Coma

Question 1

What are some causes of coma?

Answer 1

CNS:
Seizure, infection, SOL, CVA

CV:
Low CO state

Resp:
Hypoxia, hypercapnia, CO poisoning

Metabolic
Uraemia, hepatic encephalopathy, hypoglycaemia, hypo/hypernatraemia, hypothyroidism

Pharma:
Opiates
Benzos

Question 2

What components are on the Glasgow coma scale?

Answer 2

Eyes open:
3 -
2 -
1 - non

Best verbal response: 
5 - 
4 - 
3 - 
2 - 
1 - unresponsive 

Best motor response: (best predictor of mortality)
6 -
5 - localise to pain
4 - normal flexion to pain (hands go above level of clavicle)
3 - abnormal flexion to pain (to less than the level of the clavicle)
2 -
1 - none

Pain must be elicited by pressing somewhere on the face e.g. between the lower border of the orbit and the eye, as bellow are innervated by spinal nerve reflexes

Question 3

What is the AVPU-GCS conversion?

Answer 3

A - 15
V - 12
P - 8
U - 3

Question 4

What is important when assessing someone that is intoxicated that has also had a head injury?

Answer 4

Dont rule out serious underlying injury by labelling symptoms as intoxication

Will still likely need CT head/C-spine

Question 5

What are the different types of herniation?

Answer 5

Uncal:

Presents with 3rd nerve palsy

Question 6

How do you reduce ICP?

Answer 6

Cerebral dehydration:
Give mannitol (like an alcohol)
OR Hypertonic saline

Reduce cerebral blood volume:
Head up to 30 degrees

Avoid hypoxia as increases ICP

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