Coma, Persistent Vegetative State, Brain Death Flashcards
What is a coma?
A state of unarousable psychological unresponsiveness in which the subjects lie with eyes closed and show no psychologically understandable response to external stimulus or inner need
What is used to assess a coma?
Glasgow coma scale (GCS)
What does GCS stand for?
Glasgow coma scale
What are the 3 responses assesses in the GCS?
Eye opening response
Verbal response
Motor response
Describe the scores for the eye opening response part of the GCS?
Describe the scores for the verbal response part of the GCS?
Describe the scores for the motor response part of the GCS?
What are the 3 classes of injury from the GCS?
Minor brain injury
Moderate brain injury
Severe brain injury
What points on GCS is minor brain injury?
13-15
What points on GCS is moderate brain injury?
9-12
What points on GCS is severe brain injury?
3-8 points
What does consciousness depend on?
- Intact ascending reticular activating system to act on the alerting or awakening element of consciousness
- (arousal)
- A functioning cerebral cortex of both hemispheres which determines the content of that consciousness
- (awareness of environment)
What are some causes of decreased 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 (epidural haemorrhage), SDH (subdural haemorrhage), SAH (subarachnoid haemorrhage), hydrocephalus
What are some causes of raised ICP?
- Tumour, stroke, EDH (epidural haemorrhage), SDH (subdural haemorrhage), SAH (subarachnoid haemorrhage), hydrocephalus
What can cause toxic/metabolic stress and lead to decrease in GCS?
- Hypoxia/hypercapnia/sepsis/hypotension
- Drug intoxication/renal or liver failure
- Hypoglycaemia, ketoacidosis
What can increased respiration be due to?
Hypoxia
Hypercapnia
Acidosis
What can depressed respiration be due to?
Drug overdose
Metabolic disturbance
What can fluctuating respiration be due to?
Brainstem lesion
What blood samples should be done for patients who go into a coma?
- Glucose, biochemistry, haematology, blood gas
- Toxicology