coma, persistent vegetative state and brain death Flashcards
Define 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 2 things does consciousness rely on
intact ascending reticular system
Functioning cerebral cortex
What is the ascending reticular activating system responsible for?
awakening and alerting element of consciousness
What is the functioning cerebral cortex responsible for?
content of that consciousness - awareness
What GCS score(s) is defined as a coma
less than 8
Causes of decreased GCS
sepsis, hypoxia, hypotension,
drug intoxication, renal failure
hypoglycaemia
seizures, damage to reticular activating system
Raised ICP eg hydrocephalus, tumour, stroke, haemorrhage
What is persistent vegetative state?
A state in which the brainstem recovers to a considerable extent but there is no evidence of recovery of cortical function
What is the locked in syndrome?
The patient has total paralysis below the level of the 3rd nerve nuclei and can open, elevate and depress eyes although no horizontal eye movement and no other voluntary movement
Give an example of when locked in syndrome could occur
Stroke in basilar artery denying pons of blood supply
Breathing - what does fluctuating breathing and depressed respiration suggest?
fluctuating - brainstem lesion
depressed - drug overdose
First resuscitation and investigation of patient
ABC
Circulation - investigations
blood - glucose, biochemistry, haematology, blood gas and toxicology
blood pressure, pulse, temperature, IV access, stabilise neck
MENINGITIS
What is always important to discount in a coma patient?
meningitis
3 types of history for coma
expected progression eg renal failure
unpredictable with no known cause
unexpected eg head injury
Some monitoring of the patient would include..
temperature respiratory and heart rate bp abdomen meningism fundal examination