Coma, persistant vegetive state, brain death Flashcards

1
Q

What is a coma?

A

“A state of unrousable psychological unresponsiveness in which the subjects lie with eyes closed and show no psychologically understandable response to external stimulus or inner need”

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2
Q

What is the gcs fior cima?

A

less than or equal to 8

2 or less for visual or and verbal

4 or less for motor

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3
Q

What does consciousness depend on?

A

working cerebral cortex AND ascending reticular activating system

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4
Q

What are teh common cuases of a reduce gcs?

A

Toxic/metabolic states:
-Hypoxia/hypercapnia/sepsis/hypotension
-Drug intoxication/renal or liver failure
-Hypoglycaemia, ketoacidosis

Seizures

Damage to reticular activating system

Causes of raised intracranial pressure:
tumour, stroke, EDH, SDH, SAH, hydrocephalus

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5
Q

PAttterns of breathing: decreased/increased/fluctuating meaning

A

Increased = hypoxia/hypercapnia/acidosis

Decreased = likely drug induced/overdose/metabolic issues

Fluctuating =brainstem involvement/issues

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6
Q

Other than ABC what do you need to look for?

A

continue!!
D - disability (and Dont forget Glucose!)

-glucose,biochem, haematology, blood gas, toxicity.

Check for meningitis!

Establish baseline bp, pukse, temp

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7
Q

What neurological assesments would you do?

A

GCS, Brainstem, Motor and reflexes

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8
Q

How do you test brainstem function?

A

Several tests:

Pupillary responce (II and III)
Corneal responses (V+VII)
Spontaneous eye movement (III,IV, VI)
Oculocephalic responses (Doll’s eye) (III, IV, VI, VIII)
Oculovestibular responses (III, IV, VI, VIII)
Respiratory pattern (Medullary centre
)

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9
Q

How can you test ofr motor function?

A

Motor response
Muscle tone
Tendon reflexes
Seizures

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10
Q

SEE ANKI (given up lol - there is a few more tho - rejuvinated by lots of unhealthy food - 3 slices of pie, cake, cream and nutella crumpet

A
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11
Q

What is locked in syndrome?

A

When below cranial nerve 3 is all cut off. Can move eyes up and down but not much more than that

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12
Q

What do you need to do if they are in a coma?

A

Maintain vital functions , skin, bladder and bowl, control siezures, prophylaxis dvt, consider locked in syndrome

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13
Q

What is GCS scoring: eyes
Verbak response
Motor response

A

Eyes 4
1 = none
2 = pain
3 = speech
4 = spontaneous (open)

Verbal (5)
1= none
2 = incomprehensible sounds
3 = inappropriate words
4 = confused
5 = orientated

Motor (6)
1 = none
2= extends to pain
3 = flexes to pain
4 = withdrawing from pain
5 = localising to pain
6 = obeying commands

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