How to Assess Unconscious Flashcards
What is GCS and how is it used?
- Range 3-15
- 3 = dead
- 8 or less = coma
- Mild (14-15)
- Moderate (9-13)
- Severe (3-8)
How is eye opening assessed in GCS?
- Spontaneously
- Verbal stimuli
- Painful stimuli
- No eye opening
How is verbal response assessed in GCS?
- Orientated
- Confused
- Inappropriate words
- Incomprehensible
- No verbal response
How is motor response assessed in GCS?
- Obeys commands
- Localizes pain
- Withdraws to pain
- Flexion to pain
- Extension to pain
- No motor response
What are the causes of coma without primary neurological cause?
Hypoglycaemia, drugs, alcohol
What are the causes of coma with primary neurological case?
Tumours, infarction, haemorrhage
What is normal ICP?
5-15 mmHg
What are the intracranial cotents?
Tissue vol
CSF vol
Blood vol
What is the Monro-Kellie hypothesis?
Autoregulation of contents until you can no longer compensate for increase in
What are the consequences of intracranial hypertension?
Brain herniation = displacement of part of brain through opening or across separating structures into region it doesn’t normally occupy
How is intracranial hypertenison recognised?
- Cushings triad: hypertension, bradycardia + irregular respiration
- Headache, vomiting, dolls eye, blown pupil, papilledema
How is a coma managed?
- ABCDE = airway, breathing, circulation, disability, exposure
- History + exam
How is airway assessed?
- Partially obstructed? - snoring, gargling, SpO2 88%
- Airway opening manoeuvres: 1. Chin lift 2. Jaw thrust
- Use of Guedel
How is breathing assessed?
- SpO2: 88%
- RR: 24 b/min
- Trachea: central
- Breath sounds: vesicular
Intervention =
- Mask with reservoir bag
- O2 15 L/min
- Target SpO2: 94-98%
How is circulation assessed?
- Capillary refill: 2 secs
- Pulse: 50 b/min
- BP 150/10
- No JVP
How is disability assessed?
- AVPU: unresponsive GCS 3/15
- Left pupil dilated + fixed
- BM: 4
How is exposure assessed?
- Boggy swelling on left side of head
- Clear fluid leaking out of left ear
What is invasive monitoring of ICP used for?
- Early identifying increased pressure
- Quantify elevation
- Initiate treatment
- Access to CSF for sampling + drainage
- Evaluate effectiveness of treatment
How is cerebral oedema decreased?
- Osmotic diuretics (mannitol)
- Corticosteroids in brain tumour (dexamethasone)
How do we maintain cerebral perfusion?
- CPP = MAP - ICP
- Manipulate CO
- Inotropic e.g. dobutamine
- Normal CPP = 80
How do we lower volume of CSF and cerebral blood?
Ventriculostomy
How is oxygenation maintained?
- ABG monitoring
- Optimising Hb sat
How are metabolic demands reduced?
- High doses barbiturates when patient unresponsive
- Pharmacological paralysing agents
How is hyperventilation managed?
- Monitor PaCO2
- Reduce ICP
