12.Coma and Depressed consciousness (some q in confusion oops)

Question 1

Mo function - gcs measure vs muscle tone - passive vs jerks vs tremor vs myoclous 

Question 2

First tests in depressed consciouness:<br></br>1. BG<br></br>2. chem 10<br></br>3. VBG <br></br>4. LE and LFT

Question 3

<span>Serum salicylate and acetaminophen levels should be determined if toxicity is suspected, such as in a case of an unexplained anion gap acidosis or hepatic failure. Other toxicologic tests, such as the serum ethanol level and urine drug screen, are less likely to significantly affect the acute management of a patient with depressed consciousness.</span>

Question 4

<span>Noncontrast computed tomography (CT) of the brain, because of its wide availability and rapid acquisition, is the imaging modality of choice for the initial evaluation of a patient with depressed consciousness. It should be obtained in patients with preceding head trauma, those with suspected structural brain disease, and those in whom the diagnosis is not identified by other diagnostic means. </span>

Question 5

<span>CT angiography (CTA) of the head and neck should be performed if brainstem dysfunction is suspected on neurologic examination</span>

Question 6

<span>Due to bone artifact, CT has limited utility in the visualization of the posterior fossa. In comparison, magnetic resonance imaging (MRI) of the brain is better for identifying structural lesions in this region. MRI also provides greater anatomic differentiation of cortical and brainstem structures and is superior to CT imaging for detecting early ischemic stroke and identifying infectious, inflammatory, and neoplastic processes. </span>

Question 7

<span>Electroencephalography (EEG) should be performed to evaluate for NCSE,</span>

Question 8

<span>An electrocardiogram may diagnose cardiac ischemia, conduction block, or other dysrrhythmias.</span>

Question 9

<img></img>

Question 10

<span>We recommend administering an initial naloxone dose of 0.4 mg IV and increasing up to 10 mg IV if necessary</span>

Question 11

<span> In cachectic malnourished patients, women with severe hyperemesis gravidarum, chronic alcoholics, or other patients with suspected thiamine deficiency, empirical administration of thiamine 500 mg IV is recommended.</span>

Question 12

<span>We recommend endotracheal intubation in most trauma patients with coma and a GCS score less than or equal to 8 and for any patient thought to be incapable of sustained airway self-maintenance and protection</span>

Question 13

<span>Prior to intubation, a detailed neurologic examination should be performed, with particular attention to assessing brainstem function</span>

Question 14

<span>Once the airway has been reassessed and secured as needed, we recommend treating patients with undifferentiated coma and clinical suspicion for meningitis (e.g., fever, other signs of infection, sepsis, rash) empirically with ceftriaxone 2000 mg IV prior to CT imaging. Additional antibiotics may be added based on suspected infection source, local antibiogram, and patient-specific risk factors. I</span>

Question 15

Principles of neuroprotective resus:<br></br><ul><li>• <div>Elevate head of bed to 30 degrees if there is no suspicion for thoracic spine injury.</div></li><li>• <div>Avoid constricting ties or collars around neck.</div></li><li>• <div>Avoid hypoxia and hyperoxia.</div></li><li>• <div>Maintain end-tidal CO ₂ at 35 cm H ₂ O.</div></li><li>• <div>Avoid hypotension.</div></li><li>• <div>Avoid hyperthermia.</div></li><li>• <div>Prevent and treat seizure activity.</div></li></ul>