part 2

Question 1

What makes up the Glasgow Coma Scale?

Answer 1

eye
verbal
motor response

Question 2

According to the GCS what is the score that is generally accepted at coma?

Answer 2

• normal is 15

- coma is 8 and less

Question 3

The brain is well protected but also vulnerable to what?

Answer 3

pressure that may accumulate within the cranium

Question 4

As ICP increases, signs and symptoms become more pronounced and what deteriorates?

Answer 4

LOC

Question 5

What are the assessment parameters for increased ICP?

Answer 5

• LOC
• Pupillary reaction
• Vital signs
• Frequency of assessment: depends on condition; ranges from q15min to q2hours

Question 6

What are the clinical manifestations of increased ICP in infants?

Answer 6

• irritability, poor feeding
• high pitched cry, difficult to soothe
• fontanels: tense, budging
• cranial sutures separated
• eyes: setting-sun sign
• scalp veins: distended

Question 7

What are the clinical manifestations of increased ICP in children?

Answer 7

• headche
• forceful vomiting
• seizures
• drowsiness, lethargy
• diminished physical activity
• inability to follow simple commands

Question 8

What are the late signs of increased ICP?

Answer 8

• bradycardia
• decreased motor response to command
• decreased sensory response to painful stimuli
• alterations in pupil size and reactivity
• extension or flexion posturing
• decreased consciousness
• coma

Question 9

What are the specific special diagnostic procedures for ICP?

Answer 9

• lab tests
• EEC (electroencephalography)
• lumbar puncture
• assessment of evoked potentials (auditory and visual)
• imaging (CT, MRI, Radiography)

Question 10

Explain the respiratory management in the comatose child.

Answer 10

• airway management is primary concern
• cerebral hypoxia lasting >4 minutes may cause irreversible brain damage
• CO2 retention causes vasodilation, increased cerebral blood flow, and increased ICP
• gag and cough reflexes may be minimal
• risk of aspiration of secretions is increased