Unconscious Patient Flashcards

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1
Q

Outline the ‘motor response’ section of the Glasgow Coma Scale

A

6: Obeying commands
5: Localising to pain
4: Withdrawing to pain
3: Flexor response to pain
2: Extensor response to pain
1: None

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2
Q

Outline the ‘verbal response’ section of the Glasgow Coma Scale

A

5: Orientated to time, place, person
4: Confused conversation
3: Inappropriate speech
2: Incomprehensible sounds
1: None

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3
Q

Outline the ‘eye opening’ section of the Glasgow Coma Scale

A

4: Spontaneous
3: In response to speech
2: In response to pain
1: None

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4
Q

What is a minor, moderate, and severe GCS injury?

A

Minor: 13-15
Moderate: 9-12
Severe: <8 (airway protection needed)

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5
Q

What is decorticate and decerebrate posturing?

A

Decorticate: arms flexed inwards, legs extended
Implies damage above the level of the red nucleus in the midbrain

Decerebrate: adduction and internal rotation of the shoulder, pronation of the forearm
Implies damage below the level of the red nucleus

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6
Q

According to NICE guidelines, following head injury which patients require a CT head IMMEDIATELY?

A
GCS <13 on arrival
GCS <15 after two hours post-injury
Suspected open or depressed skull fracture
Any signs of basal skull fracture
Post-traumatic seizure
Focal neurological deficit
>1 episode vomiting
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7
Q

What are the signs of a basal skull fracture?

A

Haemotympanum
Panda eyes
CSF leakage from ears or nose
Battle’s sign

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8
Q

According to NICE guidelines, following head injury which patients require a CT head within 8 hours?

A

If adults have minor LOC/amnesia since the injury AND either:
>65
History of bleeding or clotting disorders
Dangerous mechanism of injury
>30min retrograde amnesia

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9
Q

What are the features of an extradural haematoma?

A

Often results from acceleration-deceleration trauma or blows to the side of the head

Features: raised ICP, some patients may have a lucid interval

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10
Q

What are the features of a subdural haematoma?

A

Most commonly occur in the frontal or parietal lobes
Bleeding into outermost meningeal layer

Risk factors: old age and alcoholism

Slower onset than extradural haematoma

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11
Q

For patients who are warfarinsed and had a head injury but have no signs or symptoms of a head injury, what is the management?

A

CT Head in 8 hours

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12
Q

What are the in hospital monitoring requirements of patients with a head injury?

A

Obs half hourly until GCS is 15

Half hourly for two hours
1 hourly for 4 hours

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13
Q

When is ICP monitoring required?

A

Appropriate if: GCS 3-8 and normal CT scan

Mandatory if: GCS 3-8 and abnormal CT scan

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14
Q

What head injury pathology presents with a unilateral dilated, sluggish pupil?

A

3rd nerve compression secondary to tentorial herniation

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15
Q

What head injury pathology presents with bilateral dilated sluggish pupils?

A

Poor CNS perfusion

bilateral third nerve compression

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16
Q

What pathologies present with bilaterally constricted pupils?

A

Opiates
Pontine lesions
Metabolic encephalopathy

17
Q

What are the risk factors for a CT cervical spine within an hour?

A

GCS <13
Patient has been intubated
Plain X-Rays are abnormal/inadequate
Clinical suspicion and either >65, focal neurological deficit, paraesthesia, dangerous mechanism of injury

18
Q

Which head injury patients should you intubate and ventilate?

A
GCS <8
Copious bleeding into mouth
Irregular respirations
Hypoxaemia/hypercapnea
Unstable fractures of the face
Head injury with seizure
19
Q

What is the immediate management of a coma?

A

ABC
IV access
Stabilise cervical spine
Blood glucose (give 200mL 10% glucose IV stat if hypoglycaemia)
Control possible seizures
Brief collateral history
Investigations: ABG, FBC, ethanol, CXR, toxin screen, drug levels, urine culture, blood cultures, CT head