IV- The Examination of the Unconscious Patient Flashcards

1
Q

● 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

A

Coma

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2
Q

● 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

A

RETICULAR ACTIVATING SYSTEM (RAS)

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3
Q

RAS FUNCTION

A

● Activates cortex with gives us wakefulness
● Melatonin shuts down RAS for sleep to occur

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4
Q

CAUSES OF COMA

A
  1. Bilateral Cortical Damage
  2. Destruction of the RAS
  3. Increased Intercranial Pressure
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5
Q

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

A

Glasgow coma scale

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6
Q

5 ASPECTS TO LOOK AT WHEN EXAMINING
UNCONSCIOUS PATIENT:

A

A. Level of sensorium
B. Breathing patterns
C. Pupillary reactions
D. Eye movements
E. Motor response

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7
Q

B. BREATHING PATTERNS

A
  1. Cheyne Strokes (bilateral/diencephalon cortex)
  2. Central neurogenic hyperventilation (upper pons)
  3. Apneustic (lower pons)
  4. Biots/ataxic (upper medulla)
  5. Apnea (lower medulla)
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8
Q

● 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

A

cheyne strokes (diencephalon/ bilateral cortex)

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9
Q

● Continuous hyperventilation
● Distinguish this from tachypnea or dyspnea
(difficulty in breathing = rapid, shallow breathing)
● CNH – continuous rapid, deep breathing

A

Central Neurogenic Hyperventilation (upper pons)

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10
Q

● Long periods of apnea (no breathing) before the
next inspiratory pattern
● Long gap between each breath

A

Apneustic (lower pons)

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11
Q

● Lose all patterns of breathing
● No pattern – irregular breathing
● E.g., inhale exhale exhale

A

Biots/Ataxic (upper medulla)

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12
Q

Absence of Breathing

A

Apnea (lower medulla)

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