Coma

Question 1

Coma Causes (3).

Answer 1

1. Cerebrovascular Disease (50%).
2. Hypoxic-Ischaemic Injury (20%).
3. Metabolic and Infective Cause (30%).
   - Hypoglycaemia,Hyperglycaemia, Renal Failure, Liver Failure, Severe Electrolyte Disturbance.

Question 2

Glasgow Coma Scoring.

Answer 2

Motor Response (6).

6. Obeys Commands.
7. Localises to Pain.
8. Withdraws from Pain.
9. Abnormal Flexion to Pain (Decorticate Posture).
10. Extending from Pain.
11. No Response.

Verbal Response (5).

5. Orientated.
6. Confused.
7. Words.
8. Sounds.
9. No Response.

Eye Opening Response (4).

4. Spontaneous.
5. To Speech.
6. To Pain.
7. No Response.

Question 3

Criteria to Diagnose Brain Death (4).

Answer 3

1. 2 Senior Doctors (neither involved in Hospital Transplant Team).
2. Must be unconscious and fail to respond to outside sitmulation.
3. Heartbeat and Breathing only maintained by Ventilator.
4. Clear Evidence that Serious Brain Damage has occured and is incurable.

Question 4

Tests to Diagnose Brain Death (6).

Answer 4

1. Reaction to Light (Torch Shone in Both Eyes).
2. Reaction to Light Touch (Cotton Wool/Tissue in Eyes).
3. Reaction to Pressure (Forehead Pressure and Nose Pinching).
4. Reaction to Cold Temperature (Ice-Cold Insertion into ears would cause eye movement).
5. Gag Reflex (Thin Plastic Tube down Windpipe).
6. Breathing (Disconnection from Ventilator for a short period of time).

Question 5

Features of Coma (5).

Answer 5

1. State of Unrousable Consciousness.
2. Defined as E2, M4, V2 so GCS Below 8.
3. The individual lies with their eyes closed and does not respond to the environment.
4. It usually lasts for 2-4 weeks and the individual may wake up or progress into a vegetative state or minimally conscious state.
5. Closed eyes, absent/decreased reflexes and motor activity but preserved circulatory function and breathing drive.

Question 6

Features of Brainstem Death (3).

Answer 6

1. A person on an artificial life-support machine no longer has any brain functions - they will not regain consciousness or be able to breathe without support.
2. They are legally confirmed as dead as there is no chance of recovery.
3. The life support machine can still cause their heart to beat or chest to rise and fall with every breath.

Question 7

Features of Vegetative State (4).

Answer 7

1. A person is awake but is showing no signs of awareness.
2. They may open their eyes, wake-up/fall asleep at regular intervals and have basic reflexes and breathe.
3. If more than 4 weeks, this is continuous vegetative state.
4. If caused by traumatic brain injury and longer than 12 months, this is permanent vegetative states (extremely unlikely recovery).

Question 8

Features of a Minimally Conscious State (1).

Answer 8

1. A person shows clear but minimal/inconsistent awareness - periods where they can communicate/respond to commands.