Coma Flashcards
what do you require to have consciousness?
1 cerebral hemisphere and the reticulare activating system
what are the three steps to coma?
decline in attention
delirium
stupor…then to coma
what is the key system that regulates consciousness.arousal?
reticular activating system
what excites the RAS?
sensory stimuli
what sensory stimuli activate the RAS?
somatosensory, auditory, visual, visceral
what do you rely on a lot in coma investigation?
lab data…because no history is there
what is the scale used for coma scores?
glasgow coma scores
is high or low score good in glasgow?
high is better
what are three aspects measures in glasgow coma score?
motor reactivity
verbal response
eye opening
what is difference in pupil size called?
aniscoria
how to measure pupil size?
have patient look at distant target that is big enough to avoid accomodation
name three locations where RAS neurons are located
tegmentus of brain stem
lateral hypothalamic area
medial/reticular nuclei of thalamus
what is nuchal rigidity?
when ask patient to take chin to neck and they are not able to due to stiff neck
who gets nuchal rigidity?
patients with meningitis
if patient has altered mental status with fever, what do they most likely have>
infectious cause
are pupils supposed to be larger or smaller in dark?
large in dark, small in light
a parasympathetic pupil issue leads to what problem?
greater anisocoria in bright light..due to larger pupil not constricting
a sympathetic pupil issue leads to what problem with pupillary change?
greater anisocoria in dark because smaller pupil not dilating
does sympathetic pupil issue have more problem anisocoria in light or dark?
dark
does parasympathetic pupil issue have more problem anisocoria in light or dark?
light
if pupils are reactive to light but way too small, what is issue?
opioid intoxication
if a pupil is large and unreactive to light, what is issue?
parasympathetic problem…due to CN III palsy
if a pupil is small and unreactive to dark, what is issue?
horners syndrome
what are the supranuclear eye movements?
eye movements toward object, voluntary eye movement
what are nuclear eye movements?
brainstem controlled eye movements
what are infranuclear eye movements?
peripheral nerve/NMJ/muscle issue related movements
where is final common pathway for horizontal eye movement?
Pons
where are vertical eye movements pathway from?
midbrain
what three things should be given to comatose patients immdiately?
naloxone
thiamine
glucose
what is a common metabolic cause of coma?
hyperglycemis
what is a common OD cause of coma?
opioid
is arousal present in coma?
no
is arousal present in vegetative state?
yes
is arousal present in minimally conscious state?
yes
is arousal present in locked in syndrome?
yes
is sleep wake cycle present in coma?
no
is sleep wake cycle present in vegetativ state, minimally conscious state and locked in syndrome?
yes
is awareness present in coma?
no
is awareness present in vegetative state?
no
is awareness present in minimally conscious state?
barely
is awareness present in locked in state?
yes
is motor fxn present in coma?
reflexes only
is motor fxn present in vegetative state?
only postures or withdrawal to noxious stimuli
is motor fxn present in minimally conscious state?
response to noxious stimuli and reaching, inconsistent command following
is motor fxn present in locked in syndrome?
nothing
is visual fxn preserved in coma?
no
is visual fxn preserved in vegetative state?
brief visual fixation
is visual fxn preserved in minimally conscious state?
sustained visual fixation or pursuit
is visual fxn preserved in locked in syndrome?
totally
is communication preserved in coma?
no
is communication preserved in vegetative state?
no
is communication preserved in minimally conscious state?
in/consistent vocalization with intelligible convo
is communication preserved in locked in syndrome?
NO
is emotion preserved in coma?
no
is emotion preserved in vegetative state?
no..or just crying
is emotion preserved in minimally conscious state?
crying and smiling
is emotion preserved in locked in syndrome?
totally
what is locked in syndrome caused by
bilateral ventral lesion of pons…lose corticobulbar and corticospinal tracts, but not the RAS
what must temperature be in brain death?
normal body temp
can you have electrolyte/acid base imbalance in brain death?
NO
can you have drugs to be clarified brain dead?
no
can you have motor response in brain death?
no
can you have brainstem reflexes in brain death?
no
