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Neuro AM > Coma > Flashcards

Coma Flashcards

1
Q

What is a coma?

A

State of unrousable psychological unresponsiveness in which subjects lie with eyes closed and show no psychological understandable response to external stimulus or inner need

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2
Q

what does consciousness depend on?

A

Intact ascending reticular activating system to act as the alerting or awakening element of consciousness
Functioning cerebral cortex of both hemispheres which determines the content of that consciousness

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3
Q

What does arousal from sleep involve?

A

Reticular system

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4
Q

What does awareness of environment involve?

A

Cerebral hemispheres

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5
Q

What are the causes of decreased GCS?

A

Toxic/metabolic states
Seizures
Damage to reticular activating system,
Raised ICP

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6
Q

What are the causes of toxic/metabolic states?

A

Hypoxia, hypercapnia, sepsis, hypotension
Drug intoxication, tenor or lover failure
Hypoglycaemia, ketoacidosis

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7
Q

What is raised ICP raised by?

A 
Tumour
Stroke
EDH
SDH
SAH
Hydrocephalus
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8
Q

What is persistent vegetative state?

A

State in which brainstem recovers to a considerable extent but there is no evidence of recovery of cortical function

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9
Q

What is locked in syndrome?

A

Total paralysis below level of CN III nuclei

Can elevate and depress eyes but no horizontal or voluntary eye movements

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10
Q

What does diagnosis of locked in syndrome dependent on?

A

Recognising that the patient can open eyes voluntarily and signal numerically by eye closure

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11
Q

What causes depressed respiration?

A

Drug overdose

Metabolic disturbance

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12
Q

What causes increased respiration?

A

Hypoxia
Hypercapnia
Acidosis

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13
Q

What causes fluctuating respiration?

A

Brainstem lesion

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14
Q

What blood samples should be done for an unconscious patient?

A

Glucose, biochemistry, haematology, ABG

Toxicology

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15
Q

What baselines should be established in an unconscious patient?

A

BP
Pulse
Temperature

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16
Q

What factors are used for neurological assessment of a patient in a coma?

A

GCS
Brainstem function
Motor function and reflexes

17
Q

Below what GCS would a patient be considered to be in a coma?

A

<8

18
Q

What CNs are responsible for pupillary reactions?

A

II and III

19
Q

What CNs are responsible for corneal responses?

A

V and VII

20
Q

What CNs are responsible for spontaneous eye movements?

A

III, IV, VI

21
Q

What CNs are responsible for the oculovestibular responses?

A

III, IV, VI, VIII

22
Q

What is responsible for the respiratory responses?

A

Medulla

23
Q

How is motor function assessed?

A

Motor response
Muscle tone
Tendon reflexes
Seizures

24
Q

What are the causes of a coma without focal or lateralising signs or meningism?

A 
Anoxic/ischaemic conditions
Metabolic disturbances
Intoxications
Systemic infections
Hyperthermia/hypothermia
Epilepsy
25
Q

What investigations are done for a coma without focal or lateralising signs or meningism?

A 
Toxicology
Blood sugar and electrolytes
LFT and renal functions
Acid base assessment
BP
Carbon monoxide
26
Q

What are the causes for a coma without focal or lateralising signs but with meningism?

A

Subarachnoid haemorrhage
Meningitis
Encaphalitis

27
Q

What investigations are done for a coma without focal or lateralising signs but with meningism?

A

CT heat

LP

28
Q

What is tested in LP for a coma with meningism?

A

Appearance
Cell count
Glucose
Capsular antigen tests

29
Q

What are the causes of a coma with focal brainstem or lateralising cerebral signs?

A

Cerebral tumour, haemorrhage, infarction or abscess

30
Q

What are the investigations of a coma with focal brainstem or lateralising cerebral signs?

A

CT/MRI
Metabolic screen
LP
EEG

31
Q

What are the medical causes of a coma lasting >5 hours?

A

Drug ingestion
Hypoxia
Cerebrovascular event
Metabolic- diabetes, hepatic failure, renal failure, sepsis

32
Q

What factors affect the outcome of a coma?

A 
Age
Cause
Depth of coma
Duration
Brainstem reflexes
33
Q

What is a the care of a patient in a coma?

A 
Maintain vital and bladder and bowel functions
Care of skin
Control of seizures
Prophylaxis of DVT and peptic ulceration
Prevention of contractures
34
Q

How can a head injury lead to focal neurological signs/epilepsy?

A

Diffuse axonal injury
Contusion
Intra or extra cerebral haemaoma

35
Q

What are the features of a subdural haematoma?

A

Convex

Can spread throughout

36
Q

What are the features of an extradural haematoma?

A

Lens shape

Bound by sutures

37
Q

What is the management of a head injury?

A 
Stabilise C spine
ABC
Intubate and ventilate of GCS <8
Treat raised ICP if present
Cranial imaging
Neuro observation
38
Q

How is raised ICP treated?

A 
Surgery to relieve pressure
Osmotic agents
Reduce pain
Maintain ABG
Reduce metabolism

Neuro AM (38 decks)

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