Comas Flashcards
what is a coma?
a state of unrousable psychological unresponsiveness in which the subjects lie with eyes closed and show no psychologically understandable response to external stimulus
what are the 3 components of the Glasgow Coma Scale?
eye opening, best verbal response and best motor response
how is eye opening scored?
spontaneous=4, to speech=3, to pain=2, none=1
how is best verbal response scored?
orientated=5, confused=4, inappropriate words=3, incomprehensible sounds=2, none=1
how is best motor response scored?
obeying commands=6, localising to pain=5, withdrawing from pain=4, flexing to pain=3, extending to pain=2, none=1
what score of GCS means someone is in a coma?
<=8 with eye opening 2 or less, verbal response 2 or less and motor response 4 or less
what does consciousness depend on?
an intact ascending reticular activating system to act as the alerting or awakening element of consciousness and a functioning cerebral cortex of both hemispheres which determines the content of that consciousness
what are possible causes of decreased GCS?
toxic/metabolic states, seizures, damage to reticular activating system, causes of raised ICP
what is included in a neurological assessment for a coma?
GCS, brainstem function, motor function and reflexes
what is ‘locked-in’ syndrome?
patient has total paralysis below the level of the 3rd nerve nuclei and although able to open, elevate and depress the eyes, has no horizontal eye movements and no other voluntary eye movements
how do we care for a patient in a coma?
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
how is raised ICP treated?
surgery to relieve pressure, osmotic agents, nurse with head at 30-40 depresses to aid venous return, reduce pain and maintain good PO2, reduce PCO2 and reduce metabolisms
