Coma

Question 1

Delirium

Answer 1

fluctuating confusion, inattention, misperceptions (illusions or hallucinations)

Question 2

Stupor

Answer 2

sleep-like state from which the patient can be aroused only by vigorous stimuli

Question 3

Coma

Answer 3

sleep-like state where the patient is unresponsive to external stimuli. No sleep-wake cycles

Question 4

GCS parameters

Answer 4

eye opening, language function, bodily movement

Question 5

decerebrate posture

Answer 5

upper extremity extension with lower extremity extension (lesion at upper brainstem)

worse prognosis than decorticate

Question 6

Typical duration of coma

Answer 6

usually less than 4 weeks

Question 7

Determination of brain death must include

Answer 7

Core body temp of 32.2 (90F)
No tox explanation for low neurological state
Adequate BP and pulse
No voluntary movements or response to pain (spinal reflexes are ok, eg. DTR, Babinski)

Question 8

Cold caloric test

Answer 8

flush each external auditory canal with 20 ml ice water x 2 and observe

Normal –> Oculovestibular reflex –> eye movements

Question 9

Confirmatory tests for brain death

Answer 9

Always for children

cerebral angiogram, radionuclide scan, EEG (flat line), CT angio, transcranial doppler flow, evoked responses

Question 10

brain death

Answer 10

irreversible cessation of all functions of the entire brain, including the brainstem

Question 11

brain death criteria

Answer 11

Unresponsive (deep coma with GCS = 3)
Cerebrally modulated motor responses absent during painful stimulation
Brainstem reflexes are absent (pupils, corneals, oculocephalic, oculovestibular, cough, gag, respirations)

Question 12

Determination of brain death must include the ABSENCE of

Answer 12

Pupillary light reflex
Corneal blink reflex
Oculocephalic reflex (doll's eyes)
Oculovestibular reflex (cold calorics)
Cough reflex
Gag reflex
Respiratory effort (apnea test)

Question 13

Decorticate posture

Answer 13

upper extremity flexion with lower extremity extension (suggests lesion at hemispheres)

Question 14

mild TBI

Answer 14

GCS = 15-13

Question 15

modearte TBI

Answer 15

GCS = 12-9

Question 16

severe TBI

Answer 16

GCS = 8-3

Question 17

vegetative state

Answer 17

sleep-wake cycles return, but no sign of cognitive function

Question 18

When is vegetative state considered permanent?

Answer 18

trauma: 12 mo after injury in adults/children

non-traumatic causes: 3 months after anoxic-ischemic injury

Question 19

minimally conscious state

Answer 19

eyes open spontaneously; normal sleep-wake cycles; normal arousal at times; reproducible, inconsistent behavioral displays of perception, communication, or purposeful motor activity