Coma

Question 0

Before giving AMS patient glucose, must give?

Answer 0

Thiamine – glucose can precipitate Wernicke’s encephalopathy

Question 1

Common reversible causes of coma/altered mental status (and treatment)?

Answer 1

#Opioid overdose – naloxone
#Warnicke's – thiamine
#Hypoglycemia – dextrose

Question 2

Nerves tested in the doll’s eyes maneuver?

Answer 2

3, 4, 6 (efferent), 8 (afferent)

Question 3

Caloric testing – tests what nerves? How to test?

Answer 3

3, 4, 6 (efferent), 8 (afferent) (same as the doll’s eyes test)

Inject 50 mL ice water into each ear and observe for conjugate eye movements towards injected ear

Question 4

Corneal test evaluates what nerves?

Answer 4

V1 (afferent) & 7 (efferent)

Question 5

Decorticate verses decerebrate posturing? Relative area of dysfunction?

Answer 5

In response to noxious stimuli,

In both, wrists flex and feet plantar flex

In decorticate – elbows flex as well

Question 6

Three main ways to depress consciousness by anatomical dysfunction?

Answer 6

1. Dysfunctional brainstem (Pontine hemorrhage)
2. simultaneous bilateral cerebral dysfunction (hypoglycemia)
3. Large unilateral cerebral hemispheric lesion that causes swelling and compression of opposite hemisphere or downward pressure on the brainstem

Question 7

Structural causes of depressed consciousness?

Answer 7

#Acute ischemic stroke
#Acute intracranial hemorrhage
#Neoplasm
#Abscess

Question 8

Metabolic causes of depressed consciousness?

Answer 8

#Electrolytes
#Glucose abnormality (hypoglycemia, DKA, and NKHC)
#hepatic failure
#Uremia
#Thyroid dysfunction
#Adrenal insufficiency

Question 9

Toxic causes of depressed consciousness?

Answer 9

#Alcohol
#Sedatives
#Narcotics
#Psychotropic
#CO
#Heavy metals

Question 10

Infectious causes of depressed consciousness?

Answer 10

#Meningitis
#Encephalitis

Question 11

Patient presents with suspected structural cause of depressed consciousness – must obtain? (Caveat?)

Answer 11

CT scan&raquo_space; MRI

avoid contrast if acute hemorrhage is possible

Question 12

Use of EEG in determining etiology of depressed mental status?

Answer 12

#Hepatic encephalopathy
#Anoxic brain injury
#Status epilepticus

Question 13

Treatments to lower ICP?

Answer 13

#Elevate head open
#Hyperventilation
#mannitol
#Corticosteroids only if tumor

Question 14

Persistent vegetative state?

Answer 14

#No awareness or cognitive function
#Eyes open, sleep-wake cycles
#Maintained respiration and autonomic function

Question 15

Locked in syndrome – lesion location? Can communicate via?

Answer 15

Base of pons; blinking and vertical eye movements

Question 16

General guidelines for declaring brain-dead?

Answer 16

patient must not be hypothermic and drug overdose must not be present

#Absent brainstem reflexes
#No spontaneous respirations even after apnea test (allow PCO2 to rise)

Question 17

Acute confusion state results from a problem of? Test?

Answer 17

Attention;

serial sevens/”WORLD “

Question 18

Differential diagnosis of acute confusion?

Answer 18

#Wernicke's Aphasia
#Psychosis
#Complex partial seizures
#Acute right-sided hemispheric lesions
#Encephalopathy