Reduced consciousness

Question 1

What is the dosage of naloxone?

Answer 1

400 - 800 mcg IV

Question 2

Mechanism of action of naloxone?

Answer 2

Non selective competitive opioid receptor antagonist, highest for mu opioid receptor, half life 30-81

Question 3

GCS

Answer 3

Motor - spontaneous, obeys commands, localises to pain, flexor response to pain, extensor response to pain
Verbal - oriented, confused, inappropriate, incomprehensible
Eyes - spontaneous, speech, pain

Question 4

Cause of unilateral dilated pupil?

Answer 4

Emergency: uncal herniation, infarction, haemorrhage, trauma

Non-emergency (e.g. normal conscious level):tumour, peripheral neuropathy, hereditary anisocoria

Question 5

Small unreactive pupil?

Answer 5

Emergency if new

Horner’s principle and reduced conscious level secondary to pressure on hypothalamus or brainstem

Question 6

Patient unable to look away from side of lesion?

Answer 6

Cerebral hemisphere lesion

Question 7

Patient unable to look toward lesion

Answer 7

Pontine lesion

Question 8

How to test brainstem integrity if no spinal injury?

Answer 8

Dolls head manoeuvre

Question 9

Treatment of status

Answer 9

IV access, glucose, UEs, Ca, Mg, AE drug levels, toxicology
Terminate seizures with lorazepam 4mg (longer acting). Repeat after 10 mins
If BZDs unsuccessful then phenytoin infusion 15mg/kg

Question 10

When to test for brainstem death?

Answer 10

All brainstem reflexes absent:

pupils fixed and dilated
absent corneal reflex
absent vestibulo-ocular reflexes
absent gag/cough reflex
no cranial nerve motor responses

apnoea (no spontaneous respirationwhen PaCO2>6.65kPa)