OME - Coma

Question 1

What is seen in coma?

Answer 1

1. Cerebral function - depressed
2. Brainstem - Normal
3. CV - Normal
4. Motor - Normal

Question 2

Coma cocktail?

Answer 2

1. Naloxone
2. Thiamine
3. D50

Question 3

How to determine cerebral function is active?

Answer 3

Get an EEG

Question 4

What is seen in persistent vegetative state?

Answer 4

1. Cerebral function - None
2. Brainstem - Normal
3. CV - Normal
4. Motor - Intact

Question 5

What is seen in brain death?

Answer 5

1. Cerebral function - none
2. Brainstem - None
3. Heart - Beating
4. Motor - None

Question 6

What happens when take brain dead patient off vent?

Answer 6

1. Stop breathing

2. Heart will still continue to beat

Question 7

What is brain death?

Answer 7

Absence of brainstem reflexes

- Must be determined by 2 or more Docs at same time

Question 8

What are the brainstem reflexes you are checking?

Answer 8

1. Corneal
2. Cold water calorics
3. Dolls eyes

Question 9

How to check corneal reflex?

Answer 9

Touch eyeball with qtip and nothing happens

Question 10

How to test cold water calorics?

Answer 10

"COWS": Cold, opposite. Warm, same. 
- Refers to nystagmus 
Cold water in ear if alive:
1. Eyes move towards ear
2. Nystagmus moves away
Cold water in ear if cerebrum dead:
1. Eyes move towards water 
2. No nystagmus 
Cold water if brain stem dead:
1. Eyes do not move at all

Question 11

How to test dolls eyes?

Answer 11

1. If stem intact, eyes move conjugately away from direction of turning (as if still looking at the examiner rather than fixed straight ahead)
2. Negative “doll’s eyes” would stay fixed (move with head as turned) sign patient brainstem is functionally not intact.

Question 12

Pathology locked in syndrome?

Answer 12

1. Pontine stroke
2. Patient 100% alive and aware
3. Can feel, but cannot move
   4 Can only communicate with eye blinks