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Evaluation, diagnosis, and treatment of an unconscious patient. How do you evaluate, diagnose, and treat an unconscious patient? When do you conclude the patient is in a coma or unconscious? What is a drug-induced coma? What are the indications and contraindications of a drug-induced coma? What are the causes of coma or unconsciousness? What is the difference between coma or unconsciousness and sleep? Did the patient receive any medication in the past 24 hours? What was the route of administration? What is the difference between coma and brain death? When do you declare a patient is dead? How often should revision of evaluation, diagnosis, and treatment be done in an intensive care unit setting? What can you do to protect yourself and others from incompetent medical doctors? What can I do to protect myself and others from incompetent medical doctors? Ask them as many questions as possible. If they can't answer, declare it publicly. You have the right to defend yourself. Can the patient do spontaneous eye opening? Is the patient capable of opening eyes to speech, to stimulus, to pain not applied to face, breast, genitals or not opening his/her eyes? Spontaneous eye opening – 4 points Eyes open to speech – 3 points Eyes open to stimulus, pain, not applied to face, breast, or genitals – 2 points No eye opening – 1 point Spontaneous eye opening: what is the mechanism involved? Eyes open to speech– what is the mechanism involved? Eyes open to stimulus, pain, not applied to face– what is the mechanism involved? No eye opening– what causes it? What are the causes? What are the causes of no eye opening? What is the mechanism involved? What are the causes of no verbal response? What is the mechanism involved? What are the causes of no movement of extremities? What is the mechanism involved? What is the conclusion? Is the patient in a coma? Is the patient comatose? Where is the lesion? What is the diagnosis? How will you treat the patient? What should be the configuration of a ventilator? What is the prognosis? At this point, it is impossible to conclude exactly. Similar patients have bad prognosis. What should be the nurse-patient ratio in an intensive care unit setting? 1:1 How many total beds are there in the intensive care unit? 12, 24. How many nurses, nursing assistants, and sanitary assistants? Forty nurses, 20 nursing assistants, and two sanitary attendants for its 12 beds. What is the total staff required for the intensive care unit? What other staff is required for the intensive care? Procurement staff, nursing assistants, sanitary attendants. How many medical doctors should be there in the intensive care unit? What are the duties and responsibilities of supervisory nurse and an “in-charge” nurse? How many hours should there be on each shift? How many hours should the shift be for a medical doctor? Twelve hours. How many days off should one have after 12 hours work in an intensive care unit? How many hours should the shift be for nurses? Eight hours. How should medical doctors hand over cases to the next shift? How should nurse hand over cases to the next shift? What are the existing resources and supplies available in the intensive care unit? Do you need any extra resources or supplies? What is the difference in the duties and responsibilities of an intensive care medical doctor and an intensive care nurse? There can be at least two medical doctors in an intensive care unit. Can the unit be supervised from a distance by a medical doctor? Yes. The primary treating medical doctor should be able to answer the following questions: What is the diagnosis? What led to the patient’s transfer to the intensive care unit? What do you want the intensive care staff to do for the patient? What is your management plan for the patient? What complications may arise? How often will the primary treating medical doctor visit the patient in the intensive care unit? What time will he/she visit the patient? What is the emergency contact information of primary treating medical doctor in case complications arise in the intensive care unit? Existing intensive care unit. When was the intensive care unit established? What types of cases were shifted to the intensive care unit up to now? What complications occurred inside the intensive care unit? How were the complications managed? What complications couldn't be managed? Why couldn't they be managed? How could this have been prevented? How many patients died in the intensive care unit? What was the patient’s age at the time of death? What was the diagnosis? What were the complications? Who was the treating medical doctor? What type of medical or surgical procedure was done? What was the cause of death? Who issued the death certificate? Who investigated the case? Q: What is critical care?
Medical ICU Neonatal ICU Combined ICU Q: What monitoring should be conducted during hospital stay? Q: When can patients be safely discharged from hospital? Q: What arrangements should be made for follow up after hospital discharge? Q: What is the difference between critical care and emergency medicine? Q: What is an intensivist? Q: How does a family physician fit into the team? Q: How does a rehabilitation physician fit into the team? Q: What arrangements should be made for follow up after hospital discharge? Q: How do you see your discipline changing over the next decade? Take a look at this. Worldwide Intensive care units. Q: Can you connect your ICU to the worldwide web? Q: What's your diagnosis? Q: What's the rhythm? Q: What's the reason for admission? Q: What type of ventilators do you have? Q: What's the management plan? Q: Can you present your cases?
Ventilators Pulse oxymeters Defibrillators Syringe pumps Intra aorta balloon pump Portable oxygen Suture machine Medicinal gasses and other equipment . Pacemaker generators. 1. The Glasgow Coma Scale assesses all of the following parameters except? Your answer: motor response verbal response eye opening memory 2. Select the correct statement regarding the Glasgow Coma Scale Your answer: A score of 3 is normal A score of 7 represents coma A score of 12 accompanies brain death A score of 15 is indicative of a poor prognosis 3. A patient who opens his eyes in response to pain, makes no verbal response, but withdraws from pain has a Glasgow Coma Score Your answer: 3 5 7 11 4. The Glasgow Coma Scale evaluates: Your answer: motor response, gag reflex, verbal response eye opening, motor response, verbal response eye opening, pupillary response, motor response verbal response, pupillary response, motor response 5. A 10-month-old is struck by a car while in his mother's arms. On arrival, the infant is moving all his extremities spontaneously, opens eyes to pain only, and is screaming inconsolably. His Glasgow Coma Scale (GCS) score is: Your answer: 10 12 14 15 6. When provided with a pain stimulus, your patient attempts to interfere with the stimulus application by grabbing at the source or pushing the source away. This response characterizes Your answer: a withdrawal response to pain decerebrate posturing the ability to localize pain and coordinate a response decorticate posturing 7. When provided with a pain stimulus, your patient flexes and/or retracts the stimulated area to avoid or escape the stimulus. This response characterizes Your answer: a withdrawal response to pain decerebrate posturing the ability to localize pain and coordinate a response decorticate posturing 8. When provided with a pain stimulus, your patient flexes and adducts both arms. This response characterizes Your answer: a withdrawal response to pain decerebrate posturing the ability to localize pain and coordinate a response decorticate posturing 9. When provided with a pain stimulus, your patient extends and abducts both arms. This response characterizes Your answer: a withdrawal response to pain decerebrate posturing the ability to localize pain and coordinate a response decorticate posturing 10. Decorticate or decerebrate posturing indicates the presents of Your answer: coordinated and localized responses to stimulation irreversible brain damage a high (C-1 to C-3) spinal cord lesion, resulting in reflexive muscle movement of the extremities a significant brain injury that is life-threatening < 11. Which of the following Glasgow Coma Scale scores in a patient would be most consistent with severe head injury? Your answer: 4 10 14 20 12. A Glasgow Coma Scale score of 8 or below is an indication of Your answer: mild head injury severe head injury moderate head injury no head injury 13. A Glasgow Coma Scale score of 9 to 12 is an indication of Your answer: mild head injury severe head injury moderate head injury no head injury 14. A Glasgow Coma Scale score of 13 to 15 is an indication of Your answer: mild head injury severe head injury moderate head injury no head injury 15. A person who requires vigorous stimulation shaking, shouting for a response is described as: Your answer: lethargic obtunded stuporous comatose 16. Which of the following statements about the use of Glasgow Coma Scale (GCS) is false: Your answer: To obtain a score, add the scores for eye opening, best verbal, and best motor. The highest score obtainable is 15. The scale can be used for infants, children, and adults. The lowest possible score is 0. 17. A patient who does not respond to body or environmental stimuli is Your answer: Obtunded Lethargic Confused Comatose 18. Commonly used standardized test, evaluates brain injuries. It rates three categories of patient responses; eye opening, best motor response, and best verbal response. Levels of responses indicate the degree of nervous system or brain impairment. Your answer: DCAP-BTLS GCS AVPU BSI 19. A state of unconsciouness from which the person cannot be aroused, even by powerful stimulation, or lack of any response to one’s environment Your answer: sleep stuporous coma confused 20. What is the miminum score possible on the Glasgow Coma Scale Your answer: zero 1 2 3 21. What is the maximum score possible on the Glasgow Coma Scale Your answer: 12 15 18 21 22. The best possible score for a Glasgow coma scale is: Your answer: eye opening 4; verbal response 5; motor response; 6 eye opening 6; verbal response 5; motor response; 4 eye opening 5; verbal response 5; motor response; 5 eye opening 3; verbal response 4; motor response; 5 23. Patient is oriented to person, place, and time but slow and sluggish Your answer: Confused Lethargic Obtunded Stuporous 24. The Glasgow Coma Scale is used as a tool to assess a patient's: Your answer: mental status level of shock neurological status tolerance to pain 25. The three spheres of orientation which you assess are Your answer: place, person and sensation time, memory and cognition person, place and time person, mentation and place The Glasgow Coma Scale provides a score in the range 3-15; patients with scores of 3-8 are usually said to be in a coma. The total score is the sum of the scores in three categories. For adults the scores are as follows: Eye Opening Response Spontaneous--open with blinking at baseline 4 points Opens to verbal command, speech, or shout 3 points Opens to pain, not applied to face 2 points None 1 point Verbal Response Oriented 5 points Confused conversation, but able to answer questions 4 points Inappropriate responses, words discernible 3 points Incomprehensible speech 2 points None 1 point Motor Response Obeys commands for movement 6 points Purposeful movement to painful stimulus 5 points Withdraws from pain 4 points Abnormal (spastic) flexion, decorticate posture 3 points Extensor (rigid) response, decerebrate posture 2 points None 1 point For children under 5, the verbal response criteria are adjusted as follow SCORE 2 to 5 YRS 0 TO 23 Mos. 5 Appropriate words or phrases Smiles or coos appropriately 4 Inappropriate words Cries and consolable 3 Persistent cries and/or screams Persistent inappropriate crying &/or screaming 2 Grunts Grunts or is agitated or restless 1 No response No response What is a Coma? Coma is an extended period of unconsciousness from which a person cannot be aroused even with the most painful stimuli. Coma is not a disease. It is a symptom of a disease or a response to an event, such as a severe head injury, seizure or metabolic problem. Most comas do not last longer than four weeks. Some people in a coma shift to a persistent vegetative state, in which breathing, maintaining normal blood pressure, digesting and eliminating foods continues without the patient's awareness. The vegetative state can last for years or decades. The outcome of a coma ranges from full recovery to death. Whether a person recovers, and to what extent, depends upon the cause of the coma and the type and extent of the brain damage. A coma involves two different concepts: Reactivity and perceptivity. * The perceptivity concept refers to responses of the nervous system to learned stimuli. These types of stimuli may be learned through language or communication skills. * The reactivity concept refers to the inborn functions of the brain. These functions include the eyes, ears, responses to pain, wakefulness and turning ones head toward a sound of movement. These movements are also called reflexive movements. A person in a coma does not experience reactivity or perceptivity. The patient can not be aroused by calling their name or experiencing pain. Symptoms of a Coma The main symptom of a coma is the inability to be aroused to consciousness. Other symptoms are: Lack of self-awareness, Lack of a sleep-wake cycle, Lack of purposeful movements, Lack of suffering and Impaired breathing. What Causes a Coma? A coma can be caused by a variety of things. The most often cause of coma is severe head injury. Other causes are: consumption of a very large amount of alcohol (toxic or metabolic coma), diabetes, morphine, shock or hemorrhage. Treatment varies depending on the cause. Overall, in coma cases, damage to the brain's "thinking, and life support centers" have occurred. When damage has occurred, bleeding in the brain, swelling and congestion of the damaged tissue is present. In extreme cases, brain swelling is so great that portions of the brain must be forcible squeezed out of the skull. This dead or "dying" tissue is then surgically removed. An alternative to squeezing portions of the brain out of the skull is to saw off the skull and place it in a cold storage to better accommodate the swollen brain. What happens during a coma? There are different stages of a coma. Most people believe that a person in a coma is in a deep sleep. This is not entirely true. Some stages of coma resemble a deep sleep but not all. The progress of coma is measured by the patient's increasing awareness of external stimuli. There are many levels of coma which the patient will pass through as functionality increases. Depending on the stage, a person in a coma may make movements, sounds and experience agitation. Coma patients may also have reflex activities that mimic conscious activities. Sometimes, coma patients must be restrained to prohibit them from removing tubes and IVs. Emerging from a Coma When a person begins to emerge from a coma, they begin to react to certain stimuli. However, to regain consciousness, both reactivity and perceptivity must be present. Reactivity and perceptivity are necessary for a state of awareness. It is often the case that some parts of perceptivity such as speech and self care must be relearned. A beneficial Coma Sometimes a coma may be chemically induced by a doctor to aid in medical treatment and recovery. This usually happens during a head injury. |