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Pt Assess II Final > Evaluation of Comatose Patient Lecture > Flashcards

Evaluation of Comatose Patient Lecture Flashcards

1
Q

If a patient is conscious and responsive, how should you objectively describe them?

A

Awake, alert and appropriate

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2
Q

If a patient is unresponsive, how should you report/describe this?

A

Report how they respond to various stimuli starting with the LEAST invasive

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3
Q

Describe verbal stimuli of an unconscious patient

A
  • Start by calling pt’s name
  • Describe how they respond
  • See if they can follow commands (stick out your tongue, open your eyes)
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4
Q

Which verbal commands are easiest to follow?

A

Midline commands

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5
Q

What are examples of midline commands?

A

Stick out your tongue

Open your eyes

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6
Q

If a patient can follow midline commands, what should be tried next?

A

Peripheral commands

lift your R hand, squeeze my finger

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7
Q

What are examples of peripheral commands?

A

Lift your R hand

Squeeze my finger

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8
Q

Example of a complex or 2 step command?

A

Squeeze your eyes shut and hold up 2 fingers

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9
Q

Stimuli from least invasive to most invasive for unconscious patient

A
  • Visual
  • Verbal
  • Tactile
  • Noxious (painful)
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10
Q

Describe tactile stimuli

A
  • Tapping pt on shoulder or chest

- More invasive than verbal stimuli

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11
Q

Describe noxious stimuli and how they can be delivered

A
  • More invasive than verbal or tactile stimuli
  • Pressure on base of nailbed
  • Pressure on superior aspect of orbit
  • Nipple tweak/pinch
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12
Q

Possible patient responses to noxious stimuli?

A
  1. Appropriate (moves to push stimulus away)
  2. Moan/move without purpose
  3. Posturing
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13
Q

Types of posturing responses to noxious stimuli

A
  1. Decorticate

2. Decerebrate

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14
Q

What is decorticate posturing?

A
  • Flexor rigidity w/adduction of shoulder, flexion of elbow/wrists/fingers
  • IR of legs w/plantar flexion of feet
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15
Q

What does decorticate posturing indicate?

A

Destructive lesion in cerebral hemispheres at or near level of corticospinal tracts

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16
Q

What is decerebrate posturing?

A
  • Extensor rigidity w/adduction of shoulder, extension of elbow
  • Pronated wrists, flexed fingers
  • Legs extended, foot plantar flexed
17
Q

What does decerebrate posturing indicate?

A

Brainstem level lesion usually in pons or midbrain

18
Q

Is posturing unilateral or bilateral?

A

Could be either

19
Q

Which posturing carries a worse prognosis?

A

Decerebrate

20
Q

Poorest prognostic indicator to noxious stimuli?

A

Unresponsive

worse than posturing

21
Q

Describe CN exam of comatose patient

A

LIMITED

  • 3/4/6 tested for “dolls eyes” and pupillary response
  • 5 and 7 tested by corneal reflex
22
Q

DTRs of comatose patient

A
  • Can be tested but not very helpful in a profoundly comatose pt
  • Can be found even in brain dead pts
23
Q

Describe “dolls eyes” test

A
  • Tests for oculocephalic reflex (CN 3/4/6) in comatose patient
  • Rapidly turn head to right and then left
  • Pt should maintain gaze straight ahead or toward contralateral side despite head movement (dolls eyes present)
  • If you get no response, this is absent Dolls eyes
24
Q

CN 3 palsy in Dolls eye test

A

Affected eye will move laterally but NOT medially with Dolls maneuver

25
Q

CN 6 palsy in Dolls eye test

A

Eye will move medially but NOT laterally

26
Q

Doll’s eyes test should NOT be performed in which patients?

A

Possible cervical fractures or responsive/awake patient

27
Q

Motor, sensory, cerebellar testing of comatose patient

A

CANNOT be done

28
Q

Describe Glasgow coma scale

A
  • Method to quantitatively assess comatose patient

- Scored based on motor, verbal, and eye opening responses

29
Q

Describe GCS scores

A
  • Lower score is worse prognosis
  • Pts w/initial score of 3-4 have 95% chance of dying or remaining in vegetative state
  • Pts w/score of 3-8 are considered comatose
30
Q

What GCS scores are considered “comatose”?

A

3-8

Pt Assess II Final (17 decks)

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