Coma, Persistive Vegetative State and Brain Death Flashcards
What are the causes of a decreased GCS?
Toxic/metabolic states- hypoxia, hypercapnia, sepsis, hypotension, drug intoxication, renal/liver failure, hypoglycaemia, ketoacidosis
Seizures
Damage to reticular activating system
Raised intracranial pressure
What is persistent vegetative state?
A state in which the brain stem recovers to a considerable extent but there is no evidence of recovery of cortical function
(arousal and wakefulness but no purposeful behaviour)
What is “locked-in” syndrome?
Total paralysis below third nerve nuclei so can open and elevate/depress eyes but cannot move eyes in any other fashion
Consciousness is still present
How can coma be assess neurologically?
GCS
Brainstem function
Motor function and reflexes
At what GCS is a patient considered unconscious?
Eight or below
What are the causes of coma without focal or lateralising signs and without meningism?
Anoxic/ischaemic conditions Metabolic disturbances Intoxications Systemic infections Hyperthermia/hypothermia Epilepsy
How can comas without focal or lateralising signs and without meningism be investigated?
Toxicology including alcohol level Measure blood glucose and electrolytes Assess hepatic function and renal function Acid-base assessment and blood gases Measure blood pressure Consider carbon monoxide poisoning
What are the causes of coma without focal or lateralising signs but with meningism?
Subarachnoid haemorrhage
Meningitis
Encephalitis
How can comas without focal or lateralising signs and with meningism be investigated?
CT head scan
Lumbar puncture
What are the causes of comas with focal or lateralising signs?
Cerebral tumour
Cerebral haemorrhage
Cerebral infarction
Cerebral abscess
How are comas with focal or lateralising signs investigated?
CT or MRI obligatory
If not diagnostic- metabolic screens, lumbar puncture, EEG
What factors affect the outcome of a coma?
Age Cause of coma Depth of coma Duration of coma Clinical signs such as brain stem reflexes
What care is given to patients in comas?
Maintenance of vital functions Care of skin, avoidance of pressure sores Attention to bladder and bowel function Control of seizures Prophylaxis of DVT and peptic ulceration Prevention of contractures Consider "locked-in" syndrome
