Coma, Cohen Flashcards Preview

Year 2 neuro exam 2 > Coma, Cohen > Flashcards

Flashcards in Coma, Cohen Deck (33):
1

most common causes of comas

cardiac pulmonary failure
drug alcohol overdose
severe derangements of oran function with abnormal serum chemistries of pH: hypoglycemis, renal failure etc
stroke or hemorrhage
cranial truma
infections
psychiatric pseudo coma or catatonia

2

how long for cardiac or pulm failure before in coma

5 minutes
hypoxic ischemic damage throughout brain

3

important part about addressing a comatose patient

learning the history
chornic conditions, drug use, psych disorder etc

4

what aspect of coma is important to Dx and prognosis

duration of coma

5

Immediate steps for comatose patient

stabilize ABC
BP perfusion check
peripheral or central IV line
intubation/ventilation if needed
look for evidence of trauma
Hx from witnesses, family etc
comprehensive labs like CBC and toxicology
check if any chance opiate overdose(give naloxone)

6

Decerebrate

arm and leg in extension
brainstem or thalamus injury

7

decorticate

arms flex legs extended
widespread damage to both hemispheres

8

posturings

posture of coma patient that indicates serious disorder

9

general neuro exam of comatose patient

observe:
spontaneous respiration or ventilator dependent
spontaneous movement, unilateral etc
abnormal movements like tremors or jerks
response to voice, physical stimulation or none
general appearance

10

Brainstem functions to check on comatose patient

pupillary light reaction
pupillary diameters
corneal reaction
eye movements
oculocephalic reflex
oculovestivular reflex
gag

11

pupillary light reaction

CN II and III

12

pupillary diameters

II III

13

corneal reacion

CN V VII

14

CN eyemovements

III IV VI

15

what is oculocephalic reflex

dolls eyes
eyes in opp direction of head turn if no inhibition of hemispheres

16

oculovestibular reflex

cold calorics
eyes deviate conjugately toward ear given ice water, nystagmus away
pons and medulla
or eye deviate away or ear with warm water nystagmus towards

17

first reflex usually to be lost

gag

18

last reflex to be lost

pupillary light reaction

19

Where are nuclei for CN III

top of brainstem in midbrain

20

what can compress CN III nuclei

if there is uncal herniation of ipsilateral and sometimes contralateral

21

what will it look like with compromise to nuclei of CN III

dilated unreactive pupil
can still move eye lateral

22

most important signs for prognostic indicator for comatose patient

pupillary reaction to light
spontaneous movements

23

what patients are exempt from 5% living after coma for 72 hours

trauma swelling, sedation from drug overdose, hypothermia, multiple missing brain stem reflexes

24

brain dead means what

legally dead

25

requirements for brain death

no evidence cerebral function
no response to stimulation
no movements
no vocalization
no evidence brainstem function

26

how to confirm loss of brainstem function

apnea test
ventilator turned off but 100% O2 still given
if CO2 rises to 60mmHg and there is no respiratory effort = brain dead

27

when to tell family about coma

right away
no matter what before 72 hours

28

families relieved to learn what of comatose patients

no pain or suffering

29

Tx brain death patients

no further Tx. Kept until organs can be taken if donator

30

Vegetative state

loss of cerebral hemispheres but maintenance of part or all of brainstem

31

vision in vegetative state

have gross vision but no specific response to what patient "sees"

32

Criteria for persistent vegetative state

>1 mo vegetative state
no awareness self surroundings
no meaningful communication
facial expressions not accurate to stimulation
sleep wake cycles can be intact
arm or leg movements but no voluntary control
CV function maintained
incontinent bowle and bladder

33

prognosis vegetative state

hopelessafter 1 mo
by 3 mo definitely hopeless