comas

Question 1

Coma is the absence of ________

Answer 1

consciousness (awareness)

Question 2

What is consciousness

Answer 2

The state of being awake and aware of one’s surroundings.

The awareness or perception of something by a person.

Question 3

consciousness requires the hard drive: _____ and the “on” switch ____

Answer 3

hard drive = at least 1 cerebral hemisphere

functional on switch = reticular activating system

Question 4

The cortex & the mesencephalic reticular activating system are __________ areas

Answer 4

mutually sustaining! you must have one to have the other working

Question 5

delirium

Answer 5

rapid decline in attention and arousal

Question 6

stupor

Answer 6

unresponsive and minimal arousal

Question 7

coma

Answer 7

unresponsive and absent arousal

Question 8

Plays central role in regulation of the state of consciousness and arousal

Answer 8

reticular activating system RAS

Question 9

neurons of the reticular activating system are located in

Answer 9

tegmentem of brain stem, lateral hypothalamic area, thalamus, some axons are projected to the cerebral cortex

Question 10

don’t memorize causes of coma so much as to think

Answer 10

mechanism of action

Question 11

mechanisms of action of coma

Answer 11

• anatomical lesions

- diffuse processes affecting all systems (toxic, metabolic, infection, hypoxia)

Question 12

worst score of Glascow coma exam

Answer 12

3

Question 13

we can access cranial nerve function in coma patients through these findings

Answer 13

pupils, fundi, EOMS, corneal reflex, gag reflex

Question 14

anisocoria

Answer 14

difference in pupil size

Question 15

are you awake if you are herniating

Answer 15

no

Question 16

PEARLA

Answer 16

Pupils Equal And Round, Reactive to Light and Accommodation

Question 17

Parasympathetic pupil problem characterized by

Answer 17

Greater anisocoria in bright light + larger pupil is not constricting

Question 18

Parasympathetic pupil problem examples

Answer 18

• Adie’s tonic pupil
• cranial nerve 3 palsy
• pharmacologic dilatiation

Question 19

Sympathetic pupil problem characterized by

Answer 19

Greater anisocoria in the dark + smaller pupil not dilating

Question 20

examples of sympathetic pupil problem

Answer 20

horners, Argyll-Robertson pupils

Pharmacologic constriction

Question 21

Decorticate coma position

Answer 21

arms are to the core

Question 22

lesion if person is in decorticate posture

Answer 22

Posturing- lesion above the red nucleus

Question 23

Decerebrate posturing

Answer 23

arms are outstretched and flexed outwards. legs extended.

Question 24

lesion in decerebrate

Answer 24

below red nucleus

Question 25

One situation in which it can appear as if someone is in a coma, but they actually have normal attention and arousal is the _____

Answer 25

“the locked in syndrome”

Question 26

variables that determine brain death

Answer 26

\+ Normal temperature
\+ No electrolyte or acid base disturbance
\+ No drugs
\+ No motor response
\+ No brainstem reflexes
\+ Apnea
\+/- EEG 
electrocerebral silence
\+/- Cerebral Angio; TCD
Nuclear scan.

Question 27

coma can be caused by______ and ___ insults to hemispheres and/or RAS

Answer 27

FOCAL

diffuse

Question 28

pharmacological treatment of a coma

Answer 28

naloxone, glucose and thiamine