Neuro - Coma Flashcards
What is a coma?
Loss of Consciousness from a disruption of the cerebral hemispheres and reticular activating system
What are the structural causes of coma?
Trauma Hemorrhage Tumor Edema/Hydrocephalus Infarct Abscess
What are the diffuse causes of coma?
Metabolic: Hypoxia (brain without 5 mins of O2) Electrolytes Hypoglycemia Hypercarbia (Increased CO2) Hypothyroid Uremia Hypothermia
Toxic:
alcohol
opiods
barbituates
Other:
Seizure, sepsis, meningitis, hypertension
What are the top causes of coma?
Alcohol
Trauma
CVA
What the types of causes what are most common?
Metabolic more than supra- and subtentorial mass lesions
What three neurological stimuli will you look for on a physical exam?
Respiration rate
Reflexes
Level of response/Posturing
What is a Cheyene-Stokes respiration?
An increase in respiration followed by decreased depth and frequency in a cyclic pattern
Indicated lesion is in the thalamus or higher
What is a Central neurogenic hyperventillation?
Constant hyperventilation
Indicates patient’s injury is in the midbrain
What is apneustic respiratory?
Appear as if patient takes in a large breath and holds it. And then another.
Indicates lesion is in the Pons
What is an apnea/gasping respiration?
Patient is gasping without any rhythmic pattern.
Lesion is most likely in the medulla
CN II check?
PERRL; threat technique will cause blink
CN III
PERRL; EOR to VOR (rolling head)
CN IV & VI
EOM to VOR
CN V & VII
corneal reflex
CN VIII
EOM to VOR; COWS in ear
IX & X
Gag and cough
X & XII
Cough and posturing (when intubation is done)
Small reactive pupils
Brainstem reflexes intact
Thalamus or higher
also would include:
Cheyene Stokes respiration
Decorticate posturing
Mid-position fixed pupils
Extraocular movements may be impaired
Midbrain
also would include:
Decerebrate posturing
Central Neurogeneic hyperventillation
Mitotic pupils (pin point)
Absent EOM
Flaccidity
Absent corneal reflexes
Pons
Also Includes:
Apneustic respirations
Descending sympathetics
Absent gag reflex
Flaccidity
Medulla
Also includes:
Gasping, apneic respiration
Cardiovascular (blood pressure) and respiratory irregularities
First thing you do for treatment for a coma patient?
ABC
What must you give along with glucose? What does it prevent?
Thiamine to prevent Wernicke’s encephalopathy
What do you give to a opiod/barbituate overdose?
Naloxone and Romazicon
