Coma [3]

Question 1

Pupillary reflex
action?
CN?

Answer 1

Shine light in eye

CN II and III

Question 2

Corneal reflex
action?
CN?

Answer 2

touch cornea with tissue

CN V and VII

Question 3

Oculocephalic reflex
action?
CN?

Answer 3

rotate head quickly to one side (create drag) and observe eyes

CN III, IV, VI, VIII

Question 4

oculovestibular reflex

cold caloric test

Answer 4

flush each external auditory canal with 20ml ice water x2 and observe for nystagmus

CN III, IV, VI, VIII

Question 5

Gag reflex
action?
CN?

Answer 5

touch oropharynx (soft palate area)

CN IX, X

Question 6

cough reflex
action?
CN?

Answer 6

suction the trachea at the carina

CNX

Question 7

APnea Test procedure

Answer 7

testing brain stem internal fxn by creating hypoxic condition to look for hypoxic drive

• 100 O2 for 10 min
• test arterial blood gas for around 40mmHG
• maintain BP and pulse
• look if pt has “tripped the vent”
• disconnect vent from ET tube
• deliver O2 at 6L/min by t-piece
• observe and feel for resp. effort
• after 8 min, draw blood gas and reconnect ventilator. If no resp. effort observed and pCO2 is 20 or more mmHg higher than baseline - apnea test is positive (brain dead)

Question 8

What confirmatory test is most helpful in determining brain fxn of infants?

Answer 8

CT angiogram

evoked response least

Question 9

Consciousness is not what 3 things? what is it?

Answer 9

awareness
insight
enlightenment

it is the product of biological events occuring w/in deep anatomical structures of the brain (brainstem + thalamus)
- derives from activation of the INTRALAMINAR NUCLEI of the thalamus by the reticular activating system

Question 10

When due to trauma vs non traumatic causes, when is vegetative states considered permanent?

Answer 10

12 months after injury

3 months (following non trauma, anoxic-ischemic injury)

Question 11

minimally conscious state

Answer 11

eyes open spontaneously
sleep wake cycles resume
arousal lvl may be nL (reproducible)
behavior displays of perception
communication
purposeful motor activity

Question 12

Criteria for establishing brain death

Answer 12

indiv. w/ IRREVERSIBLE cessation of circulatory and respiratory fxn is dead

an indiv with IRREVERSIBLE cessation of all fxn of the entire brain, including brain stem, is dead.

All must be present:
Core body temp of 32.2C (90F)
No explanation with Toxicology
Adequate BP and pulse
No voluntary movements or response to pain