Coma, persistant vegetive state, brain death Flashcards
What is a coma?
“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”
What is the gcs fior cima?
less than or equal to 8
2 or less for visual or and verbal
4 or less for motor
What does consciousness depend on?
working cerebral cortex AND ascending reticular activating system
What are teh common cuases of a reduce gcs?
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
PAttterns of breathing: decreased/increased/fluctuating meaning
Increased = hypoxia/hypercapnia/acidosis
Decreased = likely drug induced/overdose/metabolic issues
Fluctuating =brainstem involvement/issues
Other than ABC what do you need to look for?
continue!!
D - disability (and Dont forget Glucose!)
-glucose,biochem, haematology, blood gas, toxicity.
Check for meningitis!
Establish baseline bp, pukse, temp
What neurological assesments would you do?
GCS, Brainstem, Motor and reflexes
How do you test brainstem function?
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
)
How can you test ofr motor function?
Motor response
Muscle tone
Tendon reflexes
Seizures
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
What is locked in syndrome?
When below cranial nerve 3 is all cut off. Can move eyes up and down but not much more than that
What do you need to do if they are in a coma?
Maintain vital functions , skin, bladder and bowl, control siezures, prophylaxis dvt, consider locked in syndrome
What is GCS scoring: eyes
Verbak response
Motor response
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