Coma, Persistent Vegetative State, Brain Death Flashcards

1
Q

what are some features of a coma patient?

A

unrousable psychological unresponsiveness
eyes closed
no psychologically understandable response to external stimula or inner need

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2
Q

what does consciousness depend on?

A

intact ascending reticular activating system

functional cerebral cortex of BOTH hemispheres

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3
Q

what does the ascending reticular activating system do?

A

acts as the alerting or awakening element of consciousness

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4
Q

what does the cerebral cortex do with regards to consciousness?

A

determines the content of said consciousness

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5
Q

what can cause a decreased GCS score?

A

toxic/metabolic states
seizures
damage to reticular activating system
causes of raised ICP

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6
Q

what are examples of toxic/metabolic states?

A
hypoxia
hypercapnia
hypotension
drug intoxication/renal or liver failure
hypoglycaemia
ketoacidosis
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7
Q

does focal damage to part of the cortex affect conscious level?

A

no

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8
Q

what is persistent vegetative state?

A

a state in which the brainstem recovers to a considerable extent but there is no evidence of recovery of cortical function

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9
Q

what are some features of persistent vegetative state?

A

arousal and wakefullness but no regaining of awareness of purposeful behaviour of any kind

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10
Q

what is “locked in” syndrome?

A

total paralysis below the level of the third nerve nuclei

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11
Q

what are some features of locked in syndrome?

A

patient able to open, elevate and depress eyes
no horizontal eye movement
no other voluntary eye movement

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12
Q

how is locked in syndrome diagnosed?

A

recognise that patient can open eyes voluntarily and signal numerically by eye closure

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13
Q

what can cause fluctuating respiration?

A

brainstem lesion

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14
Q

what can cause depressed respiration?

A

drug OD

metabolic disturbance

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15
Q

what can cause increased respiration

A

hypoxia
hypercapnia
acidosis

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16
Q

what infection should you examine for when attempting to resuscitate a patient?

A

meningitis - treat on suspicion

17
Q

what should you establish when attempting to resuscitate a patient?

A
baseline BP
pulse
temperature
IV access
stabilise neck also
18
Q

how is a coma neurologically assessed?

A

using:
GCS
brainstem function
motor function and reflexes

19
Q

what GCS score would classify a patient as being in a coma?

A

less than or equal to 8

20
Q

what can cause a coma without focal or lateralising signs and without meningism?

A
ischaemic conditions
metabolic disturbance
intoxications
systemic infections
epilepsy
hyper/hypo thermia
21
Q

what investigations are appropriate for assessing coma patients?

A
toxicology screen
measure blood sugar and electrolytes
assess hepatic and renal function
measure BP
acid - base assessment and blood gases
CT head
Lumbar puncture
22
Q

what should you consider in a patient who is in a coma without focal or lateralising signs but with meningism?

A

subarachnoid haemorrhage
meningitis
encephalitis

23
Q

what can cause a coma WITH focal brainstem or lateralising cerebral signs

A

cerebral tumour
cerebral haemorrhage
cerebral infarction
cerebral abscess

24
Q

what investigations are obligatory in coma WITH focal brainstem or lateralising cerebral signs?

A

CT or MRI

25
Q

if CT or MRI are not diagnostic in come WITH signs then what investigations can be used to try and determine the cause of the coma?

A

metabolic screens
lumbar puncture
EEG

26
Q

what are the most common causes of coma lasting more than 5 hours?

A

40% drug ingestion with or without alchohol
25% due to hypoxia
20% due to cerebrovascular event
15% metabolic

27
Q

what are some factors that can help predict the outcome of a coma?

A
age
cause of coma
depth of coma
duration of coma
certain clinical signs such as brain stem reflexes
28
Q

what is important in continuing care of patients in a coma?

A
maintenance of vital functions
care of skin
attention to bladder and bowel function
control of seizures
prophylaxis of DVT and peptic ulceration
prevention of contractures
consider "locked in" syndrome
29
Q

what shape does a subdural haematoma take on CT?

A

ellipse shape/convex

30
Q

what shape does an extradural haematoma take on a CT?

A

concave

31
Q

how do you manage a head inury?

A
stabilise C spine
ABC
if GCS < 8 intubation and ventilation
treat raised ICP
neuro obs