Coma

Question 1

What is coma?

Answer 1

State of unrousable psychological unresponsiveness

Question 2

What does Glasgow Coma scale measure?

Answer 2

Degree of consciousness
GCS<8 is a coma

Question 3

What are the 3 components of GCS?

Answer 3

Eye opening
Verbal response
Motor response

Question 4

What are the GCS criteria for eye opening?

Answer 4

Spontaneous- 4
To speech- 3
To pain- 2
None- 1

Question 5

What are the GCS criteria for verbal response?

Answer 5

Orientated- 5
Confused- 4
Inappropriate words- 3
Incomprehensible sounds- 2
None- 1

Question 6

What are the GCS criteria for motor response?

Answer 6

Obeying commands- 6
Localising to pain- 5
Withdrawing from pain- 4
Flexing to pain- 3
Extending to pain- 2
None- 1

Question 7

What is consciousness dependent on?

Answer 7

Intact ascending reticular activating system- arousal
Functioning cerebral cortex - awareness

Question 8

What are the causes of reduced conscious level?

Answer 8

Toxic/metabolic states
Seizures
Damage to reticular activating system
Raised ICP

Question 9

What causes a raised ICP?

Answer 9

• Tumour
• Stroke
• EDH
• SDH
• SAH
• Hydrocephalus

Question 10

What is persistent vegetative state?

Answer 10

Brainstem recovers but there is no evidence of recovery of cortical function
Arousal but no awareness

Question 11

What is locked in syndrome?

Answer 11

Paralysis below level of third nerve nuclei
Able to open, elevate and depress eyes but no other voluntary eye movements

Question 12

What are the elements to resuscitation of coma patient?

Answer 12

Airway
Breathing
Circulation

Blood samples
BP, pulse, temp
IV access
Stabilise neck

Question 13

What causes depressed respiration?

Answer 13

Drug overdose
Metabolic disturbance

Question 14

What causes increased respiration?

Answer 14

Hypoxia
Hypercapnia
Acidosis

Question 15

What causes fluctuating respiration?

Answer 15

Brainstem lesion

Question 16

What are the types of coma?

Answer 16

1. Coma without focal brainstem or lateralising cerebral signs and without meningism
2. Coma without focal brainstem or lateralising cerebral signs but with meningism
3. Coma with focal brainstem or lateralising cerebral signs

Question 17

What causes a coma without focal brainstem or lateralising cerebral signs and without meningism?

Answer 17

• Anoxic/ischaemic conditions
• Metabolic disturbances
• Intoxications
• Systemic infections
• Hyperthermia
• Hypothermia
• Epilepsy

Question 18

How do you investigate coma without focal brainstem or lateralising cerebral signs and without meningism?

Answer 18

• Toxicology screen including alcohol level
• Measure blood glucose and electrolytes
• Hepatic and renal function
• Acid-base assessment
• ABGs
• BP
• Carbon monoxide poisoning

Question 19

What causes a coma with meningism?

Answer 19

• SAH
• Meningitis
• Encephalitis

Question 20

How do you investigate a coma with meningism?

Answer 20

• CT head scan
• Lumbar puncture

Question 21

What causes a coma with focal brainstem or lateralising cerebral signs?

Answer 21

• Tumour
• Haemorrhage
• Infarction
• Abscess

Question 22

How do you investigate a coma with focal brainstem or lateralising cerebral signs?

Answer 22

CT/MRI

Question 23

What is involved in care of coma patients?

Answer 23

Maintenance of vital functions
Care of skin, avoidance of pressure sores
Attention to bladder and bowel function
Control of seizures
Prophylaxis of DVT, peptic ulceration
Prevention of contractures