Neuro - Coma

Question 1

What is a coma?

Answer 1

Loss of Consciousness from a disruption of the cerebral hemispheres and reticular activating system

Question 2

What are the structural causes of coma?

Answer 2

Trauma
Hemorrhage
Tumor
Edema/Hydrocephalus
Infarct
Abscess

Question 3

What are the diffuse causes of coma?

Answer 3

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

Question 4

What are the top causes of coma?

Answer 4

Alcohol
Trauma
CVA

Question 5

What the types of causes what are most common?

Answer 5

Metabolic more than supra- and subtentorial mass lesions

Question 6

What three neurological stimuli will you look for on a physical exam?

Answer 6

Respiration rate
Reflexes
Level of response/Posturing

Question 7

What is a Cheyene-Stokes respiration?

Answer 7

An increase in respiration followed by decreased depth and frequency in a cyclic pattern

Indicated lesion is in the thalamus or higher

Question 8

What is a Central neurogenic hyperventillation?

Answer 8

Constant hyperventilation

Indicates patient’s injury is in the midbrain

Question 9

What is apneustic respiratory?

Answer 9

Appear as if patient takes in a large breath and holds it. And then another.

Indicates lesion is in the Pons

Question 10

What is an apnea/gasping respiration?

Answer 10

Patient is gasping without any rhythmic pattern.

Lesion is most likely in the medulla

Question 11

CN II check?

Answer 11

PERRL; threat technique will cause blink

Question 12

CN III

Answer 12

PERRL; EOR to VOR (rolling head)

Question 13

CN IV & VI

Answer 13

EOM to VOR

Question 14

CN V & VII

Answer 14

corneal reflex

Question 15

CN VIII

Answer 15

EOM to VOR; COWS in ear

Question 16

IX & X

Answer 16

Gag and cough

Question 17

X & XII

Answer 17

Cough and posturing (when intubation is done)

Question 18

Small reactive pupils

Brainstem reflexes intact

Answer 18

Thalamus or higher

also would include:
Cheyene Stokes respiration
Decorticate posturing

Question 19

Mid-position fixed pupils

Extraocular movements may be impaired

Answer 19

Midbrain

also would include:
Decerebrate posturing
Central Neurogeneic hyperventillation

Question 20

Mitotic pupils (pin point)
Absent EOM
Flaccidity
Absent corneal reflexes

Answer 20

Pons

Also Includes:
Apneustic respirations
Descending sympathetics

Question 21

Absent gag reflex

Flaccidity

Answer 21

Medulla

Also includes:
Gasping, apneic respiration
Cardiovascular (blood pressure) and respiratory irregularities

Question 22

First thing you do for treatment for a coma patient?

Answer 22

ABC

Question 23

What must you give along with glucose? What does it prevent?

Answer 23

Thiamine to prevent Wernicke’s encephalopathy

Question 24

What do you give to a opiod/barbituate overdose?

Answer 24

Naloxone and Romazicon

Question 25

Coma patient presents with blown pupil, ptosis, and eye deviation down and out. Also presents with bouncy reflexes and babinski sign. What is the possible cause?

Answer 25

Uncal herniation pressing on the CN III nerve and the crus cerebri

Question 26

What is brain death?

Answer 26

Absent cerebral and brainstem responses
Apnea
Isoelectric EEG
Absent cerebral blood flow

Have to know diagnosis in order to call brain death