Management of the Unconscious Patient Flashcards
What is a rapid assessment tool for consciousness?
“AVPU” mnemonic
- A = alert
- V = (response to) verbal stimuli
- P = (response to) painful stimuli
- U = unresponsive
What is the Glasgow coma scale designed for?
Blunt head trauma
Not prognostic for non-traumatic LoC
What does the Glasgow coma scale do?
Gross estimate of cerebral function
Point estimate less specific than change over time > falling GCS mandates investigation and intervention
What are the categories for the Glasgow coma scale?
Eye opening
Best verbal response
Best motor response
What is the scale for eye opening?
4 = spontaneous 3 = to verbal command 2 = to pain 1 = nil
What is the scale for best verbal response?
5 = orientated 4 = confused 3 = uses inappropriate words 2 = incomprehensible 1 = nil
What is the scale for best motor response?
6 = obeys commands 5 = localises to pain 4 = withdraws to pain 3 = abnormal flexion to pain 2 = abnormal extension to pain 1 = no response
What does abnormal flexion to pain mean?
Press on finger > flex wrists and arms
What does abnormal extension to pain mean?
Press on finger > extend arms and wrists
At what GCS score would a person be intubated in a trauma situation?
10 or less
What are the differential diagnoses for an unresponsive dilated pupil in a trauma setting?
Direct ocular trauma
Ipsilateral cerebral herniation
Along with an unresponsive dilated pupil, what other symptoms are present in the case of an ipsilateral cerebral herniation?
Decreased conscious state
Hypertension
Bradycardia
What are the urgent interventions for coning of the brainstem?
Elevate head > improves venous sinus drainage
Mannitol = osmotic diuretic
Hyperventilation > decrease pCO2 > vasoconstriction
Definitive treatment
What is the ongoing management for the stable unconscious patient?
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