Coma, Persistent Vegetative State, Brain Death

Question 1

what is the definition of a coma?

Answer 1

a state of unrousable psychological unresponsiveness in which the subjects lie with eyes closed and show no psychologically understandable respomse to external stimulus

Question 2

what does consciousness depend on?

Answer 2

1- an intact ascending reticular activating system to act as the alerting or awakening element of consciousness

2- a functioning cerebral cortex of both hemispheres which determine the content of that consciousness

Question 3

causes of a decrease in GCS

Answer 3

siezures
damage to reticular activating system
caauses of raised intracranial pressure
toxic/metabolic states

Question 4

what are the brainstem functions?

Answer 4

pupillary reactions
corneal responses
spontaneous eye movements
oculocephalic responses
oculovestibular responses
respiratory pattern

Question 5

what are the motor functions?

Answer 5

motor response
muscle tone
tendon reflexes
seizures

Question 6

investigations of coma that has absolutely no signs?

Answer 6

toxicology screen including alcohol
meausre blood sugar and electrolytes
assess hepatic and renal function
acid- base assessement and blood gases
measure blood pressure

Question 7

coma without focal or lateralising signs but with meningism

Answer 7

subarachnoid haemorrhage
meningitis
encephalitis

Question 8

investigations of coma with meningism?

Answer 8

ct head

lumbar puncture

Question 9

coma with focal brainstem or lateralising cerebral signs?

Answer 9

cerebral tumour
cerebral haemorrhage
cerebral infarction
cerebral abscess

Question 10

investigation of coma with focal brainstem signs

Answer 10

ct

Question 11

continuing care of patients in coma?

Answer 11

maintanence of vital functions
care of skin
attention to bladder
control of seizures
prophylaxis of DVT
prevention of contractures

Question 12

head injury can lead to focal neurological signs/epilepsy due to

Answer 12

diffuse axonal injury
contusion
intracerebral haematoma
extra-cerebral haematoma

Question 13

management of head injury

Answer 13

stabalise cerbical spine
ABC
intubation
treat raised ICP

Question 14

how do you treat raised ICP?

Answer 14

surgery to relieve pressure
osmotic agents
nurse with head at 30-45%
reduce pain
maintain good PO2
reduce metabolism

Question 15

clinical features of non-epileptic attacks

Answer 15

sinusoidal tremor not jerking
pelvic thrusting
side to side head movements
eyes closed and resists opening
partial responsiveness