Coma Flashcards
define delirium
fluctuating confusion, inattention, misperceptions (illusions or hallucinations).
Define Stupor
a sleep-like state from which the patient can be aroused only by vigorous stimuli
define 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.
________ is an abnormal posture– upper extremity flexion with lower extremity extension (suggests lesion at hemispheres)
Decorticate (flexion)
___________ is an abnormanl posture– upper extremity extension with lower extremity extension (suggests lesion at upper brainstem)
Decerebrate (extension)
Prognosis of decerebrate is _______ than decorticate
worse
Patients are in coma if they are unable to do what 3 things?
- Follow commands
- Speak any recognizable words
- Open either eye
describe a Vegetative state (VS)
where sleep-wake cycles re-establish, but there is no sign of cognitive function.
what is the first criterion for brain death
“Unresponsiveness”
The patient is in deep coma. The GCS is 3.
what is the second criterion for brain death
“Cerebrally modulated motor responses are absent during application of painful stimulus.”
(Spinal reflexes may be present. Seizures or flexion/extension posturing may not)
What is the 3rd criterion for brain death
“Brainstem reflexes are absent”
pupils, corneals, oculocephalic, oculovestibular, cough, gag, respirations
these 4 things must be present for brain death determination
1) Core body temp of 32.2 C (90 F)
2) Toxicology tests find no explanation for low neurological state (CNS suppressing medications may be subtherapeutic)
3) Adequate BP and pulse (SBP > 90, P >50)
4) No voluntary movements or response to pain (spinal reflexes are OK, e.g., DTR,. Babinski)
name 7 things that must be absent in determination of brain death
1) Pupillary light reflex
2) Corneal reflex
3) Oculocephalic reflex (doll’s eyes)
4) Oculovestibular reflex (cold calorics)
5) Gag reflex
6) Cough reflex
7) Respiratory effort (apnea test)
how do you perform the Oculocephalic Reflex?
Rotate the head quickly to one side and observe eyes (CNs VIII, III, IV and VI)
There must be no eye movements of any kind
the apea test consists of: disconnecting ventilator for 8 min with hand placed on chest(if breathing is felt , stop test), then draw blood gas and reconnect ventilator. If no respiratory effort was observed and the pCO2 is ____or more mmHg higher than baseline, the apnea test is positive (c/w brain death
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