Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

SS - Exam 2 > Stupor And Coma > Flashcards

Stupor And Coma Flashcards

1
Q

Consciousness

A

State of alert cognition in which
individual is aware of self and environment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Depressed

A

lethargic and less responsive to
environment, but capable of normal responses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Obtunded

A

capable of responding to stimulation,
but responses blunted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Stupor

A

somnolent at rest; rousable only with
vigorous tactile or noxious stimulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Comatose

A

unconscious and unresponsive to any
applied stimulus; reflexes may be present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Brain dead

A

comatose, comprised brainstem
reflexes and vital functions requiring life support
– +/- abnormal electrophysiologic or provocative tests of brain function
– Electrophysiologic and provocative tests must corroborate clinical exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Anatomy of consciousness

A

ARAS received incoming info - synapses in thalamus and send info to appropriate locations
Cerebral cortex - ultimate measure of consciousness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Bilateral/diffuse cerebrocortical disease

A

Traumatic cerebral edema
Toxic and metabolic encephalopathies
Inborn errors of metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Damage to RAS in brainstem

A

Compressive
Infiltration or destruction of parenchyma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Intracranial pressure physiology

A

Pressure inside the calvarium
Generated by resident tissue volumes
- brain parenchyma 80%
- blood 10%
- CSF 10%
Inelastic calvarium
Normal ICP - 5-10 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Monro-kellie hypothesis

A

Compensatory responses to ICP elevation
Two methods to decrease pressure
– remove CSF to spinal Spinal subarachnoid space
– decrease CSF production
Last resort - decrease Cerebral blood flow (CBF)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Intracranial hypertension

A

Increase due to abnormal tissue, brain edema, obstructive hydrocephalus
Ultimately decreases cerebral blood flow
As CBF ^ —> mean arterial blood pressure ^ = increased intracranial pressure
CBF = mABP - ICP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Decreased CBF

A

Decreased cerebral perfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Reversible injury

A

Hypoxia/ischemia
Excitotoxic injury cascade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Cell death

A

Selective vulnerability of brain tissues
Neurons
Glia
Endothelium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Caudal transterntorial herniation

A

Midbrain compression
Stupor to coma
Mydriasis no PLR
Decerebrate posture
+/- Ventrolateral strabismus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Rostral transtentorial herniation

A

Cerebellar and midbrain compression
Decerebellate posture

18
Q

Foramen magnum herniation
Acute

A

Stupor to come
Respiratory arrest; hypoventilation
CN IX-XII deficits
Death

19
Q

Subfalcine herniation

A

Common on one side of the cerebrum
Easy to ID in images
Clinical signs represent location
• right forebrain

20
Q

Transcalvarial herniation

A

herniation through a defect in the skull - common by trauma or after surgery

21
Q

Clinically detrimental ICP value

A

Absolut value unknown
- 20-25 mmHg too high
- 30 mmHg will decrease CBF
Rate of change is more important
Measuring ICP
- indirect Doppler
- direct - fiber optic probes

22
Q

Evaluation of altered consciousness patients

A

Postural abnormalities and motor function
Brainstem reflexes
Level of consciousness
Composite scoring system
- small animal coma scale (SACS)
- modified Glasgow coma scale

23
Q

Pupils and prognosis

A
24
Q

Brainstem reflex - oculovestibular

A
25
Q

SACS

A
26
Q

Traumatic brain injury

A

Open - defect in skull, open in skull
Closed - skull intact but brain is injured

27
Q

Primary brain injury

A

Tissue deformation produced at moment of injury
Contusion, concussion, laceration, diffuse axonal injury (spinning), vascular disruption (hemorrhage)
- these injuries have already happened and are beyond our control
- cascade into secondary injury

28
Q

secondary brain injury

A

Initiation by primary injury
Complex
Inflammation, excitotoxicity (free radicals), ischemia, lactic acidosis
Pathways are primary targets of medical treatment
Primary and secondary injury contribute to ICH

29
Q

Imaging for TBI

A

Cross sectional modalities preferred (3D imaging)
Consider if surgery is end goal

30
Q

Imaging considerations for closed injury

A

Closed injury
- focal problem
- deteriorating SACs score
- indication of other injury

31
Q

Imaging considerations for open injury

A

Open injury
- penetrating missile
- depressed skull fracture
- contaminated wounds

32
Q

When would you not consider 3D imaging?

A

In animal has history or potential for bullet fragments which can disrupt the CT or MRI images - radiograph is ideal for those patients

33
Q

Prognosis for TBI

A

Forebrain & cerebellar injury = Better prognosis
SACS of 8 = 50% probability they’ll survive 48 hours
Post traumatic epilepsy can develop m-y after injury

34
Q

Managing altered consciousness patient

A

emergency ABC
Commonly poly systemic injury
- get BP ***
Check for axial, intrathoracic, abdominal, appendicular, cutaneous injury

35
Q

Goal 1 for altered conscious management

A

Restore vital parameters
Fluids - colloids or crystaloids are ideal
Correcting shock can greatly improve prognosis

36
Q

goal 2 for managing ICH

A

Reduce Intracranial pressure
Physical non invasive
- head elevation
- induce hypothermia
Avoid jugular compression,
Invasive
Decompressive craniectomy & durotomy
CSF diversion - REFER

37
Q

Pharmacological methods to decrease ICP

A

Diuretics
Mannitol - osmotic diuretic, positive theological agent, free radical scavenger
Furosemide - synergistic w mannitol, prevents rebound ICP

38
Q

when should diuretics be admin for intracranial hypertension?

A
  1. Vital parameters restored/stable 2. SACS score deteriorating despite therapy
    • ICP spikes commonly associated with clinical decline
  2. Brain edema identified on imaging study
39
Q

Drug induced coma

A

Barbituates and NMDA
antagonists
– Neuroprotective • Disadvantages
– Hypoventilation
– Hypotension
– Complicates clinical
assessment of SACS

40
Q

Goal 3 for altered patient management

A

Supportive systemic care
Analgesics • Nursing/Hygiene • Nutritional support • Physical therapy

41
Q

Daily monitoring

A

Serial or continual
MaBP
ECG
Blood glucose
PCV/TS
Urine output
SACS
Body weight
24 hour care is necessary

SS - Exam 2 (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions