Coma

Question 1

Definition

Answer 1

X awaken;
X respond normally to stimuli(pain, light, sound);
X normal sleep-wake cycle;
X voluntary actions

Question 2

DRABC

Answer 2

R-intubation if unresponsive, anaesthetist
A-w cervical spine stabilisation.
B-bag valve mask+100% O2
C-3P’s, hypov, arrhythmias. IV access+take FBC,glucose,U&E, LFT, toxicology

Question 3

Hypoglycemia

Answer 3

Stick test for rapid. 25-50mls 50% glucose/250-500mls 5% dextrose

Question 4

Alcoholic/malnourished

Answer 4

Pabrinex IVHP

Question 5

GCS

Answer 5

E: Spontaneous, Voice, Pain
V: normal, confused, incoherent words, sounds
M: Normal, localises pain, withdraws frm pain, abn flexion, abn extension

Question 6

GCS

Answer 6

E: Spontaneous, Voice, Pain
V: normal, confused, incoherent words, sounds
M: Normal, localises pain, withdraws frm pain, abn flexion, abn extension

Question 7

Opiate OD

Answer 7

Naloxone 800 mcg, up to TDS@3 min intervals(possible infusion)

Question 8

Benzodiazepine OD

Answer 8

Flumazenil 400mg

Question 9

Meningitis

Answer 9

IV Abx

Question 10

Investigations

Answer 10

CT brain, Drug lvls, LP, Advice

Question 11

Monitor

Answer 11

Conscious lvl, BP, pulse, ECG, O2

Question 12

Brainstem death

Answer 12

Cause of failure irreversible, absence cerebral fn.(unresponsive+unreceptive),
absence of brainstem fn. despite correcting metabolic abn.

Question 13

Brainstem death

Answer 13

X response in: pupil, doll’s head eye movement, caloric testing, corneal, gag, painful stimuli, resp response to hypercapnoea.

Question 14

Locked in syndrome

Answer 14

normal awareness, X movement, communicates with vertical eye movement

Question 15

PVS

Answer 15

normal brainstem fn., opens eyes, sleep-wake pattern, X awareness, X communication