Flashcards in coma Deck (26):
1
no alteration of arousal
alert
2
motor slowness, tired, easily aroused, aware of self/environment
lethargy
3
unresponsiveness from which the patient can be aroused only be vigorous, often noxious stimuli
stupor
4
unarousable unresponsiveness
coma
5
unconsciousness occurs via what mechanisms (2)
1. affects both hemispheres
2. affects brainstem
6
where the system of arousal begins
reticular formation
7
where does the reticular formation reside?
posterior to pons
8
signs of trauma (4)
1. raccoon eyes
2. battle sign
3. hemotypanum
4. rhinorrhea or otorrhea
9
how to assess brainstem?
respirations, pupils, eye movements, motor
10
slow oscillation b/w hyper and hypoventilation
cheyne stokes respiration
11
normal respiration indicates that what is intact
brainstem + forebrain
12
rapid continuous hyperventilation 25+ bpm
central neurogenic respiration
13
prolonged inspiratory gasp with pause at full respiration
apneustic breathing
14
periodic respirations w/ variable amplitude & frequency with variable pauses b/w clusters
cluster
15
irregular breathing rate and rhymthm
ataxic
16
what type of brain problems are most commonly assc'd with cheyne stokes
diffuse (metabolic, infectious, toxic)
17
which respiratory pattern is the only one not assc'd with the brainstem?
cheyne stokes
18
pinpoint pupil that are reactive indicates lesion where?
pontine
19
dilated, asymmetric and fixed pupil
uncal
20
how to elicit eye movement in comatose patient (2)
1. oculocephalic reflex
2. vestibulo-oculogyric reflex
21
which test to use when suspect someone is braindead
vestibulo-oculogyric reflex
22
if brainstem is intact in comatose patient, which direction will the eyes deviate when cold water is injected into the ear?
towards the cold
23
bilateral flexion at the elbows/wrists with extension of lower extremities
decorticate posturing
24
bilateral extension of elbows with extension of lower extremities
decerebrate posturing
25
metabolic onset is ____vs structural is___
slower; faster
26