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Neurologic Conditions > Coma > Flashcards

Coma Flashcards

1
Q

What is Coma?

A

Medical Emergency

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2
Q

What does coma imply?

A

Diffcuse insult to the cerebral hemispheres bilaterally or focal damage to the core of the brainstem known as the Reticular Activating System (RAS)

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3
Q

What is the MCC of coma in large city hospitals?

A

Toxi-metabolic

(non-structural brain injury)

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4
Q

What is the 2nd MCC of coma?

A

Structural brain damage

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5
Q

What is the duration of coma?

A
  • Acute w/ trauma, stroke or bacterial meningitis
  • Subacute or gradual in abscess or neoplasm
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6
Q

What is the 1st step in all medical emergencies?

A

Evaluate ABC’s

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7
Q

What are the #1 priorities until secure & stable?

A

Pulse, airway secure & breathing

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8
Q

What do unstable pts often need?

A

Endotracheal intubation & resp assistance

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9
Q

What should always be established in a coma pt?

A

IV access & indwelling Foley catheter

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10
Q

How should you speak to the pt during the exam?

A

Speak loudly to the pt & call their name directly into their ear

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11
Q

What should you ALWAYS do to check for Locked-in-synd?

A

Ask pt to try to move their eyes or blink

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12
Q

What should be done bilaterally when examing the pt?

A

Check for withdrawal movement to painful or noxious stim (pressure on supraorbital ridge, pinching nipple, strong pressure to nail bed)

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13
Q

If there is suspicion of trauma what should be performed before doing maneuvers that require the neck to move?

A

Cross table lateral AP X-ray of the cervical spine

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14
Q

What will pt have w/ brainstem injury when putting limbs through ROM?

A

Symmetrical or asymmetrical spasticity

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15
Q

What will pts w/ brainstem lesions have when checking DTRs?

A

Symmetrical or asymmetrical inc DTRs

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16
Q

What will pts w/ brainstem lesions have when checking pathological reflexes?

A

Unilateral or bilateral + Babinski’s, Hoffmans or Tromner’s

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17
Q

What will pt w/ brainstem lesions have when checking the pupillary light reflex?

A

Pupillary ABN

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18
Q

What other signs are often ABN ina brainstem injury?

A
  • Doll’s eyes
  • Ice water caloric stim
  • Corneal reflexes
  • Gag reflexes (if not intubated)
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19
Q

What is the best imaging for the brainstem?

A

MRI

20
Q

What is the quickest & easiest to obtain in a comatose pt?

A

CT

21
Q

What will bedside EEG rule out?

A

Subclinical seizures & determine if cortical activity present

22
Q

What is the tx of coma?

A
  • Support ABC’s
  • Trial of IV Narcan (narcotic antagonist) in comas of unkown etiology
23
Q

How can Focal structural hemispheric damage cause coma?

A

Do not lead to coma unless the lesions are numerous & widespread

24
Q

What do focal lesions cause?

A

Herniation of hemispheres leading to secondary compression of RAS in brainstem

25
Q

Who usually gets coma d/t drug intoxication?

A

Young adults or adolescents

(all age groups represented)

26
Q

What is the hx of coma d/t drug intoxication?

A
  • Freq psychiatric hx
  • Record of prior events
  • Rx meds at scene
27
Q

What is the most resistant reflex to metabolic or toxic suppresion?

A

Pupillary light reflex

28
Q

What will toxicology studies show in coma d/t drug intoxication?

A
  • Causative substance
  • Narcotics
  • Barbituates
  • Tricyclic compounds
  • Benzodiazepines
29
Q

How does drug intoxication cause coma?

A

Depreses the cerebral cortex diffusely & effect will last until the durg is metabolized

30
Q

What does death usually result from in drug intoxication?

A
  • Apnea
  • Hyopxemia
  • Hemodynamic collapse
  • Arrythmias
31
Q

Which metabolic disordes can lead to coma?

A
  • Diabetic Ketoacidosis
  • Hyperthyroid Myxedmea
  • Liver failure
32
Q

How do metabolic disorders lead to coma & death?

A

Creating a metabolic milieu that cannot sustain diffuse brain function

33
Q

What is most vulnerable to metabolic insults?

A

Cerebral cortex> brain stem

34
Q

What are the tech features of metabolic disorders causing coma?

A
  • DKA, inc TSH, inc serum ammonium, ABN hepatic function studies
  • Brain imaging not dx
  • EEG is ABN in non-specific fashion
35
Q

What factors can cause coma d/t cerebral perfusion or hypoxemia?

A
  • Mi
  • Cardiac arrhythmia
  • Strangulation
  • Drowning
  • Air way occlusion
  • Resp failure
36
Q

What is the hx of coma d/t decreased cerebral perfusion of hypoxemia?

A
  • Hx of near-drowning
  • Strangulation
  • Suffocation
  • Airway occlusion
  • Cardiac arrest or lethal arrhythmia
37
Q

What are the PE findings of coma d/t dec cerebral perfusion or hypoxemia?

A

No ABN focal neuro fidnigs or abundant focal finding d/ multiple cerebral infarctions

38
Q

What are the brain MRI findings of dec cerebral perfusion or hypoxemia?

A

Cerebral hypoxemia or ishcmeia but may take time to evolve

39
Q

What are the EEG changes of dec cerebral perfusion or ischemia?

A

Non-specific but sensitive

40
Q

What will EKG or Chest X-ray show in dec cerebral perfusion or ischemia?

A

Underlying cardiac or pulmonary causes

41
Q

What features distinguish brain death from coma?

A
  • Absent pupillary light or corneal reflex
  • No withdrawal from painful stimuli
  • Apnea even following removal of ventilator support while maintaining adequate oxygenation
42
Q

What are the tech features of Brain death?

A

Absencent EEG activity or cerebral perfusion on imaging studies

43
Q

What does Obtunded mean?

A

Less than full mental capacity

44
Q

What is lethargy?

A

Subjective feeling of tiredness or fatigue

45
Q

What is Stupor?

A

Lack of crtical congnitive function & consciousness

46
Q

What is comatose?

A

State of unconsciousness >6 hours where a pt can’t be awakened or aroused

Neurologic Conditions (15 decks)

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