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Pt Assess II Final > Evaluation of Comatose Patient Lecture > Flashcards

Flashcards in Evaluation of Comatose Patient Lecture Deck (30)
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1

If a patient is conscious and responsive, how should you objectively describe them?

Awake, alert and appropriate

2

If a patient is unresponsive, how should you report/describe this?

Report how they respond to various stimuli starting with the LEAST invasive

3

Describe verbal stimuli of an unconscious patient

-Start by calling pt's name
-Describe how they respond
-See if they can follow commands (stick out your tongue, open your eyes)

4

Which verbal commands are easiest to follow?

Midline commands

5

What are examples of midline commands?

Stick out your tongue
Open your eyes

6

If a patient can follow midline commands, what should be tried next?

Peripheral commands
(lift your R hand, squeeze my finger)

7

What are examples of peripheral commands?

Lift your R hand
Squeeze my finger

8

Example of a complex or 2 step command?

Squeeze your eyes shut and hold up 2 fingers

9

Stimuli from least invasive to most invasive for unconscious patient

-Visual
-Verbal
-Tactile
-Noxious (painful)

10

Describe tactile stimuli

-Tapping pt on shoulder or chest
-More invasive than verbal stimuli

11

Describe noxious stimuli and how they can be delivered

-More invasive than verbal or tactile stimuli
-Pressure on base of nailbed
-Pressure on superior aspect of orbit
-Nipple tweak/pinch

12

Possible patient responses to noxious stimuli?

1. Appropriate (moves to push stimulus away)
2. Moan/move without purpose
3. Posturing

13

Types of posturing responses to noxious stimuli

1. Decorticate
2. Decerebrate

14

What is decorticate posturing?

-Flexor rigidity w/adduction of shoulder, flexion of elbow/wrists/fingers
-IR of legs w/plantar flexion of feet

15

What does decorticate posturing indicate?

Destructive lesion in cerebral hemispheres at or near level of corticospinal tracts

16

What is decerebrate posturing?

-Extensor rigidity w/adduction of shoulder, extension of elbow
-Pronated wrists, flexed fingers
-Legs extended, foot plantar flexed

17

What does decerebrate posturing indicate?

Brainstem level lesion usually in pons or midbrain

18

Is posturing unilateral or bilateral?

Could be either

19

Which posturing carries a worse prognosis?

Decerebrate

20

Poorest prognostic indicator to noxious stimuli?

Unresponsive
(worse than posturing)

21

Describe CN exam of comatose patient

LIMITED
-3/4/6 tested for "dolls eyes" and pupillary response
-5 and 7 tested by corneal reflex

22

DTRs of comatose patient

-Can be tested but not very helpful in a profoundly comatose pt
-Can be found even in brain dead pts

23

Describe "dolls eyes" test

-Tests for oculocephalic reflex (CN 3/4/6) in comatose patient
-Rapidly turn head to right and then left
-Pt should maintain gaze straight ahead or toward contralateral side despite head movement (dolls eyes present)
-If you get no response, this is absent Dolls eyes

24

CN 3 palsy in Dolls eye test

Affected eye will move laterally but NOT medially with Dolls maneuver

25

CN 6 palsy in Dolls eye test

Eye will move medially but NOT laterally

26

Doll's eyes test should NOT be performed in which patients?

Possible cervical fractures or responsive/awake patient

27

Motor, sensory, cerebellar testing of comatose patient

CANNOT be done

28

Describe Glasgow coma scale

-Method to quantitatively assess comatose patient
-Scored based on motor, verbal, and eye opening responses

29

Describe GCS scores

-Lower score is worse prognosis
-Pts w/initial score of 3-4 have 95% chance of dying or remaining in vegetative state
-Pts w/score of 3-8 are considered comatose

30

What GCS scores are considered "comatose"?

3-8