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Flashcards in Stupor and coma Deck (6)
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1

Definitions of arousal 1

-Consciousness: state of full awareness of self and one's relationship to environment
-Delirium: disturbance of consciousness with reduced ability to focus, sustain, or shift attention (develops over short period of time and leaves relatively quickly)
-Obtunded: mild to moderate reduction in alertness, accompanied by a lesser interest in environment. Slow physiologic responses to stimulation (even more unresponsive than delirium)

2

Definitions of arousal 2

-Stupor: deep sleep or unresponsiveness, but can be aroused w/ vigorous and continuous stimulation
-Coma: state of unresponsiveness in which eyes are closed and cannot be aroused from vigorous stimuli
-Minimally conscious state: severely impaired consciousness in which minimal but definite evidence of behavior or environmental awareness is demonstrated (typically transition from conscious -> unconscious)
-Vegetative state: crude cycling of arousal states heralded by appearance of "eyes-open" periods in an unresponsive patient (no interaction w/ outside world)
-Persistent vegetative state: vegetative state for 30 days

3

Pathophysiology of consciousness

-Bithalamic tracts, bihemispheric tracts, and the reticular activating system (RAS) are all responsible for maintaining consciousness
-These pathways can be damaged (either structurally or non-structurally) to reduce consciousness
-Structural damage: tumors, stroke, hemorrhage, abscesses, ect
-Non-structura: infections, drugs, metabolic disorders, ect

4

Approach to the comatose pt

-Level of consciousness
-Pattern of breathing
-Size and reactivity of pupils
-Eye movements and oculovestibular responses
-Skeletal motor responses

5

General examination of comatose pt

-Examine the room (ventilator, sedative, ect)
-Physical: signs of trauma, check skin, resistance of neck to flexion
-Coma exam: Determine intensity of stimulation (voice, shaking, pain) required to get a response and the quality of the response

6

Decorticate vs decerebrate

-Decorticate: flexor posturing of upper extremities and extension of lower extremities (can be unilateral)
-In upper midbrain and higher (above red nucleus)
-Decerebrate: extensor posturing of both upper and lower extremities (can be unilateral)
-Progression of lesion to red nucleus (and below)

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