IV- The Examination of the Unconscious Patient

Question 1

● Often used to describe unconscious patients
● State wherein the patient who appears to be asleep
and is at the same time incapable of being aroused
by external stimuli and inner needs

Answer 1

Coma

Question 2

● Located in the tegmentum of the midbrain and pons
● Responsible for wakefulness
● Activates the cortex
● Asking someone if they are awake: are you in full
cortical function right now
o Awake when cortex is fully functioning

Answer 2

RETICULAR ACTIVATING SYSTEM (RAS)

Question 3

RAS FUNCTION

Answer 3

● Activates cortex with gives us wakefulness
● Melatonin shuts down RAS for sleep to occur

Question 4

CAUSES OF COMA

Answer 4

1. Bilateral Cortical Damage
2. Destruction of the RAS
3. Increased Intercranial Pressure

Question 5

a scale that has a nice way to look at the level of sensorium but it is
not enough to tell the type of damage seen on the
brain

Answer 5

Glasgow coma scale

Question 6

5 ASPECTS TO LOOK AT WHEN EXAMINING
UNCONSCIOUS PATIENT:

Answer 6

A. Level of sensorium
B. Breathing patterns
C. Pupillary reactions
D. Eye movements
E. Motor response

Question 7

B. BREATHING PATTERNS

Answer 7

1. Cheyne Strokes (bilateral/diencephalon cortex)
2. Central neurogenic hyperventilation (upper pons)
3. Apneustic (lower pons)
4. Biots/ataxic (upper medulla)
5. Apnea (lower medulla)

Question 8

● Periods of hyperventilation followed by
hypoventilation (alternating periods)
● Damage to diencephalon and bilateral cortex =
become very sensitive to rises and drops of carbon
dioxide
● Greatest stimulus to breathing is increased CO2
levels

Answer 8

cheyne strokes (diencephalon/ bilateral cortex)

Question 9

● Continuous hyperventilation
● Distinguish this from tachypnea or dyspnea
(difficulty in breathing = rapid, shallow breathing)
● CNH – continuous rapid, deep breathing

Answer 9

Central Neurogenic Hyperventilation (upper pons)

Question 10

● Long periods of apnea (no breathing) before the
next inspiratory pattern
● Long gap between each breath

Answer 10

Apneustic (lower pons)

Question 11

● Lose all patterns of breathing
● No pattern – irregular breathing
● E.g., inhale exhale exhale

Answer 11

Biots/Ataxic (upper medulla)

Question 12

Absence of Breathing

Answer 12

Apnea (lower medulla)