IV- The Examination of the Unconscious Patient Flashcards
● Often used to describe unconscious patients
● State wherein the patient who appears to be asleep
and is at the same time incapable of being aroused
by external stimuli and inner needs
Coma
● Located in the tegmentum of the midbrain and pons
● Responsible for wakefulness
● Activates the cortex
● Asking someone if they are awake: are you in full
cortical function right now
o Awake when cortex is fully functioning
RETICULAR ACTIVATING SYSTEM (RAS)
RAS FUNCTION
● Activates cortex with gives us wakefulness
● Melatonin shuts down RAS for sleep to occur
CAUSES OF COMA
- Bilateral Cortical Damage
- Destruction of the RAS
- Increased Intercranial Pressure
a scale that has a nice way to look at the level of sensorium but it is
not enough to tell the type of damage seen on the
brain
Glasgow coma scale
5 ASPECTS TO LOOK AT WHEN EXAMINING
UNCONSCIOUS PATIENT:
A. Level of sensorium
B. Breathing patterns
C. Pupillary reactions
D. Eye movements
E. Motor response
B. BREATHING PATTERNS
- Cheyne Strokes (bilateral/diencephalon cortex)
- Central neurogenic hyperventilation (upper pons)
- Apneustic (lower pons)
- Biots/ataxic (upper medulla)
- Apnea (lower medulla)
● Periods of hyperventilation followed by
hypoventilation (alternating periods)
● Damage to diencephalon and bilateral cortex =
become very sensitive to rises and drops of carbon
dioxide
● Greatest stimulus to breathing is increased CO2
levels
cheyne strokes (diencephalon/ bilateral cortex)
● Continuous hyperventilation
● Distinguish this from tachypnea or dyspnea
(difficulty in breathing = rapid, shallow breathing)
● CNH – continuous rapid, deep breathing
Central Neurogenic Hyperventilation (upper pons)
● Long periods of apnea (no breathing) before the
next inspiratory pattern
● Long gap between each breath
Apneustic (lower pons)
● Lose all patterns of breathing
● No pattern – irregular breathing
● E.g., inhale exhale exhale
Biots/Ataxic (upper medulla)
Absence of Breathing
Apnea (lower medulla)