Management of the Unconscious Patient Flashcards

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1
Q

What is a rapid assessment tool for consciousness?

A

“AVPU” mnemonic

  • A = alert
  • V = (response to) verbal stimuli
  • P = (response to) painful stimuli
  • U = unresponsive
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2
Q

What is the Glasgow coma scale designed for?

A

Blunt head trauma

Not prognostic for non-traumatic LoC

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3
Q

What does the Glasgow coma scale do?

A

Gross estimate of cerebral function

Point estimate less specific than change over time > falling GCS mandates investigation and intervention

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4
Q

What are the categories for the Glasgow coma scale?

A

Eye opening
Best verbal response
Best motor response

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5
Q

What is the scale for eye opening?

A
4 = spontaneous
3 = to verbal command
2 = to pain
1 = nil
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6
Q

What is the scale for best verbal response?

A
5 = orientated
4 = confused
3 = uses inappropriate words
2 = incomprehensible
1 = nil
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7
Q

What is the scale for best motor response?

A
6 = obeys commands
5 = localises to pain
4 = withdraws to pain
3 = abnormal flexion to pain
2 = abnormal extension to pain
1 = no response
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8
Q

What does abnormal flexion to pain mean?

A

Press on finger > flex wrists and arms

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9
Q

What does abnormal extension to pain mean?

A

Press on finger > extend arms and wrists

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10
Q

At what GCS score would a person be intubated in a trauma situation?

A

10 or less

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11
Q

What are the differential diagnoses for an unresponsive dilated pupil in a trauma setting?

A

Direct ocular trauma

Ipsilateral cerebral herniation

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12
Q

Along with an unresponsive dilated pupil, what other symptoms are present in the case of an ipsilateral cerebral herniation?

A

Decreased conscious state
Hypertension
Bradycardia

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13
Q

What are the urgent interventions for coning of the brainstem?

A

Elevate head > improves venous sinus drainage
Mannitol = osmotic diuretic
Hyperventilation > decrease pCO2 > vasoconstriction
Definitive treatment

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14
Q

What is the ongoing management for the stable unconscious patient?

A
Maintain vital signs in normal range
- O2 saturation
- BP
- CO2
Prevent aspiration
Adequate hydration
Manage pressure areas
- DVT prophylaxis
- Stress ulcer prophylaxis
May need sedation
Nutritional support over medium term
Appropriate monitoring
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