Unconsciousness

inability to respond to any sensory stimuli except which causes pain; unaware and unale to make movements

Consciousness

highest legvel of brain function

Evaluating level

one of most reliable mechanisms for s=determining neuro status of patient

Levels of consciousness

Alertness

Confusion

Lethargic

Obtunity

Stuporous

Unconscious

Coma

Alertness

readily aroused and aware of environment

Confusion

Impaired memory or disorientation

Lethargic

drowsy and nonattentive, sleeps when not stimulated, can be easily awakened, responds to name, loses train of thought, decreased spontaneity, thinks slowly and fuzzy, answer ?s when awake

Obtunity

decreased LOC, responds to loud voice and painful stimulation, confused, talks in monosyllables, mumbles, need constant stimuli to communicate, answers ?s when awake

Stuporous

(Semi-coma) respond to painful stimuli, shaking, groans/mumbles, reflex activity, nearly unconscious, decreased responsiveness, falls asleep easily, awake for short time, answers ?s but falls asleep rapidly

Unconscious

unable to respond to any sensory stimuli except which causes pain

Coma

decreased unconsciousness, no stimuli

Causes of Unconsciousness

derangement of brain- moved or out of placed

Intereference with Oxygen levels

Heat stroke

Diabetes

Epilepsy

Cerebral Malfunction

Cardiac malfunction

Seizures

abnormal electrical discharges that occur suddenly in the brain; usually caused by head trauma, but characterized by disturbances of movement, altered consciousness or sensations

Grand Mal seizures

patient falls down and jerks or shake, teeth often clench, excessive salivation, decreased bladder control, spastic contractions of diaphragm resulting in cyanosis of lips or fingernails; most stop after a few minutes and patient will want to rest, and normal breathing follows

Primary Survey

1. Check responsiveness with loud and repeated verbalization

2. Do ABCs if unconscious

3. Check for severe injuries

4. Obtain ABCs

Secondary survey

1. Vitals- respirations, pulse, consciousness

2. History- nonverbal, but may show signs, get info from surroundings, med history, assess stability, record findings and changes

3. Questions- LOC? Arousal? Responsiveness? Awareness of time and environment? Accuracy of answers?

4. Observation- alignment and position, equipment and supplies, hemorrhaging and manage it, shock and take measurements

Respirations

Look, listen, and feel

Number of breaths per minute

     30x2 or 60 secs total

     Normal is 12-20 per minute

Should be quiet and effortless

Apnea 

periods of nonbreating

Ataxic

Deep and shallow, random breaths

Hyperventilation

Prolonged, rapid breathing, resulting in decreased CO2 blood levels; should make them hold their breath a second

Hyperpnea

abnormal increase and depth and rate of respiratory movements

Biot's Response

Regular period of hyperpnea and irregular apnea

Cheyne Response

periods of hyperpnea altenating with period of apnea; regular acceleration and deceleration in depth

Cluster breathing

breaths follow disorderly with pauses in between

Pupil Exam

Pupillary reflex

     look for size, equality, reaction

     Sometimes normally unequal pupils

     Normal is round, = in size, and quickly react to

     light

     Unequal pupils may indicate a hematoma;

     dilation should be on side of lesion due to pressure on 3rd

     oculomotor nerve

     Unconscious pt often have slight bilateral dilation

Rubor

Reddish color of the skin that indicates increased blood flow, possible heat stroke, and/or high BP

Pallor

White coloration of ths skin that indicates the constriction of blood vessels, and results in decreased circulation; possibly due to hemorrhaging or shock

Cyanosis

Blue coloration of the skin that indicates poor oxygenation; possibly due to heart failure or airway obstruction

Signs of Trauma to the head

Check the head and throat for:

    scalp lacerations, bumps, deformities, or blood

Ottorhea

blood or cerebrospial fluid (clear) fluid in ear; look for the halo effect with a dipstick

Battle's Sign

Discoloration of mastoid process area- means of temporal or basilar fx

Rhinorrhea

discharge from the nose; the common cold

Epistaxis

A comon nose bleed

Raccoon Eyes

Ecchymosis around the eyes, which may indicate a fx and may take several hours to develop

Posturing

Taking a certain body position that normally indicates a brain injury; is an emergency and must refer immediately

Decorticate

Legs in extension and upper limbs in flexion, which normally involves the diencephalon of the brain

Deceberate

Extension of all the extremities, which normally involves the brain stem

Pulse

Heart Rate (HR), which is normally 50-80 beats per minute

All pulses

1. Radial- most common pulse at the distal end of the radius

2. Brachial- medial bicep

3. Carotid- middle of neck, lateral to the trachea

4. Posterior Tibial- posterior to the medial malleollus of the tibia

5. Dorsal Pedis- between 1st and 2nd metatarsals of the foot

Weak Pulse

indicates shock (decreased blood volume)

Vasodilation

dilated blood vessels

Strong, Rapid pulse

indicates fright or hypertension; always check pulse distal to potential injury

Blood pressure

pressure circulating blood measured by a sphygmomanometer and stethoscope; upper and lower

Auscultation

listening to the sounds of the body

Systolic/Diastolic

Normal is 120/80; changes in BP indicates changes in blood volume

Losing BP= insufficient circulation

Increased BP

cerebral hemorrhaging if HR decreases

Hypertension

increased BP = anything increase 140/90, borderline systolic is 140 to 160 hypertension (silent killer); anything increase 160 systolic or 96 diastolic is definitely hypertension; increased BP for elderly and increased for younger

Hypertension Table

1. Mild-