THE UNCONSCIOUS PATIENT AND RESUSCITATION PRINCIPLES INCLUDING ICU CARE Flashcards
What is consciousness?
Consciousness means a state of wakefulness with awareness of oneself and the environment and ability to respond to external stimuli
What are the 3 components of consciousness
Wakefulness
Awareness
Alertness
What is coma
Profound and occasionally persistent state of unconsciousness. Objectively it is defined as GCS less than 8.
Just the neurological causes of unconsciousness
• CVA (stroke)
• TBI
• Seizures
• Cerebral edema
• Cerebral tumors
• Intracerebral hemorrhage
• Subdural hemorrhage
• Extradural hemorrhage
• CNS infections
• CNS abscess
• Acute hydrocephalus
List the metabolic causes of unconsciousness
• Hypoglycemia
• Hyperglycemia
• Hyponatremia
• Hypernatremia
• Hypercalcemia
• Adrenal crisis
• Encephalopathy( Uraemic, Hepatic, Sepsis )
• CO2 Narcosis
List the diffuse physiological brain dissociation causes of unconsciousness
• Seizure disorders
• Opioid toxicity
• Alcohol intoxication
• Drug overdose
• Poisoning
• Illicit drug usage
• Hypothermia
List the psychiatric causes of unconsciousness
• Catatonia
• Severe depression
• Conversion disorder
• Malingering
List some of the investigations you will do for an unconscious patient
Blood glucose
Toxicology
EUCr
LFT
FBC
Serum cortisol
Blood culture
Blood film for MP
CSF analysis
Neuroimaging – CT scan, MRI,
EEG
What is the treatment for opioid toxicity
Naloxone
What is the treatment for benzodiazepine toxicity
Flumazenil
How would you manage a case of excess alcohol
Thiamine
Components of basic ICU care
• Airway management and ventilatory support
• Cardiovascular support
• +/- Head end elevation
• Fluid and nutritional support
• Thromboprophylaxis
• Ulcer prophylaxis
• Infection prevention and control
• Glycaemic control
What is airway management?
Are set of medical procedures performed in order to prevent airway obstruction and thus ensuring an open pathway between patient’s lung and outside world.
ICU cardiovascular support includes?
• Fluid optimization
• Inotropic support ( + increases or - decreases the force of contraction) e.g. Dopamine
• Vasopressors (causes vasoconstriction thus increasing BP) e.g. Norepinephrine
Head end elevation is also known as?
What are the contraindications for this?
FOWLER’S POSITION
Contraindications
• Cervical spine injured patients
• Hypotension
• Low cardiac index (hemodynamic parameter that relates CO with body surface area. CO/BSA. Normal is 2.5-4.0L/min/m square
• Prone positioned px
• Colon transplanted px.
