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MS2 - Nervous System > Coma > Flashcards

Flashcards in Coma Deck (13):
1

Differentiate the terms delirium, stupor, and coma.

Delirium: fluctuating levels of consciousness with misperceptions and inability to maintain attention

Stupor: a sleep-like state from which the patient can only be aroused by vigorous stimuli

Coma: a state from which the patient cannot be aroused by stimuli; no sleep-wake cycles

2

By GCS definition, "coma" means ____________.

- inability to follow commands
- inability to speak recognizable commands
- inability to open either eye

3

Define vegetative state.

A state in which sleep-wake cycles reestablish, but no cognitive function is present. A patient may open eyes spontaneously, but there is no evidence of perception, communication, or purposeful motor activity.

4

The Uniform Determination of Death Act defines death as _________________.

(1) irreversible cessation of cardiopulmonary function or (2) irreversible cessation of brain function

5

The three criteria of brain death (for the Death Act) are ____________________.

(1) unresponsiveness, (2) lack of motor response to painful stimuli, and (3) absence of brainstem reflexes

6

Brain death is determined by neurologic finding of _____________.

(1) core body temp of less than 90° F
(2) toxicology tests find no explanation for neurologic state (CNS depressants must be subtherapeutic)
(3) adequate BP and pulse (SBP greater than 90; HR greater than 50
(4) no voluntary movements to pain or otherwise (spinal reflexes are not included in this)

7

What is the cold caloric test?

Pour 20 mL in the external auditory canal. A positive result is eye movement.

8

How do you elicit a cough reflex?

Suction the carina – this tests CN X

9

The apnea test is done by __________________.

disconnecting the ventilator. If the patient has even a little brainstem function, then they will start breathing deeper/faster. If they don't, then they will not. The test is stopped when the patient's pCO2 has risen 20 mmHg above normal and no ventilatory effort is present.

10

Consciousness is ____________________.

the product of biological events occurring within deep anatomical structures of the brain called the brainstem and thalamus

11

Plum and Posner – in 1982 – defined unconsciousness as ______________________.

"bilateral impairment of cerebral functions or failure of the brainstem ascending reticular activating system or both"

12

Upper extremity ______________ suggests a decerbrate (upper brainstem) lesion with a worse prognosis.

extension (EXTension = EXTra bad)

13

Vegetative state is considered permanent ____ months after an anoxic event and _____ months after trauma.

3; 12

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