Coma Flashcards
* touch cornea with a tissue –> test CN 5 and 7
- dead = no response in either eye
the corneal reflex test
About ____% of those coming into the NICU with coma with die within the first month.
50%
Understand the criteria for establishing brain death.
- unresponsiveness; GCS = 3
- Cerebrally modulated motor responses are absent during application of painful stimulus
- Brainstem reflexes are absent:
- Pupillary light reflex
- Corneal reflex
- Oculocephalic reflex (doll’s eyes)
- Oculovestibular reflex (cold calorics)
- Cough reflex
- Gag reflex
- Respiratory effort (apnea test)
This is a sleep-like state from which the patient can be aroused only by vigorous stimuli.
stupor
Describe the anatomical pathways tested with the cough reflex.
* Suction the trachea at the carina –> tests CN 10
- dead = no cough response
This is a sleep-like state where the patient is unresponsive to external stimuli, and there are no sleep-wake cycles. Usually lasts no more than 4 weeks. GCS 8 or less.
coma
Which sign is worse: decerebrate or decorticate posturing?
decerebrate (extension)
Describe the anatomical pathways tested with the corneal blink reflex.
* touch cornea with a tissue –> tests CN 5 and 7
- dead = no response in either eye
This is fluctuating confusion, inattention, misperceptions (illusions or hallucinations).
delirium
decerbrate posturing
*extension*
- upper and lower extremity extension (suggests lesion at upper brainstem)
stupor
a sleep-like state from which the patient can be aroused only by vigorous stimuli
Consciousness derives from the activation of the _____ by the RAS, which project from the reticular formation of the brainstem.
intralaminar nuclei of the thalamus
Discuss ethical, legal, and cultural issues related to brain death and organ transplantation.
- surgeon that harvests may not be involved in determining death
- proper documentation
What is a vegetative state?
sleep-wake cycles re-establish but there is no sign of cognitive function
This is upper extremity flexion with lower extremity extension (suggests lesion at hemispheres).
decorticate posturing
This is when sleep-wake cycles re-establish, but there is no sign of cognitive function.
vegetative state
What are the 3 areas tested by the Glascow-coma scale?
- motor
- verbalization
- eye opening
decortiate posturing
*flexion*
- upper extremity flexion with lower extremity extension (suggests lesion at hemispheres)
*touch the oropharynx with Q-tip –> test CN 9 and 10
- dead = no movement of oral structures
the gag reflex test
* Suction the trachea at the carina –> tests CN 10
- dead = no cough response
the cough reflex test
Dx?
- eyes open spontaneously
- sleep-wake cycles resume
- no evidence of perception, communication, or purposeful motor activity
vegetative state
Dx?
- eyes open spontaneously
- sleep-wake cycles resume
- arousal level may be normal at times
- reproducible, though inconsistent, behavioral displays of perception, communication, or purposeful motor activity
minimally conscious state
This is upper extremity extension with lower extremity extension (suggests lesion at upper brainstem).
decerebrate posturing
Describe the anatomical pathways tested with the cold water calorics.
- aka oculovestibular reflex
- * flush each external auditory canal with 20mL ice water x2 –> test CN 3, 4, 6, 8
- dead = no eye movements
delirium
fluctuating confusion, inattention, misperceptions (illusions or hallucinations)
Consciousness derives from the activation of the intralaminar nuclei of the thalamus by the ____, which project from the _______ of the brainstem.
RAS; reticular formation
coma
- a sleep-like state where the patient is unresponsive to external stimuli
- no sleep-wake cycles
- usually lasts no more than 4 weeks
- GCS 8 or less
Describe the anatomical pathways tested with the gag reflex.
* touch the oropharynx with Q-tip –> test CN 9 and 10
- dead = no movement of oral structures
What is the outcome from a vegetative state?
- 1% chance of recovery in 12 mos
- esp. bad if non-traumatic cause
