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Specialist Studies 2 > Coma ITU Recordings > Flashcards

Coma ITU Recordings Flashcards

1
Q

What is consciousness?

A

Awareness of self and environment, consisting of awareness and arousal

It can be tested by brainstem reflex testing and responses to command.

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2
Q

Define coma.

A

State of unconsciousness without wakefulness, characterized by lack of response to stimuli

Eyes usually closed, no awareness of self or surroundings.

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3
Q

What is the role of the reticular activating system?

A

Responsible for wakefulness, projecting to areas of the cortex responsible for awareness

Located in the mesopons.

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4
Q

What are the main disorders of consciousness?

A
  • Coma
  • Vegetative state
  • Minimally conscious state
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5
Q

Describe the vegetative state.

A

Patients are awake with sleep-wake cycle maintained but have no awareness of self or environment

Classified as persistent if lasts over 1 month and permanent if lasts longer than 6 months (non-traumatic) or 12 months (traumatic).

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6
Q

What characterizes a minimally conscious state?

A

Severely altered conscious level with behavioral manifestations present but minimal

Includes fluctuating attention and purposeful tracking motions.

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7
Q

What distinguishes locked-in syndrome from disorders of consciousness?

A

A person is conscious and aware but completely paralyzed and unable to speak

Only vertical movements of the eyeballs and blinks are retained.

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8
Q

What is anoxia/hypoxia?

A

Common cause of coma, resulting from reduced brain oxygen levels below 20mmHg

Can lead to cell dysfunction and death.

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9
Q

What are the effects of prolonged anoxic coma?

A
  • Permanent cognitive decline
  • Rigidity/Ataxia/Spasticity
  • Movement disorders
  • Persistent coma
  • Epileptic phenomena
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10
Q

What criteria confirm a diagnosis of a disorder of consciousness?

A

Extensive testing to determine wakefulness and awareness

Conducted by experienced professionals with consideration of family views.

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11
Q

Define brain death.

A

Cerebral death with no signs of cortical and brainstem functions

Confirmed by isoelectric EEG.

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12
Q

What is the significance of EEG in coma assessment?

A

EEG activity may correlate with depth of coma

Slowing of normal activities towards the delta range indicates deeper coma.

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13
Q

What are characteristics of alpha coma?

A

Normal looking rhythmical activities in the alpha range occurring in deep comatose states

Differentiated by spatial distribution and reactivity.

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14
Q

What is the prognosis associated with EEG reactivity in coma?

A

Presence of EEG reactivity to noxious stimuli is the most important prognostic factor

Mortality rates vary significantly with different causes.

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15
Q

Describe theta coma.

A

Occurs transiently with hypoxic brain damage, brainstem lesions, and some drug intoxications

Can resemble Stage II sleep.

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16
Q

What are PLEDs and their significance?

A

Periodic lateralized epileptiform discharges, indicating different outcomes based on epilepsy history

Better outcomes for known epileptics.

17
Q

What does burst suppression indicate in EEG?

A

Associated with deeper levels of coma and dire prognosis

Can be induced by therapeutic levels of barbiturates.

18
Q

What are the EEG findings in postanoxic coma?

A
  • Triphasic waves
  • Continuous epileptiform discharges
  • Burst suppression patterns
19
Q

True or False: Alpha coma is characterized by fluctuating amplitude and reactivity.

A

False

Alpha coma shows no or minor fluctuations in amplitude and no reaction to stimulation.

20
Q

What is the EEG pattern associated with metabolic comas?

A

Diffuse slow wave activity

Triphasic waves suggest a hepatic basis.

21
Q

What is a common EEG finding in deeply comatosed patients?

A

Triphasic waves

Other findings may include continuous epileptiform discharges, burst suppression patterns, and mixed alpha/theta activity.

22
Q

What does prolonged coma typically show on an EEG?

A

Diffuse slowing and FIRDA

It may also show PLEDs/BIPLEDs and intermittent suppression with bursts of spikes.

23
Q

What indicates severe prolonged diffuse cortical and subcortical insults?

A

True burst suppression

This can be spontaneous or stimulus induced.

24
Q

What is the mortality rate for patients in prolonged coma?

A

80-90%

This high mortality rate highlights the severity of prolonged comatose states.

25
Q

What is a significant predictor of outcome in comatose patients?

A

EEG reactivity

Reactivity on EEG indicates a better prognosis.

26
Q

What is an irreversible sign of severe brain damage on an EEG?

A

Flatline EEG

This indicates an irreversible depolarization of the membrane potential.

27
Q

What is the major determinant of outcome in coma?

A

Duration of anoxia

The duration of CPR is also an important factor.

28
Q

What EEG features indicate a favorable prognosis?

A
  • Reactions to exogenous stimulation
  • Normal looking sleep potentials/sleep cycles
  • Normal looking sleep spindles

Improvement in EEG over serial recordings is also a favorable sign.

29
Q

What are signs of poor outcome on EEG?

A
  • Burst suppression
  • Unreactive high voltage delta activity
  • Absence of reactivity
  • Absence of spindles

These signs are associated with a poor prognosis.

30
Q

What is the Synek Score Grade 1 EEG pattern?

A

Dominant reactive alpha activity with some theta activity

This indicates a reactive pattern.

31
Q

What is the Synek Score Grade 5 EEG pattern?

A

Isoelectric

This indicates a non-reactive pattern.

32
Q

What should be recorded in an Intensive Therapy Unit (ITU) during an EEG?

A
  • Patient confirmation off sedation
  • Decontamination of the machine
  • Full head of electrodes with impedances below 5KOhm

ECG and other useful polygraphy should also be applied.

33
Q

What minimum recording duration is recommended for EEG?

A

20 minutes

This duration helps in capturing significant EEG activity.

34
Q

What types of stimulation should be used to assess EEG reactivity?

A
  • Auditory stimulation (name calling)
  • Bilateral hand clapping
  • Noxious stimulation (nailbed squeeze)
  • Sternal rub

Passive eye opening can also be used.

35
Q

What should be done to reduce artifacts in EEG recordings?

A
  • Ensure impedances below 5KΩ
  • Keep leads lying in the same direction
  • Turn off unnecessary equipment

Polygraphy can also help identify and confirm artifacts.

36
Q

True or False: Most comas lasting a few hours result in complete recovery.

A

True

Comas lasting longer than 2-3 days rarely result in complete recovery.

Specialist Studies 2 (10 decks)

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