week 4

Question 1

discuss the different definitions of conciousness

Answer 1

fully concious:
Confused: alert but confused to time and place (not orientated)
Delirium: alert, mental confusion, delirium and hallucinations
Lethargy: drowsy, aroused with moderate stimuli
Obtunded: more drowsy, slow responses
Stupor: roused only by voigorous stimuli - but quickly fall back to sleep
Coma: unresponsive

Question 2

Describe the key brain regions involved in control of conciousness

Answer 2

The reticular activating system - RAS
maintains arousal and the waking state

Consists of the brain stem and thalamus, alongside projections for the posterior hypothalamus (involved in the control of the sleep-awake cycle)
interuption to the RAS = unconciousness

Question 3

Name the clincial tests assess conciousness

Answer 3

AVPU and GCS
Eyes
4: spontaneous
3: sound/voice
2: pain or pressure
1: none
Verbal
5: orientated
4: Confused
3: inappropriate words
2: sounds
1: nons
Motor
6: obeys commands
5: localising to pain
4: normal flexing
3: abnormal flexing
2: abnormal extension
1: none

Question 4

Define a cerebovascular accident, state the main types, identify key risk factors and outline the pathphysiology of this condition

Answer 4

CVA: stroke
interuption to cerebral artey blood flow, (oxygen and glucose).
ischaemic and haemorragic
haemorragic - brain bleed - increases ICP and then goes down the cell death cycle (swelling -> cell death)
ischamic - thrombus and embolus
thrombus is where it forms in the brain, embolous is from elsewhere in the body.

virchows triad:
stasis - plain ride - atrial apendage
hypercoaguability - pregnancy, contraceptives,
vessel wall injuiry - trauma, athrosclerosis

Question 5

Describe the clinical manifestations, diagnosis, and prehospital management of cerebrovascular accidents including large vessels occlusive cva’s

Answer 5

Diagnosis - ROSIER + ACT (act positive = large vessel occlusion in circle of willis)
Managment - rural - consult thrombylsis
ct scan, 12 lead and iv access each arm (18g), notify, time = tissue
ischaemic - thrombylisis or clot retrival procedure
haemorragic - surgery to release pressure and stop bleeding