Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pathologies of Neuro > Coma, PVS, Brain death > Flashcards

Coma, PVS, Brain death Flashcards

1
Q

What is a coma?

A
  • unrousable
  • psychological unresponsiveness
  • eyes closed
  • Does not respond to external/internal stimuli
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 2 factors which consciousness depends on?

A
  • Cortex for awareness of environment/ content

- Reticular ascending pathway for the awakening system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Causes for decreased consciousness

A
  • Metabolic/toxic
  • Seizures
  • Damage to reticular activating system
  • Causes for raised ICP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are examples of metabolic/toxic causes for decreased consciousness ?

A
  • Hypoxia
  • Hypercapnia
  • Drug intoxication
  • Hypoglycemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What happens during persistent vegetative state

A

Brainstem recovers but cortex does not
There is arousal and wakefulness
There is no awareness or purposeful behaviour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What happens during locked in syndrome?

A
  • Total paralysis below the third cranial nerve nuclei
  • Can elevate and depress eyes
  • Cannot move eyes horizontally
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Stages of Resuscitation

A
  • Airway
  • Breathing:
  • Hyperventilation : hypoxia, hypercapnia
  • Hypoventilation : drug overdose
  • Fluctuating: brainstem lesion

-Circulation :
Take blood samples
Establish Pulse, temperature, IV access and stabilise the neck
Examine for presence of meningitis

  • History : predictable/ unpredictable incident
  • Examination and monitoring
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What need to be monitored in resus

A
  • Temperature
  • Heart rate
  • Blood pressure
  • Respiration
  • Abdomen
  • Meningism
  • Fundal examination
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Stages of a neuroexamination in a coma patient

A
  • GCS
  • brainstem function
  • motor function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

GCS in a coma patient.

A

Less than 8
Will not open eyes in response to pain
Grunting or absent vocal response
Weak flexion in response to pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Brainstem function testing

A
  • Pupillary response
  • Corneal response
  • Spontaneous eye movements
  • Oculo-cephalic movements
  • Oculo-vestibular responses
  • Respiratory pattern
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Testing motor function

A
  • Motor response
  • Motor tone
  • Tendon reflex
  • Seizures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

3 Different types of coma

A
  • No focal laterising signs, no meningism
  • Menigism, no focal lateral signs
  • Focal laterising signs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Causes of coma with meningism

A

SAH
Meningitis
Encephalitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Investigation of coma with meningism

A 
CT scan 
Lumbar puncture:
-Apperance 
-Cell count 
-Glucose level 
-Capsular antigen tests
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Causes of coma with no signs

A 
Ischaemic/anoxic conditions 
Metabolic disturbance
Intoxication
Hyperthermia/hypothermia 
Systemic infection
Seizures
17
Q

Investigation of coma with no signs

A 
Toxicology for alcohol
Blood sugar and electrolytes 
Hepatic and renal function 
Acid-base assessment 
Blood pressure 
Carbon monoxide levels
18
Q

Causes of coma with focal laterising signs

A

Cerebral tumour
Cerebral hemorrage
Cerebral infarction
Cerebral abscess

19
Q

Investigation of coma with focal laterising signs

A

CT/MRI

If these are not diagnostic: Metabolic screens, LP, EEG

20
Q

Medical causes of a coma

A
  • Drug ingestion
  • Hypoxia e.g. following MI
  • CVS event e.g. hemorrage/infarction
  • Metabolic e.g. diabetes, renal failure
21
Q

Prognosis of a coma

A
  • Only 15% of patients in a non-traumatic coma lasting more than 6 hours will make a good- moderate recovery
  • Recovery is seen most in those whose cause way: metabolic, Hypoxic ischaemic, CVS related
  • The rest die, remain in a vegetative state or remain severely disabled
22
Q

Factors affecting the outcome of a coma

A
  • Age
  • Depth of coma
  • Cause of coma
  • Duration of come
  • Clinical signs such as brainstem reflexes
23
Q

Care of those in a coma

A
  • Maintainance of vital function
  • Care of skin
  • Attention to bladder
  • Control of seizures
  • Prophylaxis of DVT, peptic ulceration
  • Prevention of contractors
  • Look for locked- in syndrome
24
Q

Head injury consequences

A
  • Diffuse axonal injury
  • Contusion
  • Intracerebral hematoma
  • Extracerebral hematoma: extra-dural/ sub-dural
25
Q

Difference on a CT between a subdural and extra-dural hemorrage

A

Sub-dural: ellipse

Extra-dural: concave

26
Q

Management of a head injury

A 
Stabilise cervical spine 
ABC 
If GCS <8 then intubation/ventilation 
Treat ICP 
Imagining may reveal need to decompress or remove a hematoma 
Neuro-observation
27
Q

Treatment of increased ICP

A 
Surgery to relieve pressure 
Osmotic agents e.g. mannitol 
Nurse with head at 30-45 %- venous return 
Reduce pain
Maintain good PO2, reduce PCO2
Reduce metabolism

Pathologies of Neuro (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions