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Flashcards in Coma Deck (35)
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1
Q

Practice pattern 5I

A

impaired arousal associated with coma, near coma or vegetative state. inability to responsd purposely or become consciously aroused by external or internal stimuli. cerebral cortex must be activated to reach and maintain conscious arousal. Alertness and consciousness are regulated by the RAS in the brainstem.

2
Q

RAS

A

reticular activating system is activated by various sensory inputs. feeback mechanism between the RAS and cerebral cortex maintains consciousness. bilat. damage to the ascending RAS or brainstem will result in some level of coma.

3
Q

coma

A

state of profound unresponsiveness. inability to obey commands. inability to verbally respond. inability to open eyes and visually track. lack of sleep-wake cycles.

4
Q

minimally conscious state

A

aka, light coma. may present with reflex, primitive or disorganized responses to stimuli. minimal but some purposeful awareness. gestural or verbal responses even if incorrect. verbalizaions of any words even if incorrect. movement or behaviors that are environmentally triggered not reflexive.

5
Q

deep coma

A

no response to painful or any stimuli. not even a reflex.

6
Q

vegetative state

A

state of arousal without behavioral evidence of awareness or ability to interact with the external environment. rudimentary arousal and apparent sleep-wake cycles. may have spontaneous eye opening bu no real visual tracking or purposeful limb movements.

7
Q

locked in syndrome

A

all higher cortical functions intact. extensive lesions in the corticobulbar and corticospinal tracts but higher CNS system intact. cannot speak, move, or breathe.

8
Q

Glasgow coma scale

A

eye opening (E 1-4), motor response (M 1-6), verbal response (V 1-5). worst possible score is 3=deep coma. best score is 15.

9
Q

Glasgow scale outcome prediction

A

3-5 at admission 62% chance of death. 6-8=20% death and 74% good prog w/ mod. disability. 12-14=no chance of death or severe disability.

10
Q

initial neuro exam for TBI/coma

A

pupillary response to light, eye movements (oculocephalic), oculovestibular (COWS), motor testing, sensory testing

11
Q

factors affecting outcome

A

severity of initial TBI, hypoxemia, arterial hypotension, intracranial pressure, cellular responses secondary to injury.

12
Q

Rancho Los Amigos Scale of Cognitive Function

A

ten levels of cognitive functioning used extensively to document status of patient and plan for medical/rehabilitative intervention.

13
Q

PT related assessment

A

r/o fx esp. to C-spine. note spontaneous movement, response to external stimuli, respiratory pattern (Cheyne Stokes breathing controlled by CO2 receptors in CNS, ROM, tone, pathological posturing (decorticate v. decerebrate),

14
Q

decorticate posturing

A

(pathological) lesion of the corticospinal tracts at the thalamus and internal capsule. =flexion of UE’s, ext of LE’s

15
Q

decerebrate posturing

A

(pathological) lower ponse intact, vestibular nucleus intact. tone influenced by tonic neck reflexes and vetibular reflexes. extension of all 4 extremities.

16
Q

flaccidity after TBI indicates…

A

lower brainstem lesion

17
Q

coma treatment approaches

A

ROM, Sensor stim, orientation, prevent contractures and deformity, neck and trunk mobility, education for family and care team

18
Q

Coma stimulation program

A

facilitates neuronal reorganizatin by providin meaningful stimuli during first few weeks post injury. pt must be neurologically stable w/ normal ICP, has a 1-3 in Ranch scale. can be noxious as last try. use tactile, kinesthetic, gustatory, olfactory, auditory, visual

19
Q

positioning goals

A

to avoid contractures, deformity and skin breakdown. identify involuntary reflexes that influence posture. use splints or positioning devices as necessary.

20
Q

positioning solutions for high extension tone

A

ABduction wedge between legs to prevent adduction, and heel lifter off the bed like the multi-podus boot.

21
Q

positioning solutions for high flexor tone

A

can use long leg brace and a child’s size long leg brace on the arm

22
Q

positioning solutions

A

hand cones, AFOs, dynasplint, functional hand splint, philadelphia collar if it will help hold up the head

23
Q

severe posturing interventions

A

1st r/o medical deterioration. baclofen oral or intrathecal, botox for smaller mm.

24
Q

TBI

A

dx post coma.

25
Q

signs for TBI

A

LOC, pupil dilation uni/bilateral, motor weakness, confusion, disorentation, headache, blurred vision, vertigo, memory loss

26
Q

epidural hematoma

A

between the inner skull and dura. tends to result in arterial bleed with fast onset of symptoms. “space occupying lesion”

27
Q

subdural hematoma

A

btwn dura and arachnoid. can progress in days or even 2 weeks. “space occupying lesion”

28
Q

subarachnoid hematoma

A

between the arachnoid and the pia-mater.most comm site of hemorrhage. AVM, aneurism, trauma. worst headache ever.

29
Q

Grade 1 concussion

A

transient confusion. no LOC. sx resolve in 15 minutes.

30
Q

Grade 2 concussion

A

takes longer than 15 minutes to resolve.no return to activity until a week after any symptoms have cleared.

31
Q

Grade 3 concussion

A

LOC, seconds or minutes, immediate hospitalization.

32
Q

2nd impact syndrome

A

sustaining a second head injury soon after the first, possibly before the brain has healed.

33
Q

post concussion syndrome

A

dizziness, impaired memory and concentration, sensitivity to light, headache, irritability. weeks-months to resolve.

34
Q

concussion tx

A

eval at 1-3 and 24 hours. rest, monitor sign and symptoms and get imaging if symptoms persist. risk of concussion goes up with each concussion and more so after a 2nd or third.

35
Q

CTE

A

chronic traumatic encephalopathy-only diagnosed on autopsy. come on 10-15 later. often seen first as a personality change (depression and emotional lability w/ lack of impulse control). some movement abnormalities and cognitive changes.