Coma, persistant vegetive state, brain death

Question 1

What is a coma?

Answer 1

“A state of unrousable psychological unresponsiveness in which the subjects lie with eyes closed and show no psychologically understandable response to external stimulus or inner need”

Question 2

What is the gcs fior cima?

Answer 2

less than or equal to 8

2 or less for visual or and verbal

4 or less for motor

Question 3

What does consciousness depend on?

Answer 3

working cerebral cortex AND ascending reticular activating system

Question 4

What are teh common cuases of a reduce gcs?

Answer 4

Toxic/metabolic states:
-Hypoxia/hypercapnia/sepsis/hypotension
-Drug intoxication/renal or liver failure
-Hypoglycaemia, ketoacidosis

Seizures

Damage to reticular activating system

Causes of raised intracranial pressure:
tumour, stroke, EDH, SDH, SAH, hydrocephalus

Question 5

PAttterns of breathing: decreased/increased/fluctuating meaning

Answer 5

Increased = hypoxia/hypercapnia/acidosis

Decreased = likely drug induced/overdose/metabolic issues

Fluctuating =brainstem involvement/issues

Question 6

Other than ABC what do you need to look for?

Answer 6

continue!!
D - disability (and Dont forget Glucose!)

-glucose,biochem, haematology, blood gas, toxicity.

Check for meningitis!

Establish baseline bp, pukse, temp

Question 7

What neurological assesments would you do?

Answer 7

GCS, Brainstem, Motor and reflexes

Question 8

How do you test brainstem function?

Answer 8

Several tests:

Pupillary responce (II and III)
Corneal responses (V+VII)
Spontaneous eye movement (III,IV, VI)
Oculocephalic responses (Doll’s eye) (III, IV, VI, VIII)
Oculovestibular responses (III, IV, VI, VIII)
Respiratory pattern (Medullary centre
)

Question 9

How can you test ofr motor function?

Answer 9

Motor response
Muscle tone
Tendon reflexes
Seizures

Question 10

SEE ANKI (given up lol - there is a few more tho - rejuvinated by lots of unhealthy food - 3 slices of pie, cake, cream and nutella crumpet

Question 11

What is locked in syndrome?

Answer 11

When below cranial nerve 3 is all cut off. Can move eyes up and down but not much more than that

Question 12

What do you need to do if they are in a coma?

Answer 12

Maintain vital functions , skin, bladder and bowl, control siezures, prophylaxis dvt, consider locked in syndrome

Question 13

What is GCS scoring: eyes
Verbak response
Motor response

Answer 13

Eyes 4
1 = none
2 = pain
3 = speech
4 = spontaneous (open)

Verbal (5)
1= none
2 = incomprehensible sounds
3 = inappropriate words
4 = confused
5 = orientated

Motor (6)
1 = none
2= extends to pain
3 = flexes to pain
4 = withdrawing from pain
5 = localising to pain
6 = obeying commands