Consciousness Flashcards
What is consciousness?
State of wakefulness & awareness of self + environment
What is it called when you have a aroused from sleep cycle, have eyes open and motor activity?
Wakefulness
What is the feeling of “I am” and subjective experience called?
Awareness
What is a state of unrousable responsiveness?
Coma
What is a coma-like state that has some but very little responsiveness?
Stupor
What is acute, cyclical pattern of confusion called?
Delirium
What is abnormally slowed thinking called?
Obtundation
What four things constitutes consciousness?
Brain arousal / activation
Connected thought patterns
Ability to sense sensory inputs
Ability to effect controlled outputs
What is the sense of the internal state of the body called?
Interoception
Where is the interoception sense located in the brain?
Anterior Insular Cortex
Which neurons facilitate interoception?
von Economo neurons
What is the definition of a coma?
A depressed level of consciousness resulting in an unresponsive P who cannot be awakened with pain - that lasts for MORE THAN 6 HOURS
Do Ps have a normal sleep-wake cycle in a coma?
No
Do Ps respond to painful stimuli, light or sound in a coma?
No
How are the P’s eyes in a coma
May get blink response to visual threat & pupillary reactions
When moving P’s head, eyes may stay fixed on a stationary object (Doll’s head manoeuvre positive).
Which two groups commonly cause impaired consciousness?
Neurological causes
Metabolic causes
What are the commonest neurological causes of impaired consciousness?
Trauma
Cerebrovascular
Infection (esp meningitis)
What are the commonest metabolic causes of impaired consciousness?
Hypoglycaemia
Hypoxia
Drugs & toxins
Which test of consciousness is often used with dementia Ps?
4A’s Test (4AT)
What is the GCS?
Glasgow Coma Scale
What is the AVPU and how does it work?
Alert
Visual
Pain
Unresponsive
Which response on this scale that Ps respond to
What is the RASS?
Richmond Agitation Sedation Scale
What do we look at when assessing a P’s consciousness?
Sensori-motor stimulus and responses inc
- Eyes
- Verbal
- Protective movements and postures
- Spontaneous and voluntary movements
- Voice
Which three things are assessed by the GCS?
Eye Opening (1 none, 4 spontaneous)
Best verbal response (1 none, 5 - orientated)
Best motor response (1 no movement, 6 - obeys commands)
What is the lowest score a P can have on the GCS?
3
What is localising pain in a P?
Patient can recognise where the pain is, localise and try to push you away from the pain
When Ps move their limb in an abnormal way - by rotating or extending in response to pain - what does this indicate?
That the higher parts of the brain are not functioning
Why do we use these tools?
To determine which Ps may need protection of airway & determine which are at risk of complications
What is the score on the GCS at which Ps cannot protect their airway?
< 8
How is GCS correlated to outcome in brain injury?
Score on GCS can be linked to the successfulness of an outcome for Ps with a brain injury,
Name 3 questionnaires used to measure cognitive impairment
Mini Mental State Examination (MMSE)
Confusion Assessment Method (CAM)
4 A’s Test (4AT)
Name three types of confusion
Hyperactive
Hypoactive
Mixed
How can you determine delirium from dementia?
Delirium - acute & fluctuates
Demential - chronic, steady progression
What is a transient loss of consciousness called?
Blackout (or syncope)
What is syncope usually caused by?
Cardiovascular causes
What are the three causes of blackout?
Syncope
Epilepsy
Hypoglycaemia
What is it important to treat blackouts caused by hypoglycaemia?
The brain has no store of glycogen = therefore important to treat this.
What is it important to ask in the history about what happened prior to the blackout episode?
- Did it follow a change in posture / position
- Did it follow an activity
- Did they have an aura
- Did they have chest symptoms
- Do they remember falling? (Yes - blackout can be due to head injury, no - unconscious before they hit the floor)
What symptoms are important during a blackout?
Duration
Seizures?
Urinary incontinence?
Tongue biting?
Pale?
Flushing?
Pulse?
BP? BG?
What are risk factors for blackout?
Past medical history
Drugs
