Ns-Coma

Front 1

What is coma?

Back 1

A symptom: pathological unresponsiveness to ext stim or inner needs(only reflex)

Front 2

What are the the 2 components of consciousness?

Back 2

Reciprocal interactions of 1) Arousal 2) Content

Front 3

What is responsible for arousal?

Back 3

RAS (crude)

Front 4

What is responsible for content?

Back 4

Ctx & Basal Ggl

Front 5

What can produce coma?

Back 5

Impairment of either arousal or content

Front 6

What is the scale of consciousness?

Back 6

Alert, lethargic, obtunded, stupor, coma

Front 7

What is the reticular formation located? Function?

Back 7

Is @ the central core of BS. Imvolved in control of movement, modulation of pain, & autonomic reflexes

Front 8

What part of the brain is responsible for control of movement?

Back 8

Pontomedullary

Front 9

What part of the brainstem is responsible for mod of pain?

Back 9

midbrain & pons

Front 10

Where is RAS located?

Back 10

Reticular formation in the core of the upper BS

Front 11

What are in inputs to the Retic form?

Back 11

From every sensory sys

Front 12

What are the outputs form retic form?

Back 12

Projections to the thalamus (diffuse, intralaminar, basal forbrain, hypothal) & ctx

Front 13

What is the function of RAS

Back 13

Involved in sleep/wake & arousal/consciousness

Front 14

What are the 2 substrates of coma

Back 14

1) Bilat hemisphere destruction 2) Upper midbrain injury (pontine retic form structural or functional)

Front 15

What can cause bilat hemisphere injury? Type of coma produced?

Back 15

1) diffuse ischemia (irreversible) 2) Barbituate OD (reversible depression of entire ctx)

Front 16

What ca cause the upper midbrain injury?

Back 16

Primary lesion in BS or compression from cerebral displacement (herniation)

Front 17

What neurotransmitter is produced by the retic form?

Back 17

Ach

Front 18

What are the 4 rules of coma?

Back 18

1) Glucose/thiamine/naloxone (reversible) 2) Bilat hemisphere or upper midbrain injury 3) Structural, metabolic, seizure disease processes 4) Exam (4)

Front 19

What are the 3 ways disease can produce coma?

Back 19

1) structural (hematoma, infarct) 2) Seizure (prolonged ictal or postictal) 3) Metabolic (normal imaging)

Front 20

What can cause metabolic coma?

Back 20

ubstrate deprivation, Dearangements in water, electrolyte, osmola, hyerglycemia, Hypo/Hyperthermia, vitamin deficiences, Difuse infections, Microvascular occlusions (malaria, DIC), Organ failure, Exogenou toxins, Subarachnoid hemorrhage

Front 21

How do you treat coma in an emergency?

Back 21

Labs (glucise, elec, renal, liver, coag, CBC, tox), Consider (naloxone, thiamine, D50), Arterial gas, Treat seizure, History, Exam

Front 22

What do you want to know in a coma history?

Back 22

Onset & Progression

Front 23

What can cause sudden onset of coma?

Back 23

Vascular origin (post fossa, SAH, or hypoglycemia)

Front 24

What can cause rapid progression of coma?

Back 24

hemispheric ICH or another rapidly growing mass lesion

Front 25

What can cause slower progression of coma?

Back 25

Another type space taking lesion

Front 26

What can suggest metabolic coma?

Back 26

Coma preceded by confusion or delirium w/o lateralizing signs

Front 27

What signs of trauma are used to diagnose comas?

Back 27

Basilar skull fx (battle's sign, raccon eyes), hemotympanum, CSF oto-rhinorrhea

Front 28

What vital signs can be used to diagnose coma?

Back 28

Hypothermia w/ EtOH OD, myxedema, Wernicke's, sedative OD, hypgycemia. Hyperthemia w/ infection, anticholinergic OD

Front 29

How can an eye exam help diagnose coma?

Back 29

Optic fundi will have papilledema/hemorrhages, meningeal irratation

Front 30

What are the 4 important aspects of the neurological exam?

Back 30

1) Pupils 2) Eye movements 3) Motor response 4)Ventilation pattern (acid/base)

Front 31

What can cause respiratory acidosis?

Back 31

Sedatives- hypnotic drug OD

Front 32

What can cause respiratory alkalosis?

Back 32

Hepatic encephalopathy, Salicylate intox, sepsis

Front 33

What can cause metabolic acidosis?

Back 33

Diabetic keto, uremia, lactic acidosis (sepsis), drugs (MeOH, ethylene, glycol, INH, salicylate

Front 34

What BS reflex is most resistant to metabolic depression?

Back 34

Pupillary rxn to light

Front 35

What cause pupillary light reflex?

Back 35

Parasym (CN III) & Sym (hypothal via SC & sym chain)

Front 36

What can cause pin point pupils?

Back 36

Pontine hemorrhage, organophosphate poisoning (aceytlcholine esterase inhib- inc parasym), narcotics, syphillis, glaucoma drops

Front 37

What can ause fixed dilated pupils?

Back 37

Inc ICP on ipsi CN III. Implies worsening clinical state (herniation)

Front 38

What can cause metabolic fixed pupils?

Back 38

Anoxia (severe), major barbituate OD, antcholinergic poisoning (atropine), hypothermia (severe)

Front 39

What are the motor patterns in coma? (pain, purposeful, absent, seizure frag, reflex)

Back 39

Limited response to pain, purposeful is away midline, subtle seizures, reflex movements toward midline

Front 40

Describe reflex movements in metabolic coma.

Back 40

symmetric

Front 41

Describe reflex movements w/ structural disease.

Back 41

asymmetric (contra)

Front 42

What is oculocephalic eye movements?

Back 42

Doll's eyes

Front 43

Describe nystagmus w/ cold water calorics?

Back 43

COWS

Front 44

What does normal eye movements in coma suggest?

Back 44

Intact upper medulla to BS