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44 Cards in this Set

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