Coma Flashcards
coma
state of unrousable pyscholosgical response, where subjects have eye closed and show no psychologically undersatble response
what is the need to be intact for arousal
reticular activating system
what is needed to be intact for awareness
cerbral hemispheres
what would be seen if you had reticular activating system but no cerebal hemispheres activign
vegative state
what are the cuases of reduced gcs
seizure, damage to the reticualr activating system, intracranial pressure rises - tumours, strokes, edh sdh, sah, hydrocephalus
causes of toxic/ metabolic causes of rised gcs
hypoxia, hypercapnia, sepsis, hypotension
durg intoxication/ renal failure
hypoglycameia, ketoacidosis
what is locked in syndome
whre the paiten is paraeled belwo the levle of the 3rd neve nucleia
diagnsois of locked in syndoem
recongi the paitne cna open theyre eyes voluntarily and signal numerically by eye clousre
what monitoring is needed for coma
temp
heart rate, bp, cvs
resp
skin, abdomen
meningitis, fundal examiniation
what are the neurologial assesments for strokes
gcs
brain stem function
motor fucntion and reflexes
what are the classes for eye opening in gcs
spontaneous - 4
to speech - 3
to pain - 2
none - 1
what are the best verbal response to gcs scores
orianted - 5
confused - 4
inappropiate words - 3
incomprehensible sounds -2
none - 1
what are teh gcs motor scores
obeying commands - 6
localising pain - 5
withdrawal from pain - 4
flexing to pain - 3
extending to pain - 2
none - 1
what is the gcs of a coma paitent
8 or less
what are the componatn that make up coma score for gcs
2 - or less for eye
2 - or less for verbal
4 - or less for motor
how to test 2 and 3 nreves
pupillary recation
how tot tests v and vI nerves
corneal responses
how to test 3, 4 and 6 nerves
spontaneous eye movements
how to test 3, 4, 6 and 8
oculocephalatic resonse
oculoveisbular responce
what are the causes of coma without focal sings or meningism
anoxic
metabolic distubance
intoxications
systemic infections
hyperthermia
hypothermia
epilepsy
investigations for coma without focal sings of menignism
toxicology screen for alchol level, mesure bm and electolies
asses hepatic and renal function
acid - blood gases
bp
consider co poising
cause of a coma wihtou focal signs but menigism
subararchnoid haemoorage
meningitis
encephaltiis
investigations for coma withough focal signs but menigism
ct head
lumbar pucnutre
cuases of coma with focal brain stme signs
cerbral tumour, cerebaral haemmorage, cerbral infration, cerbral abcess
investigations for coma with focal brain stme signs
ct/ mri
metabolic screen
lumbar pucnre
eeg
main cuase of coma that last more than 5 hours
durgs
hypoxia - due to mi
stroke
metabolic events
most importa clicnal sign for outcome of tumour
brian stem reflexes
what pecent of paitne in a non truamtaic coma will make a good recovery
15%
what kind of provaltic treit is done for comas
dvt, peptic ulcerationtin
how does a subdural ehamoa look on ct
convex, banna in shape
how does a head extra dural look on cv
convex or conave in shepae
what gcs is intubaation requreid
8 or less
what osmotic agens can relive icp
mannitol
