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