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Undeleted > Coma > Flashcards

Coma Flashcards

0
Q

Define awareness

A

The ability to have and the having of experience of any kind

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1
Q

What are the three main disorders of consciousness

A

Coma
Vegetative state (VS)
Minimally conscious state (MCS)

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2
Q

Define wakefulness

A

A state in which the eyes are open and there is a degree of motor arousal: it contrasts with sleep: a state of eye closure and motor quiescence

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3
Q

Define coma

A

The extreme of a graded continuum of impairment of consciousness, at the opposite pole, from full alertness and awareness… Incapable of sensing or responding… Little or no spontaneous movement…no evidence of mental activity.

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4
Q

What are the qualities of a coma

A

Absent wakefulness and awareness : untouchable, unresponsive, lasting >6 hrs

Unaware patient unresponsive to external stimuli
No response to painful stimuli
No normal sleep wake cycles
Does not initiate voluntary movements

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5
Q

What are the 6 alternations of consciousness

A 
Clouding of consciousness 
Confusion
Delirium 
Obtundation 
Stupor 
Coma
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6
Q

What is clouding of consciousness

A

Reduced wakefulness and attention, excitability and irritability

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7
Q

What is confusion

A

Misinterpreted stimulus associated with a shortened attention span

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8
Q

What is delirium

A

Disorientation , fear , irritability, misperception of sensory stimuli and (visual) hallucinations

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9
Q

What is obtundation

A

Mental blunting or torpidity

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10
Q

What is stupor

A

Rousable unresponsive ness

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11
Q

What are the 5 main causes of an altered awareness

A 
Hypoxia/ischaemic 
Metabolic and infective
Trauma
Structural brain diseases
Psychogenic
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12
Q

What’s part of the brain maintains arousal

A

Intralaminar nuclei of the thalamus

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13
Q

Stimulation of what area causes arousal

A

Posterior hypothalamus

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14
Q

Lesions in which regions are involved in MCS

A

Cuneus and precuneus association cortex

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15
Q

Anterior cingulate lesions result in

A

Abulia ( lack of motivation )

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16
Q

Describe the features of stupor

A

Variable responsiveness
Mute or near mute
Akinesia
Restricted passive movement or catatonic or bizarre posture
Normal reflexes
Responds to visual stimuli
Resists passive eye opening and may blink to pain

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17
Q

What are the three main origins of stupor

A

Structural
Metabolic
Psychogenic

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18
Q

List 4 structural causes of stupor

A

Raised ICP
infection
Dementia
Ictal/ post ictal

19
Q

List 5 metabolic causes of stupor

A 
Hypoglycaemia
Liver/kidney failure
Pituitary /adrenal 
Alcohol
Deficiency states
20
Q

List four psychogenic causes of stupor

A

Depression
Mania
Schizophrenia
Hysteria

21
Q

Depressive stupor presents with

A

Depressive history
Weight loss
Restless motor activity or bizzare postures

22
Q

Treatment for depressive stupor

A

Supportive -fluids
ECT
Antidepressants via NG or IVI
Benzodiazepines

23
Q

How does manic stupor present

A

Lying in ecstasy
Previous mania or affective symptoms
Short episodes of stupor interspersed with over active episodes
Misdiagnosed as attention seeking

24
Q

How does schizophrenic stupor present

A

Catatonic
Lying, sitting or standing
Waxy flexibility
Interspersed with non directed motor excitement

25
Q

What is the treatment for manic stupor

A

Treat the mania
: Benzos , APs, mood stabilisers, ECT if prolonged

Supportive measures

26
Q

What is the treatment for schizophrenic stupor

A

Supportive
Benzos
ECT
antipsychotics- not very effective and beware malignant hyper pyrexia

27
Q

How does hysterical stupor present?

A

Sudden dissociations
Previous hysteria
May co exist with organic illness

28
Q

What is the treatment for hysterical stupor

A

Supportive
Wait
Benzos
EVT only if prolonged

29
Q

What types of drugs induce stupor

A

Alcohol
Psychotropics
Adverse reactions

30
Q

Name four chronic states of altered consciousness

A

Dementia
Hypersomnia
Akinetic mutism
Apallic syndrome

31
Q

What is locked in syndrome

A

Conscious- aware of self and the environment
No voluntary movement
High brain stem pathology with retention of blinking or vertical eye movements via dejerines bundle

32
Q

What is a minimally conscious state

A

State of severely altered consciousness in which minimal but clearly discernible behavioral evidence of self or environmental awareness is demonstrated
Inconsistent but reproducible responses above the level of spontaneous or reflexive behaviors indicating some degree of interaction with surroundings

33
Q

What behaviors are exhibited in MCS

A

May follow simple commands

Gestural or verbal yes/no responses regardless of accuracy

Intelligible verbalisation

Purposeful or discriminating behavior including movement or affective behaviors that occur contingent in relation to relevant environmental stimuli and are not reflexive

34
Q

People in a minimally conscious state may exhibit …. What addressed

A

Eye contact or head movement

35
Q

Can people in an MCS hold or use an object

A

Sometimes yes

36
Q

People in an MCS are emotionless but with …..

A

Tracking eye movements

37
Q

Describe the features of a persistent vegetative state

A 
No awareness of self or environment 
No sustained behavioral responses
No language 
Cranial nerve function largely intact
Roving/ jerky eye movements 
Sleep wake cycles 
Stable BP and respiratory drive
Incontient
38
Q

What are the RCP criteria for diagnosis of PVS

A

No evidence of awareness of self
Cyclical and spontaneous eye movements
Extended limbs to pain- no evidence of verbal responsiveness
No demonstration of any experience of pain through motor or verbal response
Normal respiratory function

39
Q

How should coma patients be examined

A

History
General examination ie skin, temp, BP
Neurological examination

40
Q

What are the three components of the GCS

A

Eye opening
Motor
Verbal

41
Q

What investigations are done for coma

A

Lab tests: acidosis, anion gap, osmolar gap- antifreeze

Drug screen

Blood cultures
Imaging
EEG
CSF

42
Q

What immediate management is available for a coma

A 
Oxygenation 
ABC
Correct BP, Temp
Glucose
Naloxone (opioids), flumenazil (benzo)
Correct Na, Ca, and eliminate toxins
Neurosurgery and ICP
infection
43
Q

What long term management should be considered for coma

A 
Tracheostomy
PEG
wean from ventilator
Avoid MRSA
prevent contractures
Protect skin
Avoid neurostimulation including drugs
44
Q

What factors are associated with poorer prognosis in coma

A 
Myoclonic status 
Absent corneal / pupil at 3 days 
Absent motor at three days 
Absent SEP
increased serum neurone specific enolase
45
Q

How is brain stem death diagnosed

A 
Known cause
No drugs >36.5c >SPB 100mmHg
Eu volaemia, capnia, oxaemia, BP. 
Absent brain stem reflexes 
Apnoea with no co2 response when off ventilator

Undeleted (12 decks)

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