Clin - Stupor and Coma Flashcards
(36 cards)
requirements for consciousness
1) arousal (level of alertness, ability to interact w/ environment)
2) awareness (know what’s going on)
which state of altered consciousness is represented by mental blinding, increased sleep, and arousal to mild stimuli (voice)
obtundation
what is battle’s sign
a bruise behind the ear that indicates a fracture at the bottom of the skull, typically temporal bone fx
what does a general examination of a stupor/coma patient entail
1) vital signs (respiratory rate and pattern)
2) skin
3) breath odor
4) signs of trauma (raccoon eyes, battles sign, CSF leak)
5) CSF stiffness
if a stupor/coma patients presents with HTN, what are some considerations
- pheochromocytoma
- drugs (amphetamine, cocaine, PCP)
- increased ICP
- PRES (posterior reversible encephalopathy syndrome)
if a stupor/coma patients presents with hypotension, what are some considerations
- addison’s
- sepsis
- drugs (beta blocker, Ca2+ blocker, TCAs, lithium, sedatives, opioids)
if a stupor/coma patients presents with hyperthermia, what are some considerations
- infection
- heat stroke
- drugs (amphetamines, TCAs, cocaine, salicylates, neuroleptics)
- serotonin syndrome
- central hemorrhage
if a stupor/coma patients presents with hypothermia, what are some considerations
- hypothyroid
- hypoglycemia
- drugs (opioids, sedatives, barbiturates, alcohol)
During a general medical exam of the skin of a patient with impaired consciousness what should be considered with cold, puffy, yellowish appearance?
myxedema coma
During a general medical exam of the skin of a patient with impaired consciousness what should be considered with purpura?
- meningococcal meningitis
- TTP (Thrombotic thrombocytopenic purpura)
- DIC
- vasculitis
- aspirin OD
During a general medical exam of the skin of a patient with impaired consciousness what should be considered with rash?
meningitis, viral encephalitis, rickettsia
what should you consider when a stupor/coma patient comes in with breath odor that smells like:
- dirty restroom
- fruity
- musty
- onion
- garlic
- dirty restroom: uremia
- fruity: ketoacidosis
- musty: hepatic failure
- onion: paraldehyde (rare tx for seizures)
- garlic: organophosphates (insecticides, herbicides, sarin)
list the bilateral supratentorial causes of coma
- subarachnoid hemorrhage
- multiple infarcts
- venous thrombosis
- cerebral edema
- acute hydrocephalus
- multiple mets
list the SUBtentorial causes of coma
- pontine hemorrhage
- basilar artery occlusion
- central pontine myelinolysis
- cerebellar hemorrhage/infarct
- cerebellar/brainstem neoplasm
- cerebellar abscess
describe the caloric stimulation test and what nerves it tests
COWS
1) pour cold water in left ear –> eyes should slowly move to right and quick movement to the left (left nystagmus)
2) pour cold water in right ear –> eyes should slowly move to left and quick movement to the right (right nystagmus)
coma pt: eyes will deviate away and then stay there
nerves 8 (stimulation from the water to the brainstem), 6 (abducting the eye), 3
what nerves are tested in the corneal test
5 and 7
what is the rule of thumb for anisocaria?
if it’s the large pupil –> should fail to constrict to light
if it’s the small pupil –> should fail to dilate in the dark
if pupils are pinpoint, what could this indicate
- pontine lesion
- opiates
- pilocarpine
if pupils are mid position and unreaction, what could this indicate
sympathetic + parasympathetic dysfunction (midbrain)
how does atropine/scopalomine affect the pupils
dilated, fixed
how does glutethimide affect the pupils
dilated, fixed, unequal
how does hypothermia, anoxia, and ischemia affect the pupils
possibly dilated, fixed, unequal
in hemispheric lesions, where does the eyes deviate towards with destructive and irritative lesions
destructive: toward lesion
irritative: away from lesion
in brainstem lesions, were does the eye deviate towards with destructive lesions
away from the lesion
