Coma Flashcards
Delirium
Fluctuating confusion, inattention, misperceptions (illusions or hallucinations).
Stupor
A sleep-like state from which the patient can be aroused only by vigorous stimuli
Coma
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.
Patients are in coma if they are unable to:
- Follow commands
- Speak any recognizable words
- Open either eye
Decerebrate posturing
extension
upper extremity extension with lower extremity extension (suggests lesion at upper brainstem)
Decorticate posturing
Flexion
upper extremity flexion with lower extremity extension (suggests lesion at hemispheres)
Criteria for establishing brain death
- Unresponsiveness (GCS is 3)
- Cerebrally modulated motor responses are absent during application of painful stimulus. (Spinal reflexes may be present. Seizures or flexion/extension posturing may not)
- Brainstem reflexes are absent (pupils, corneals, oculocephalic, oculovestibular, cough, gag, respirations)
Core body temp of 32.2 C (90 F)
Toxicology tests find no explanation for low neurological state (CNS suppressing medications may be subtherapeutic)
Adequate BP and pulse (SBP 90, P >50)
No voluntary movements or response to pain (spinal reflexes are OK, e.g., DTR,. Babinski)
Corneal blink reflex
Touch cornea with tissue. (CNs V and VII)
There must be no blink response in either eye for no reflex
Cold water calorics
Oculovestibular reflex
Flush each external auditory canal with 20 ml ice water x 2 and observe (CNs VIII, III, IV and VI)
There must be no eye movements for no reflex
Cough reflex
Suction the trachea at the carina. (CN X)
There must be no cough response for no reflex
Gag reflex
Touch the oropharynx with Q-tip. (CNs IX and X)
There must be no movement of the oral structures for no reflex
Vegetative state
Eyes open spontaneously; sleep-wake cycles resume but there is no evidence of perception, communication, or purposeful motor activity
