The unconscious patient Flashcards
What is meant by an unconscious patient?
An unconscious patient is a clinical state in which patients have
impaired responsiveness (or are unresponsive) to external stimulation
and are unarousable.
What is the pathophysiology of unconsciousness? (5)
- Ascending reticular activating system (ARAS) induces and maintains
alertness. - Alterations in alertness can be produced by focal lesions within the
upper brainstem by directly damaging the ARAS - caused by diffuse bilateral hemisphere damage
- Alteration in the projections to the cortex through the diencephalon
before the cerebral cortex also alters mental status - An impaired oxygen or substrate delivery alters cerebral metabolism
- Interferes with neuronal excitability and/or synaptic function.
Define obtundation.
Responds to verbal stimuli although slow and inappropriate
Define stupor.
The subject can be aroused only by vigorous and repeated noxious stimuli
Define coma.
Unarousable and unresponsive
What is the general approach to an unconscious patient?
A, B, C, D, E
What do you look for on Airway? (3)
How do we know airway is obstructed?
* Gurgling, Snoring, Stridor, Apnoea
What do we do?
* airway maneuvers : head tilt, chin tilt, jaw thrust
* Use Airway adjuvants: simple and advanced
What do you look for on Breathing? (6)
- Is the patient breathing?
- What is the respiratory rate?
- Causes of tachypnoea and bradypnoea
- What is the respiratory pattern?
- Hyper/hypoventilation, Cheyne stoke, kussmaul
- What is the respiratory effort?
- Use of accessory muscles
- What is the oxygen saturation and is it on or off oxygen?
What do you look for on Circulation? (5)
- Peripheries warmth, CRT, PR, BP
- Correlation of PR to BP when BP cuff far off?
- Radial = systolic > 90 mmHg
- Brachial = systolic >80mmHg
- Femoral = systolic >70 mmHg
- Carotid = systolic > 60 mmHg
Name the types of shock. (4)
Hypovolemic, obstructive, cardiogenic, distributive
What do you look for on Disability? (4)
- GCS
- Pupils: size and response to light
- Medium to dilated symmetrical pupils fixed to light structural disease of the
brain stem. - Small symmetrical pupils reactive to light : metabolic diseases and drug
overdose. - Unequal pupil fixed to light : intracranial mass lesion producing 3rd nerve
palsy e.g in unilateral uncal herniation.
- Medium to dilated symmetrical pupils fixed to light structural disease of the
- Lateralising signs
What do you look for on Exposure? (3)
- Temperature
- External signs of trauma
- Rash
Name 4 immediate investigations you would do in an unconscious patient.
RBS, FBC, ABG, CXR, U&E, LFTs, Creatinine
What does the mnemonic AEIOUTIPS stand for in altered mental status?
- A is for alcohol.
- E is for epilepsy (and other forms of seizure).
- I is for insulin.
- O is for overdose (and oxygenation).
- U is for uremia (or underdose).
- T is for trauma.
- I is for infection.
- P is for psychiatric (and poisoning).
- S is for stroke (and shock).
What can cause coma without focal signs or meningism? (3)
Anoxic-ischemic, metabolic, toxic, and drug induced insults, infections, and
post ictal states
