PD Neuro Part 1 Flashcards Preview

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Flashcards in PD Neuro Part 1 Deck (225):
1

Concerning neuro symptoms

Changes in mood, attention, or speech
Changes in memory, orientation, insight, or judgement
Delirium or dementia
Headache
Pain
Dizziness or vertigo
Weakness
Numbness/loss of sensation
Syncope
Seizures
Tremors or involuntary movement

2

Areas of neuro exam

Mental status
Cranial nerves
Motor system
Sensory system
Reflexes

3

Mental status exam

Total expression of a person's emotional responses, mood, cognitive functioning, and personality
Determined throughout interview

4

Mental status exam appearance and behavior

Grooming
Emotional status
Body language

5

Mental status exam emotional stability

Mood and feelings
Thought processes

6

Mental status exam cognitive abilities

State of consciousness
Memory
Attention span
Judgement

7

Mental status exam speech and language

Voice quality
Articulation
Comprehension
Coherence
Aphasia

8

Prep for mental status exam

Make patient comfortable and secure
Make it easy for patient to talk freely
Trust, confidentiality, desire to help

9

Difficult to separate ... from ... history

Separate medical from psychiatric history

10

History for MSE

ETOH use
Drug abuse
Recent medications
Suicidal thoughts/attempts
Homicidal/unusual behavior
History of mental illness

Previous hospitalizations
Prior visits to practitioners
Family history
Birth and developmental hx
School record
Work experience
Antisocial behavior/legal problems
Marital hx
Interpersonal relationships
Home life
Military hx

11

Describing speech

Soft
Loud
Stuttering
Hesitancy
Accent
Enunciation
Rate
Relationship to motor activity
Delay
Coherency
Disorganized speech

12

Delusion

Abnormalities in the content of thought
False beliefs which cannot be explained, including by patient's cultural background

13

Types of delusion

Persecutory
Jealousy
Sin or guilt
Gradiose
Religious
Somatic
Reference
Being controlled
Mind reading
Thought broadcast
Thought insertion
Thought withdrawal

14

Hallucinations

Abnormalities in perception, which occur in the absence of some identifiable external stimulus

15

What sensory modality are affected by hallucinations?

All:
Hearing
Sight
Smell
Taste
Touch

16

What must a patient describe about hallucinations?

Must describe an actual, specific perception

17

Questions for suicidal homicidal ideation

Very important to remember these questions in all psychiatric examinations
Ask directly about thoughts of self harm or harming others
Do you have a plan?

18

Risk factors for suicide

Hx of mental DO
ETOH or drug abuse
Major physical illness
Job loss
Relationship loss
Lack of support system
Impulsive behavior

19

Activities of daily living dependent on...

Patient's mental status

20

Basic ADLs

Bathing
Dressing
Toileting
Feeding
Ambulating

21

Instrumental ADLs

Housekeeping
Grocery shopping
Meal preparation
Managing medications
Communication skills
Money management

22

Glasgow Coma Scale

Used to quantify consciousness when a patient has altered level due to head trauma or hypoxic event
Developed to predict mortality and for emergency assessment of consciousness

23

What two brain components do we assess with a GCS?

Cerebral cortex and brainstem

24

3 factors of GCS

Eye opening - 4 points
Verbal response - 5 points
Motor response - 6 points

25

Max and min GCS

3-15

26

Eye opening

4 - spontaneously
3 - speech
2 - pain
1 - none

27

Verbal response

5 - orientated
4 - confused
3 - inappropriate
2 - incomprehensible
1 - none

28

Motor response

6 - obeys commands
5 - localizes pain
4 - withdraws from pain
3 - flexion to pain
2 - extension to pain
1 - none

29

Unexpected levels of consciousness

Confusion
Lethargy
Delirium
Stupor
Coma

30

Confusion

Inappropriate responses to questions
Decreased attention span
Decreased memory

31

Lethargy

Drowsy, falls asleep easily
When aroused, responds appropriately

32

Delirium

Confusion accompanied by agitation or hallucinations
Inappropriate reactions to stimuli
Confusional state characterized by disturbance of consciousness, impaired attention, and change in cognition

33

Stupor

Arousable for short periods by questions or painful stimuli

34

Coma

Motionless
Unresponsive to stimuli

35

Mini mental state exam

Standardized method for grading the cognitive state of patients

36

Max score for mini exam

30

37

Depressed patients without dementia score for mini exam

24-30

38

Score of 20 or less on mini exam

Dementia
Delirium
Schizophrenia
Affective disorder

39

Components of mini mental status exam

Orientation: season, D/M/Y, day, city, state, hospital
Registration - name 3 objects, have pt repeat
Attention/calculation - serial 7s
Recall - repeat 3 objects
Language - pt says "no ifs, ands, or buts about it"
Pt follows 3 step command

40

Dementia

Syndrome of failing memory and impairment of other intellectual functions, behavioral abnormalities, and personality changes
Chronic progressive deterioration of the brain
Usually related to obvious structural diseases of the brain tissue
Most causes non-reversible

41

Dementia symptoms

Insidious onset
Cognitive impairment - permanent and progressive
Agnosia
Speech/language -disordered, rambling, incoherent, struggles to find words
Mood and affect - depressed, apathetic, uninterested
Delusions
NO hallucinations

42

Agnosia

Loss of ability to recognize persons, objects, etc

43

Types of dementia

Alzheimer's
Vascular dementia - multi-infarct dementia
Lewy body dementia
Alcohol induced
Parkinson's

44

Delirium

Confusional state characterized by disturbance of consciousness, impaired attention, and change in cognition
Confusion accompanied by agitation or hallucinations
Inappropriate reactions to stimuli

45

Etiology of delirium

Hypoxia or hypercapnea
Sepsis
Uremia
Electrolyte imbalance
ETOH withdrawal
Meds
Brain injury
Liver failure

46

Is delirium curable?

Yes - reversible if treating underlying problem

47

Delirium symptoms

Acute onset
Duration - hours to days
Anxiety, intense
Decreased memory
Decreased attentiveness
Decreased consciousness
Delusions/hallucinations - visual, auditory, tactile
Mood/affect - rapid mood swings, fearful, suspicious, agitated
Disturbed sleep

48

Depression

Common psych illness
Symptoms range from mild to psychotic
Episodic or persistent

49

Causes of depression

Grief
Reaction to medical DO

50

Symptoms of depression

Mood and affect - extreme sadness, anxious, irritability
Somatic c/o - decreased appetite, HA, constipation, fatigue
Speech - slow/sluggish, slow to respond
Cognitive - c/o memory loss, inability to concentrate

51

CNS

Brain and spinal cord
Main network of coordination and control of body

52

PNS

Carries info to and from the CNS
Motor and sensory nerves
Ganglia

53

How is the CNS protected?

Skull
Vertebrae
Meninges
CSF

54

3 layers of meninges
Produce and drain...

Dura mater
Arachnoid mater
Pia mater
Produce and drain CSF

55

Where does CSF circulate?

Between an interconnecting system of ventricles in the brain and around the brain/spinal cord

56

Arteries to brain

2 internal carotid
2 vertebral
1 basilar

57

Veins draining brain

Venous sinuses that empty into the internal jugular veins

58

4 major regions of brain

Cerebrum
Cerebellum
Brainstem
Diencephalon

59

Brainstem

Medulla oblongata
Pons
Midbrain

60

Diencephalaon

Thalamus
Hypothalamus
Pituitary

61

Brain tissue colors

Gray or white

62

Gray matter

Made up of neuronal cell bodies
Rims surface of cerebral hemispheres forming cerebral cortex

63

Deep clusters of gray matter

Basal ganglia
Thalamus
Hypothalamus

64

White matter

Consists of neuronal axons coated with myelin, allows nerve impulses to travel faster

65

Lobes of cerebrum

2 hemispheres each divides into 4 lobes

66

Frontal lobe

Motor cortex - voluntary mvmt
Speech formation
Areas for emotions, affect, drive, self-awareness
Autonomic response related to emotional stress

67

Frontal lobe area for speech

Broca's area

68

Parietal lobe

Processes sensory data
Interpretation of tactile sensations - pain, temp, texture
Visual, gustatory, olfactory, auditory sensation
Comprehension of written words, proprioception, recognition of body parts

69

Occipital lobe

Primary vision center and interpretation of visual data

70

Temporal lobe

Responsible for perception and interpretation of sounds
Speech area - comprehension of spoken word and written language
Integration of taste, smell, and balance, as well as behavior, emotion, and personality

71

Temporal lobe area for speech comprehension

Wernicke's

72

Cerebellum

Aids the motor cortex of cerebrum in the integration of voluntary movement
Processes sensory info from eyes, ears, touch receptors, musculoskeleton
Utilizes sensory data to control muscle tone, equilibrium, and posture

73

Brainstem

Pathway between cerebral cortex and spinal cord
Control involuntary functions

74

Components of brainstem

Medulla oblongata
Pons
Midbrain
Diencephalon

75

What structures arise from brainstem?

Nuclei of the 12 cranial nerves arise from these structures

76

Cranial nerves

Peripheral nerves that arise from brain instead of spinal cord
Motor and/or sensory function

77

4 CN with parasympathetic functions

III, VII, IX, X

78

Basal ganglia

Pathway and processing station between motor cortex and upper brainstem

79

Autonomic nervous system

Regulates internal environment of body
Person has no voluntary control
2 divisions - balance the impulses of the other

80

Sympathetic nervous system

Prods body into action during time of physiologic and psychologic stress

81

Parasympathetic nervous system

Conserves body resources and maintain day-to-day body functions (digestion and elimination)

82

Spinal cord

Extends from medulla to L1-L2
Conus medullaris
Cauda equina
Sensory, motor, autonomic impulses between brain and body

83

Level of cauda equina

L4

84

White matter tracts of SC

Ascending and descending tracts

85

Gray matter of SC

Butterfly shape with anterior and posterior horns

86

Descending spinal tracts originate in...

Brain

87

Pyramidal tract

Great motor pathway that carries impulses for voluntary movement

88

Ascending spinal tracts

Mediate various sensations

89

Posterior dorsal column

Carry fibers for discriminatory sensations of touch, deep pressure, vibration, position of joints, stereognosis, +2 point discrimination

90

Spinothalamic tracts

Carry fibers for crude touch, pressure, temp, and pain

91

... Motor neurons make up the descending pathways from brain to spinal cord

Upper motor neurons

92

Lower motor neurons originate... and terminate...

Originate in anterior horn
Terminate in muscle fibers

93

How many pairs of spinal nerves?

31 pairs
8 cervical
12 thoracic
5 lumbar
5 sacral
1 coccygeal

94

Spinal nerves arise... and exit...

Arise from SC and exit at each intervertebral foramen

95

Dermatome

Sensory and motor fibers of each spinal nerve supply and receive information in a specific body distribution

96

Formation of nerve plexus

Anterior branches of several spinal nerves combine

97

Spinal nerve separates into...

Ventral and dorsal roots

98

Ventral root

Motor fibers carry impulses from SC to the muscles and glands of the body

99

Dorsal root

Sensory fibers carry impulses from the sensory receptors of the body to the SC

100

Impulses from dorsal root travel...

Up to brain for interpretation
Initiate reflex action when it synapses immediately with motor fiber after a stimulus

101

Reflex arc

Dependent upon intact afferent nerve fibers, functional synapses in SC, intact motor nerve fibers, functional NMJ, and competent muscle fibers

102

When upper motor neurons are damaged above the cross over of its tracts in the medulla, motor impairment develops on what side?

Contralateral

103

In damage below the cross over, motor impairment occurs on what side?

Ipsilateral

104

How many pairs of peripheral nerves?

12 pairs

105

Where do peripheral nerves arise from?

Brainstem/diencephalon

106

Where do these nerves arise from?
I-II
III-IV
V-VIII
IX-XII

I-II diencephalon
III-IV midbrain
V-VIII pons
IX-XII medulla

107

Motor and sensory innervation of the head and neck

Voluntary muscles
Visceral motor
General sensation
Special sensation

108

Name cranial nerves

I Olfactory
II Optic
III Oculomotor
IV Trochlear
V Trigeminal
VI Abducens
VII Facial
VIII Vestibulococchlear
IX Glossopharyngeal
X Vagus
XI Spinal accessory
XII Hypoglossal

109

Which senses are not routinely tested?

Taste and smell are not routinely tested unless abnormality suspected

110

Prep for sensory testing

Patients eyes are closed

111

Sensory testing

Light touch
Sharp versus dull

112

Light touch

Light strokes of cotton swab or brush/monofilament
Ask for when and where stimulus was felt

113

Sharp versus dull

Tests superficial pain
Broken tongue blade, paper clip
Alternate sharp and dull testing in unpredictable fashion
Ask pt if they feel sharp versus dull and location

114

CN I

Special sense of olfaction
Anosmia
Patient closes eyes
Make sure both nares are patent
Occlude one nostril and test smell with familiar, non offensive odor
Test opposite using different odor

115

Causes of anosmia

Nasal disease
Allergies
Trauma
Smoking
Aging

116

CN I skull fracture

Tearing of fibers crossing cribiform plate
CSF rhinorrhea

117

How to distinguish between rhinorrhea and CSF

CSF is salty

118

CN I Frontal lobe mass

Tumors or abscess
Leads to compression

119

CN I damage to primary cortical olfactory area

Temporal lobe
Masses or seizures may present with olfactory hallucinations

120

CN II motor or sensory

Sensory

121

CN II

Visual acuity and visual field testing portion of eye exam
Fundoscopic exam for direct visualization

122

CN III motor or sensory

Motor

123

CN III

Raise eyelids
Extraoccular movements
Parasympathetic - pupillary constriction, changes in lens shape

124

CN IV motor or sensory

Motor

125

CN IV

Downward, inward eye movement
Extraocular movements

126

CN V motor or sensory

Motor and sensory

127

CN V motor

Jaw opening/clenching
Chewing
Mastication

128

CN V sensory

Cornea
Iris
Lacrimal glands
conjunctivae
Eyelids
Forehead
Nose
Nasal and oral mucosa
Teeth
Tongue
Ear
Face
Scalp

129

Divisions of trigeminal
Sensory or motor

V1 - opthalmic (sensory)
V2 - maxillary (sensory)
V3 - mandibular (both)

130

Testing CN V motor

Observe face for muscle atrophy, jaw deviation, fasciculations
Have pt clench teeth as you palpate masseter and temporalis is muscles

131

What condition are you suspicious of with fasiculations?

ALS

132

Testing CN V sensory

Test each division (All 6) for light touch, sharp versus dull

Test corneal reflex

133

What would we test if normal CN V sensory function is impaired?

If impaired, test temp sensation using test tubes filled with hot or cold water in all 6 divisions and compare

134

Who do we test corneal reflex in?

Comatose patients

135

What is the normal response for corneal reflex?

Blink when cotton wisp touches cornea

136

What two CN need to be intact for the corneal response?

CN V and VII

137

Which branch of trigeminal is dangerous to be infected with herpes zoster?

V1 - risk of blindness
Opthalmic emergency!

138

Trigeminal neuralgia

Unilateral pain syndrome, usually limed to 1 division of Cn V
Hot lancinating pain can be debilitating
Ofte associated with trigger - light touch, chewing, sneezing

139

Cause of tic douloureux

Idiopathic

140

Most common patient with CN V neuralgia

Over 60

141

Neuro exam with tic douloureux

Unrevealing

142

Treatment for trigeminal neuralgia

Carbamazepine (Tegretol)
Gabapentin (Neurontin)
Pregabalin (Lyrica)
Microvascular decompression
Gamma Knife

143

CN VI motor or sensory

Motor

144

CN VI

Lateral eye movement

145

CN VII motor or sensory

Motor and sensory, parasympathetic

146

CN VII motor

Movement of facial expression muscles except jaw
Close eyes
Labial speech sounds (b, m, w, p)

147

CN VII sensory

Taste on anterior 2/3 of tongue (salty/sweet)
Taste on posterior 1/3 tongue (bitter)
Sensation to pharynx, auricle, and small area skin posterior

148

Anterior tongue

Anterior 2/3 salty/sweet

149

Posterior tongue

Posterior 1/3 bitter

150

Parasympathetic CN VII

Secretion of saliva and tears

151

CN VII testing facial function

Motor function assessed by facial functions:
Raise eyebrows
Squeeze eyes shut as tightly as possible and against resistance
Wrinkle forehead
Smile
Show teeth
Frown
Purse lips
Puff cheeks
Listen to speech

152

CN VII taste testing

Not routinely done unless abnormality suspected
Four solutions - salty, sweet, sour, bitter
Apply one at a time to area of tongue

153

What other CN are we testing when testing taste with CN VII

CN IX - taste to posterior 1/3 of tongue

154

Reflexes involving CN VII

Corneal V --> VII
Bright light II --> VII
Loud noise VIII --> VII
Suck reflex in infant V --> VII

155

CN VII Bell's palsy

Inability to wrinkle brow
Drooping eyelid
Inability to close eye
Inability to puff cheeks - no muscle tone
Drooping mouth
Inability to pucker or smile

156

CN VIII

Special sense
Auditory info from cochlea
Balance info from semicircular canal

157

Testing auditory CN VIII

Whisper test
Weber
Rinne
Audiometric evaluation

158

Testing vestibular CN VIII

Romberg test

159

Romberg test

Patient stands with feet tightly together, eyes closed, arms out in front
Observe for drifting, loss of balance

160

Positive Romberg test indicates...

Vestibular dysfunction
Cerebellar ataxia
Sensory loss

161

What do you need to make sure to do when doing the Romberg test?

Protect your patient!

162

CN IX motor or sensory

Motor, sensory, parasympathetic

163

CN IX motor

VOluntary muscles for swallowing and phonation

164

CN IX sensory

Sensation of nasopharynx
Gag reflex
Taste - posterior 1/3 of tongue

165

CN IX parasympathetic

Secretion of salivary glands
Carotid body/sinus reflex

166

What nerve is simultaneously tested during examination, and for what sensations?

IX is simultaneously tested during exam of CN X for nasopharyngeal sensation (gag reflex) and motor function of swallowing

167

CN X motor or sensory

Motor and sensory, parasympathetic

168

CN X motor

Voluntary muscles of phonation and swallowing

169

Voluntary muscles of phonation

Guttural speech sounds - harsh sounds produced in throat/back of mouth

170

CN X sensory

Sensation behind ear and part of external auditory canal

171

CN X parasympathetic

Secretion of digestive enzymes
Peristalsis
Carotid reflex
Involuntary action of heart, lungs, and GI tract

172

Gag reflex CN

CN IX and X

173

Gag reflex

Evaluating nasopharyngeal sensation
Tell patient
Touch posterior wall of pharynx with tongue blade
Observe upward mvmt of palate and contraction of the pharyngeal muscles
Uvula should remain midline
No drooping or absence of arch on either side of soft palate should be noted

174

CN IX and X

Motor function is evaluated by again inspecting soft palate for symmetry
Have pt say aahh and observe for mvmt and asymmetry
Easily swallows water
Listen to speech

175

Damage of IX and X

Palate will fail to rise and uvula will deviate from midline
Retrograde passage of water through the nose
Hoarseness, nasal quality, difficulty with guttural sounds

176

CN XI motor or sensory

Motor

177

CN XI

SCM and trapezius innervation

178

Testing CN XI

Have pt shrug shoulders against resistance

179

CN XII motor or sensory

Motor

180

CN XII motor

Tongue movement for lingual speech articulation (l, t, n) and swallowing
Inspect tongue while at rest on floor of mouth and while protruding
Assess strength of tongue by having pt press tongue against inside of each cheek against resistance

181

Tongue deviation with CN XII lesion

Deviates towards lesion

182

Evaluation of proprioception and cerebellar function

Rapid rhythmic alternating movements
Accuracy of movements
Balance (equilibrium, gait)

183

Rapid rhythmic alternating movements

Ask seated patent to pat his hands on his knees with both hands, alternately turning palm up and down
Gradually increase rate

Pt touches thumb to each finger on same hand and increase speed

Movements should be smooth, maintaining rhythm
Looking for stiff, slowed, nonrhythmic, or jerky clonic movements

184

Accuracy of movement tests

Finger to finger test
Finger to nose test
Heel to shin test

185

Finger to finger test

Pt uses index finger to alternately touch his nose and your index finger
About 18 inches away
Moving around

186

Finger to nose test

With eyes closed have pt touch their own nose with their index finger, alternating hands
Increase speed

187

Heel to shin test

Sitting, standing, or supine
Pt runs the heel of one foot down the shin of the other leg
Heel should move straight up and down shin in straight line

188

Equilibrium test

Romberg test

189

If patient staggers or loses balance during Romberg test...

Defer further tests of cerebellar function requiring balance

190

Further test of balance

Push pts shoulder with enough force to throw him off balance
Should recover balance quickly

Pt closes eyes, arms straight at sides, have pt stand on one foot, then the other
Should balance in about 5 seconds

Have pt hop on one foot, then the other
Should maintain balance for 5 seconds or more

191

Gait test

Observe pt walk without shoes
First with eyes open
Then eyes closed

Heel to toe walk
Walk on heels
Walk on tip toes

192

What to note during gait examination

Simultaneous arm movement and posture
Shuffling
Widely placed feet
Toe walking
Foot flop
Leg lag
Scissoring
Staggering
Loss of arm swing

193

Pronator drift

Standing or sitting
Pt puts arms straight out in front, palms up and eyes closed
20-30 seconds
Tap arms briskly downward
Arms should return smoothly

194

What are we testing during pronator drift?

Muscle strength
coordination
Sense of position

195

Positive pronator drift

Pt with upper motor neuron disease
Will not maintain position
Arm will drift down and start to pronate

196

Patients with asterixis

Metabolic encephalopathy

Uremia
Severe pulmonary insufficiency
Cerebrovascular disease

197

Asterixis test

Pt extends both arms in front with hands cocked up and fingers spread (stop traffic)
Sudden, brief, nonrhythmic "flapping" of hands

198

Meningeal signs

Nuchal rigidity
Brudzinski sign
Kernig sign

199

Nuchal rigidity

Patient is supine
Try and flex neck
Should be done with ease and pain free
Pain or resistance to neck motion is positive nuchal rigidity

200

Brudzinski sign

Involuntary flexion of hips and knees when flexing the neck

201

Kernig sign

Flexing the leg at the knee and hip with patient supine
Attempt to straighten the leg
Pain in the lower back and resistance to straightening the leg

202

Abnormal posture in comatose patients

Decorticate rigidity
Decerebrate rigidity

203

Decorticate rigidity

Abnormal flexor response
Upper arms are held tight to sides with elbows, wrists, and fingers flexed
Legs are extended and internally rotated
Feet plantar flexed

204

Cause of decorticate rigidity

Indicates damage to corticospinal tract above brainstem
Ex. IC hemorrhage
Head injury
Increase IC pressure
Stroke

205

Which is more favorable, decorticate or decerebrate?

Decorticate

206

Decerebrate rigidity

Abnormal extensor response
Jaws clenched, neck extended
Arms fully extended, forearm pronated, wrist/fingers flexed
Back may be arched
Feet plantar flexed
May occur spontaneously or only response to stimuli (nose, light, pain)

207

Causes of decerebrate rigidity

Indicates lesion in diencephalon, midbrain, or pons, although severe metabolic DOs (hypoxia, hypoglycemia) may also be the cause

208

Oculocephatlic reflex
If brainstem is intact...

Doll's eyes
Make sure there is no neck injury
Hold open eyelids, then turn head quickly to one side, then to other side
If intact, as head turns to one side, the eyes move towards the opposite side

209

What does oculocephalic reflex assess?

Assesses brainstem function in stuporous or comatose patients

210

Does an alert patient have a oculocephalic reflex?

No, because the reflex is suppressed

211

Cause of lack of Doll's eyes

If reflex is absent, suggests lesion or disorder of midbrain or pons

212

Oculovestibular reflex

Make sure TM intact and external canal is clear
Pts head at 30 degrees
With large syringe, inject cold water into ear canal
Watch for deviation of eyes in horizontal plane

If brainstem is intact, eyes drift toward irrigated ear

213

Do we test the oculovestibular reflex on alert patients?

No

214

What does the oculovestibular reflex assess?

Further assesses brainstem function when oculocephalic reflex is absent

215

Cause of absent oculovestibular reflex

If absent, suggests lesion of pons, medulla, or less commonly CN III, IV, VI, or VIII

216

Determining death for most patients

Cardiac activity
Respiratory activity
Neurologic activity

217

Cardiac activity to determine death

Palpate for pulsations in carotids
Auscultate precordium for heart sounds
If in doubt, get EKG

218

Respiratory activity to determine death

Listen for breath sounds over lungs and mouth
Can hold cold mirror over mouth to look for water vapor

219

Neurologic activity to determine death

Call to patient to test mentation
Retract eyelids - pupils fixed and dilated in death
Rote head from side to side for Doll's eyes
If absent, perform oculovestibular reflex
Sternal run or squeeze Achilles to test for deep pain perception
Lift and let limbs fall to test for muscle tone
Gag reflex

220

Apnea test

Pre-oxygenate
Baseline ABG for CO2 level
Disconnect ventilator (but do not take O2 away)
Administer oxygen
Observe respirations
Draw ABG in 8-10 minutes

221

Brain death criteria of apnea test

pCO2 of greater than 60, or increase of greater than 20 over normal baseline, with no respiratory effort supports a positive apnea test consistent with brain death

222

Brain death

Irreversible cessation of all brain activity
Brain is not capable of maintaining life without advance life support

223

What structure death is equivalent to brain death?

Brainstem death is equivalent to brain death because brainstem is essential to maintain life

224

Does a patient have a heartbeat with brain death?

Yes, they could

225

What happens to patients in a coma?

Some recover
Some enter persistent vegetative state
Some become brain dead