Flashcards in Coma Deck (13):
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
By GCS definition, "coma" means ____________.
- inability to follow commands
- inability to speak recognizable commands
- inability to open either eye
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.
The Uniform Determination of Death Act defines death as _________________.
(1) irreversible cessation of cardiopulmonary function or (2) irreversible cessation of brain function
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
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)
What is the cold caloric test?
Pour 20 mL in the external auditory canal. A positive result is eye movement.
How do you elicit a cough reflex?
Suction the carina – this tests CN X
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.
Consciousness is ____________________.
the product of biological events occurring within deep anatomical structures of the brain called the brainstem and thalamus
Plum and Posner – in 1982 – defined unconsciousness as ______________________.
"bilateral impairment of cerebral functions or failure of the brainstem ascending reticular activating system or both"
Upper extremity ______________ suggests a decerbrate (upper brainstem) lesion with a worse prognosis.
extension (EXTension = EXTra bad)