Coma Flashcards

1
Q

What is the level of consciousness:

normal awake and responsive state

A

Alert

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2
Q

What is the level of consciousness:

easily aroused with mild stimulation. Arousal is more easily maintained.

A

Lethargy

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3
Q

What is the level of consciousness:

Awakens and follows commands and will awaken to simple stimulation such as voice or touch but requires sustained stimulation to maintain arousal

A

Somnolent

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4
Q

What is the level of consciousness:

arousable only with painful stimuli, does not respond to verbal stimuli or simple stimuli as much.

A

Obtunded/Stupor

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5
Q

What is the level of consciousness:

no arousal, no or few purposeful movements despite vigorous stimulation

A

Comatose

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6
Q

What is the evaluation of a Coma?

A

Start with level of consciousness

then check pupillary reflex

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7
Q

What are some interpretations of the following exams during a coma:

  1. eye movements
  2. Fundoscopic exam
  3. Babinski
  4. pupillary
A
  1. roving eye movements can suggest seizure
  2. swollen optic disc = intracranial pressure
  3. upper motor neuron deficit
  4. brainstem is doing ok
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8
Q

What do the following suggest?

  1. bilateral small pupils
  2. bilateral pin point pupils
A
  1. sign of metabolic disorder

2. pontine lesion

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9
Q

Interpret the following motor exams:

  1. arms and legs turn into the body
  2. feed and hands turned outwards
A
  1. Decorticate - dysfxn above mid brain (red nucleus), BRAINSTEM problem
  2. Decerebrate - dysfxn below mid brain, corticospinal tracts, Pontine injury
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10
Q

What are signs that there may be a cerebellar herniation?

A
Abnormal respiration
Fixed/minimally reactive pupils, asymmetric dilated pupil
Gaze deviation
Decrebrate/decorticate postruing
Brady cardia
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11
Q

what is the drug of choise of absence seizures?

A

Ethosuxamide

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