Clinical Assessment of Conciousness Flashcards
What is consciousness?
An awake state in which one is fully aware of oneself and the environment, including the ability to perceive and interpret stimuli and to interact and communicate with others in the absence of motor deficits
Give 3 reasons why consciousness may be lost
Metabolic disturbance
Raised intracranial pressure
Direct lesion of brainstem
What is a coma?
Absence of consciousness with impaired wakefulness and awareness. No purposeful movement or reaction to stimuli.
What is delirium?
Acute confusional state with impaired awareness and fluctuating arousal level. They may have delusions or hallucinations.
What is the Monroe-Kellie Doctrine?
The maximum volume in the cranium is fixed because of the rigid nature of the skull. If a mass appears in or around the brain, venous blood and CSF is pushed out to compensate.
If the volume can no longer be compensated for then the intracranial pressure will rise and produce symptoms
Give 5 causes of raised intracranial pressure
Cerebral oedema Tumours Haemorrhage Trauma Hydrocephalus Venous outflow obstruction
What is a tonsillar herniation?
Cerebellar tonsils are pushed into the foramen magnum
What is a subfalcine herniation?
Cingulate gyrus pushed under the falx cerebri
What is a tentorial herniation?
Uncus moves through the tentorial membrane
Describe ways in which a person’s consciousness can be assessed when they first present to a healthcare professional
Airway, Breathing, Circulation, Disability, Exposure Take a full history General examination Neurological examination AVPU GCS
What is a decerebrate posture?
Arms adducted and extended, wrists pronated, fingers flexed, legs extended, plantar flexion of feet
What is a decorticate posture?
Arms adducted, elbows flexed, wrists and fingers flexed.
What does AVPU stand for?
Alert
Voice
Pain
Unresponsive
How is a GCS score worked out?
Eye opening- 1-4
Verbal 1-5
Motor 1-6
Add together score to get score between 3 and 15
