III- Coma and Intracranial Pressure Flashcards
● Greatest danger in neurologic disease
increased intracranial pressure
PROGRESSION OF INCREASED ICP
- Headache – very early sign
- Vomiting – progression; ICP is worsening
- Decrease sensorium
- Herniation
- Brain death
EARLY SIGNS OF INCREASING INTRACRANIAL PRESURE:
● Cushing’s phenomenon
o Can occur before other clinical signs of ICP occur
o ↑ ICP = ↑ BP + ↓ HR
LEVEL OF SENSORIUM (FROM HIGH TO LOW)
- Alert/Awake
- Drowsy, Lethargic
- Stupor
- Coma or Unconscious
(highest level of sensorium) – eyes
open spontaneously
awake/alert
eyes open to verbal stimulation
or light touch
drowsy/lethargic
eye opening to pain stimuli
stupor
no eye opening no matter
what stimulus (has different levels:)
unconscious/coma
when you give a pain stimulus, px can locate the
stimulus and try to remove it
Purposeful withdrawal to pain (lightest coma)
try to move
but cannot locate where the pain stimulus is given
Non-purposeful withdrawal to pain
flexion response of UE and
LE extension
Decorticate posturing
extensor response where
UE are extended
Decerebrate posturing
no movement when you
stimulate the px
Unresponsive coma
pressure of all the substances inside the
cranium (skull)
Intercranial Pressure
amount of blood that goes up
to the brain
Cerebral blood flow
How many mL of blood enters the brain in every minute?
700 mL