Coma Flashcards
What is coma?
State of unrousable psychological unresponsiveness
What does Glasgow Coma scale measure?
Degree of consciousness
GCS<8 is a coma
What are the 3 components of GCS?
Eye opening
Verbal response
Motor response
What are the GCS criteria for eye opening?
Spontaneous- 4
To speech- 3
To pain- 2
None- 1
What are the GCS criteria for verbal response?
Orientated- 5
Confused- 4
Inappropriate words- 3
Incomprehensible sounds- 2
None- 1
What are the GCS criteria for motor response?
Obeying commands- 6
Localising to pain- 5
Withdrawing from pain- 4
Flexing to pain- 3
Extending to pain- 2
None- 1
What is consciousness dependent on?
Intact ascending reticular activating system- arousal
Functioning cerebral cortex - awareness
What are the causes of reduced conscious level?
Toxic/metabolic states
Seizures
Damage to reticular activating system
Raised ICP
What causes a raised ICP?
- Tumour
- Stroke
- EDH
- SDH
- SAH
- Hydrocephalus
What is persistent vegetative state?
Brainstem recovers but there is no evidence of recovery of cortical function
Arousal but no awareness
What is locked in syndrome?
Paralysis below level of third nerve nuclei
Able to open, elevate and depress eyes but no other voluntary eye movements
What are the elements to resuscitation of coma patient?
Airway
Breathing
Circulation
Blood samples
BP, pulse, temp
IV access
Stabilise neck
What causes depressed respiration?
Drug overdose
Metabolic disturbance
What causes increased respiration?
Hypoxia
Hypercapnia
Acidosis
What causes fluctuating respiration?
Brainstem lesion
What are the types of coma?
- Coma without focal brainstem or lateralising cerebral signs and without meningism
- Coma without focal brainstem or lateralising cerebral signs but with meningism
- Coma with focal brainstem or lateralising cerebral signs
What causes a coma without focal brainstem or lateralising cerebral signs and without meningism?
- Anoxic/ischaemic conditions
- Metabolic disturbances
- Intoxications
- Systemic infections
- Hyperthermia
- Hypothermia
- Epilepsy
How do you investigate coma without focal brainstem or lateralising cerebral signs and without meningism?
- Toxicology screen including alcohol level
- Measure blood glucose and electrolytes
- Hepatic and renal function
- Acid-base assessment
- ABGs
- BP
- Carbon monoxide poisoning
What causes a coma with meningism?
- SAH
- Meningitis
- Encephalitis
How do you investigate a coma with meningism?
- CT head scan
- Lumbar puncture
What causes a coma with focal brainstem or lateralising cerebral signs?
- Tumour
- Haemorrhage
- Infarction
- Abscess
How do you investigate a coma with focal brainstem or lateralising cerebral signs?
CT/MRI
What is involved in care of coma patients?
Maintenance of vital functions
Care of skin, avoidance of pressure sores
Attention to bladder and bowel function
Control of seizures
Prophylaxis of DVT, peptic ulceration
Prevention of contractures
