1 / 51

Management of unconscious patient

Management of unconscious patient. Özlem Korkmaz Dilmen Associate Professor of Anesthesiology and Intensive Care Cerrahpasa School of Medicine. Learning Objectives. Definition of unconsciousness Common causes Diagnosis and treatment of unconscious patient. Definition.

kenna
Télécharger la présentation

Management of unconscious patient

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Management of unconscious patient Özlem KorkmazDilmen Associate Professor of Anesthesiology and Intensive Care Cerrahpasa School of Medicine

  2. Learning Objectives • Definition of unconsciousness • Common causes • Diagnosis and treatment of unconscious patient

  3. Definition Unconsciousness is a state in which a patient is totally unaware of both self and external surroundings, and unable to respond meaningfully to external stimuli.

  4. A system of upper brainstem and thalamic neurons, the reticular activating system and its broad connections to the cerebral hemispheres maintain wakefulness.

  5. Common Causes I • Interruption of energy substrate delivery • Hypoxia • Ischemia • Hypoglycemia • Alteration of neurophysiologic responses of neuronal membranes • Drug intoxication • Alcohol intoxication • Epilepsy

  6. Common Causes II • Abnormalities of osmolarity • Diabetic ketoacidosis • Nonketotichyperosmolar state • Hyponatremia • Hepatic encephalopathy • Hypertensive encephalopathy • Uremic encephalopathy

  7. Common Causes III • Hypercapnia • Hypothyroidism • Hypothermia • Hyperthermia

  8. Anunconscious case • 46 years old, male • DM • Unconscious

  9. First Aid • A (Airway) • B (Breathing) • C (Circulation) • D (Disability) • E (Exposure)

  10. Airway - A • Head tilt, chin lift • Jaw trust

  11. Airway - A • Clearance (aspiration) • Oral/Nasal Airway • Intubation

  12. Breathing - B • Look, listen and feel for NORMAL breathing.

  13. Breathing - B • Symmetry • Breathing Sounds • Tidal Volume • Respiratory rate

  14. Abnormal breathing • Occurs shortly after the heart stops in up to 40% of cardiac arrests • Described as barely, heavy, noisy or gasping breathing • Recognise as a sign of cardiac arrest

  15. Circulation - C • Pulse • Rate • Rhytme • Arterial Pressure • Hypertension • Hypotension

  16. Disability - D • Disability is determined from the patient level of consciousness according to the AVPU or GCS. A for ALERT V for VOICE P for PAIN U for UNRESPONSIVE to any stimulus

  17. GLASGOW COMA SCALE • I. Motor Response6 - Obeys commands fully 5 - Localizes to noxious stimuli 4 - Withdraws from noxious stimuli 3 - Abnormal flexion, i.e. decorticate posturing 2 - Extensor response, i.e. decerebrate posturing 1 - No response • II. Verbal Response 5 - Alert and Oriented 4 - Confused, yet coherent, speech 3 - Inappropriate words and jumbled phrases consisting of words 2 - Incomprehensible sounds 1 - No sounds • III. Eye Opening 4 - Spontaneous eye opening 3 - Eyes open to speech 2 - Eyes open to pain 1 - No eye opening

  18. Exposure an Environment - E The patient’s clothes should be removed or cut in an appropriate manner so that any injuries can be seen.

  19. General Physical Examination • History • Neurologic examination • The eye examination • Fundoscopy • Ventilatory pattern

  20. History • In many cases, the cause of coma is immediately evident; • Trauma • Cardiac arrest • Drug ingestion • In the reminder, historical information may be helpful. .

  21. Cirrhosis

  22. Meningococcemicrashs

  23. Evolution of neurologic signs in coma from a hemispheric mass lesion as the brain becomes functionally impaired in a rostral caudal manner. Early and late diencephalic levels are levels of dysfunction just above (early) and just below (late) the thalamus.

  24. Neck rigidity

  25. Neck rigidity • Bacterial meningitis • Subarachnoid hemorrhage

  26. Hepatic coma

  27. The eye examination Pupillary abnormality is one of the cardinalfeatures differentiating surgical disorders from medical disorders. Pupillary abnormalities in coma generally herald structural changes in brain, whereas in metabolic coma such abnormalities are not present.

  28. Fixed and dilated pupils

  29. Fixed and dilated pupils • The terminal stage of brain death • Atropine effect

  30. Pinpoint pupils

  31. Pinpoint pupils • Narcotic overdose • Bilateral pontine damage

  32. Pupillary dilatation

  33. Pupillary dilatation Sudden lesion of the midbrain; ruptere of an internal carotid artery aneurysm

  34. Fundoscopic examination

  35. Fundoscopic examination • Subarachnoid hemorrhages • Hypertensive ensefalopaty • Increased inrtacranial pressure

  36. Laboratory examination Chemical blood determinations are made routinely to investigate metabolic, toxic or drug induced encephalopaties. • Electrolytes • Calcium • Blood urea nitrogen • Glucose • NH3

  37. Laboratory examination • Toxicological analysis is of great value in any case of coma where the diagnosis is not immediately clear. • The presence of alcohol does not ensure that alcohol is the cause of the altered mental status. Other, life-threatening, causes must be ruled out.

  38. Imaging • In coma of unknown etiology, CT or MRI must be performed. • Radiologically detectable causes of coma; • Hemorrhage • Tumor • Hydrocephalus

  39. Brain herniation

  40. Electroencephalography EEG is useful inunrecognized seizures.

  41. Lumbar puncture • The use of LP in coma is limited to diagnoses of meningitis and instances of suspected subarachnoid hemorrhage in which the CT is normal.

More Related