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44 Cards in this Set
- Front
- Back
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WHAT IS THE SINGLE MOST IMPORTANT SYMPTOM OF NEUROLOGICAL PROBLEMS?
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CHANGE IN LEVEL OF CONSCIOUSNESS.
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WHAT ARE THE 2 COMPONENTS OF THE CONSCIOUS STATE?
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IS PATIENT AWAKE? ALERT
AWARENESS - ABLE TO REACT IN A PURPOSEFUL MANNER WITH THEIR ENVIRONMENT. (EVEN IF IT'S JUST PULLING BACK FROM A PAINFUL STIMULI) |
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WHAT DOES AWARENESS INDICATE?
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INDICATES THE CEREBRAL CORTEX IS INTACT.
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A CONSCIOUS PERSON IS BOTH -
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AWAKE - OPENS EYES AND
AWARE - RESPONDS WITH PURPOSE (OPENS EYES OR WITHDRAWS FROM PAIN) |
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UNCONSCIOUS STATE
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COMATOSE - PERSON NEITHER AWAKE NOR AWARE. RAS NOT INTACT AND PERSON DOESN'T RESPOND WITH PURPOSE.
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WHEN SOMEONE IS COMATOSE IS USUALLY INDICATES A PROBLEM WITH ...
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UPPER BRAIN STEM - COULD BE CEREBRAL
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PERSISTANT VEGETATIVE STATE
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OPERATES ON SOME INNER CYCLE THAT APPEARS LIKE SLEEP/WAKE CYCLES. LOOKS LIKE RAS IS FUNCTIONING, BUT DON'T REACT WITH PURPOSE TO ENVIRONMENT; NO RESPONSE TO PAINFUL STIMULI.
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A PERSISTANT VEGETATIVE STATE IN INDICATIVE OF WHAT KIND OF PROBLEM?
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PROBLEM BETWEEN RAS AND CEREBRAL CORTEX. MAY BE GLOBAL - ANOXIA AT CHILDBIRTH, COULD BE A STROKE.
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LOCKED IN SYNDROME
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PT. IS BOTH AWAKE AND AWARE BUT CANNOT RESPOND TO STIMULI.
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WHAT IS THE CAUSE OF LOCKED IN SYNDROME?
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MOTOR DEFICITS. DAMAGE TO BRAIN IS IN MOTOR PATHWAYS THAT COME DOWN FROM BRAIN. COULD BE STROKE, GUILLIAN BARRE SYNDROME. INTELLECTUALLY KNOW WHAT'S GOING ON BUT CAN'T RESPOND.
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WHAT IS THE BEST WAY TO ASSESS UNCONSCIOUS STATE?
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DESCRIBE BEHAVIOR BECAUSE MOTOR RESPONSE IS THE MOST INCONSISTENT WITH DIFFERENT ASSESSORS.
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GLSASGOW COMA SCALE
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PROVIDES A QUANTITATIVE MEASURE OF LOC
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WHAT DOES THE GLASCOW MEASURE?
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ALERTNESS - OPENS EYES
AWARENESS - VERBAL AND MOTOR RESPONSES TO STIMULI - OBEYS COMMANDS. |
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WHAT IS THE SCALE OF THE GLASCOW?
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3 TO 15
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WHAT SCORE IS CONSIDERED A COMA?
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7 OR LESS
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what Glascow score is considered dead?
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3
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decorticate posturing
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problem in cerebral cortex
legs internally rotate, extend toes, point down, flexion of arms, wrist, fingers |
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decerebrate posturing
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abnormal extension of arms, wrists hyperextend. Worse damage on R side of brain. Brain stem problem.
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which posturing is worse?
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decerebrate posturing
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irreversible coma
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cerebral death w/ intact brain stem; RES doesn't function; pt. appears to be sleeping, don't respond to stimuli.
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Does pt. in irreversible coma have sleep/wake cycle?
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no
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Does pt. in irreversible coma require a vent. or life support.
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No, because brain stem intact - BP, RR works.
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Brain death
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Cerebral and brain stem death
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who can declare a person brain dead?
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2 doctors, if concur
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What criteria do doctors look at when deciding if pt. is brain dead?
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No motor or reflex movements to pain.
No spontaneous respirations. No cephalic reflexes. |
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What do doctors usually do to assess motor or reflex movements to pain?
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pinch, pressure on periorbits; pressure under nails.
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What do doctors usually do to assess spontaneous resp?
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take off vent for a while; after CO2 good, well-oxygenated, take off; watch and wait until CO2 is above 60- about 6 minutes.
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What do doctors usually look at when assessing cephalic responses?
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Pupillary constriction - Cr. Nerve III
Has to be fully dilated and nonreactive. If see any movement or pinpoint pupils - not brain dead. |
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What is necessary for pt. to be off of to test for brain death?
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pt. should be off all sedatives.
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Doll's eyes
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Cr nerves III, IV, VI, VIII
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What is positive doll's eyes?
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Normal when move head to L, eyes deviate to R and vice versa
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What is negative doll's eyes?
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When move head L to R eyes don't deviate. Eyes are fixed - brain death.
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Corneal Reflex
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Cr. nerves V (tearing up), VII (blink)
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What is positive corneal reflex?
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normal if touch cornea, eye tears up and person blinks.
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What is negative corneal reflex?
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No tearing, no blinking - brain death
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Caloric Stimulation
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Cr.nerves III, IV, VI, VIII
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What is normal or positive caloric stimulation?
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Inject ice water in ear, eyes will deviate in direction of stimuli. Warm water injected in R eye - get nastagmas on L side.
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What is negative caloric stimulation?
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no response, brain dead
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what is nystagmas?
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involuntary rapid movement of eyeballs.
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Flat EEG
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no electrical currents in brain
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persistance of negative response to assessment criteria for how long can define brain death?
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persistance of the signs for 30 minutes after 6 hours of comatose state.
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What does Alabama law require for a pt. to be declared brain dead?
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Independant evals by 2 doctors licensed to practice in state.
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Is EEG required by law to declare pt. brain dead?
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No, but it may be required by institutional policy or physician practice.
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Can a physician take a pt. off a vent without family's consent?
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Yes
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