - **15.
A coma is typically described as a GCS score of ≤ ______.
A coma is typically described as a GCS score of ≤ 8.
What are the three assessments of the Glascow coma scale?
Eye response (1 - 4)
Verbal response (1 - 5)
Motor response (1 - 6)
An unconscious patient presents with flexed, adducted arms with supinated wrists.
This is a sign of de_______tion and damage to the ______________.
An unconscious patient presents with flexed, adducted arms with supinated wrists.
This is a sign of decortication and damage to the upper midbrain.
An unconscious patient presents with extended arms with pronated, flexed wrists.
This is a sign of de_______tion and damage to the ______________.
An unconscious patient presents with extended arms with pronated, flexed wrists.
This is a sign of decerebration and damage to the upper pons.
Locked-in syndrome (i.e. you are conscious and yourself but unresponsive and immobile) occurs due to occlusion of which artery?
The basilar artery
Management of comatose patients involves what sort of targeted temperature adjustments?
Maintenance at 33°C (91.4°F) or 36°C (96.8°F) followed by strict avoidance of fever.
What is the medical term for a vegetative state (i.e. one is awake, exhibits reflexes, and may even keep their eyes open, but they are still unresponsive and exhibit no signs of awareness or interaction with their environment)?
Unresponsive wakefulness syndrome
A patient has suffered a severe brain injury and resultant loss of consciousness. She awakes briefly every now and then and seems to exhibit purposeful behavior for very short periods of time. She has no language ability.
What is this termed?
Minimally conscious state (-)
A patient has suffered a severe brain injury and resultant loss of consciousness. She awakes briefly every now and then and seems to exhibit purposeful behavior for very short periods of time. She has some language ability.
What is this termed?
Minimally conscious state (+)
What is the presentation of an individual with brain death?
Preservation of systemic circulation with irreversible loss of function of the brain and/or brainstem
What are the three steps of assessing and determining brain death in a patient?
- Coma or unresponsiveness- no cerebral motor responses to pain in all extremities
- Absence of brainstem reflexes - pupillary, oculocephalic, corneal, jaw, pharyngeal reflexes are absent
- Apnea test - the patient is not breathing above the ventilator settings
