Unconsciousness presentation 1

• Loss or lack of consciousness.
• Alteration of mental state.
 Complete or near complete lack of
responsiveness to people and other
environmental stimuli.
 Comatose state is an illustration of
unconsciousness.

Unconsciousness is a state in which:-
• Unable to responds to people and
activities.
• Lacking awareness and the capacity for
sensory perception.
• Temporarily lacking consciousness.

• Without conscious control.
• Not awareness of one’s actions,behaviour
etc.
• Lacking normal sensory awareness of the
environment.
• Without conscious volition.
• Unconsciousness can be brief, lasting for
a few seconds to an hour or few hours or
longer.

To produce unconsciousness, a disorder
must-
o Disrupt ascending RAS extends length of
brain stem and up in to the thalamus .
o Disrupt the function of both cerebral
hemisphere.
o Metabolically depress over all brain
function, as in drug overdose.

Coma is a state of sustained unconscious
in which the patient:-
• Does not respond to verbal stimuli.
• May have varying painful stimuli.
• Does not move voluntarily.
• Altered respiratory patterns.
• Altered papillary response to light.
• Does not blink.

• In general the longer coma lasts, its
irreversible due to a permanent
disorder in the brain structure.
• The longer the coma, the higher the
mortality rates, and poorer the
neurologic outcome.

 Stupor: - State of semiconsciousness in which
person responds to external stimuli or loud
noise or painful stimuli i.e., pricking or
pinching.

 Somnolent :-State when person
feels drowsy or sleepy and will
responds only if spoken to directly.

 Excitatory :- Patient does not respond to
but disturb by sensory stimuli i.e., bright
light, noise and sudden movement.

 Deep coma :-Complete loss of
consciousness. Person is aware of himself
and the environment and cannot be aroused
if he is in deep coma.

• Light coma:-Spontaneous and evoked
movement.

• Deep coma :-Heart rate is slow and
respiratory rate is fast and the depth is
increased.

• Premoribund :-Rhythm is periodic, pulse
is irregular and BP rises.

• Moribund :-Apnoeic respiration, pupil
dilated and fixed; pulse rates beats faster
and BP falls.

Consciousness is a complex function
controlled by RAS.
RAS begin in the medulla as reticular
formation.
Reticular formation connect to RAS
located in the midbrain, connects to
the hypothalamus and thalamus.
Integrated pathway connects to the
cortex via thalamus and to the limbic
system via hypothalamus.

Reticular formation produces
wakefulness where as RAS are
responsible for awareness of self and
environment .
Disorder that affect any part of RAS
can produce coma .
To produce coma a disorder must
affect both cerebral hemisphere and
the brain stem.

i. Laboratory test .
ii. CT or MRI Scan.
iii. Lumbar puncture.
iv. EEG.

a) OCULOCEPHALIC RESPONSE :-
 Also known as Doll’s eye reflex.
 Movement of eye in the opposite direction
that in which head is moved .
 Test can be performed only in unconscious
patient.
 Presence of Doll’s eye indicate brain stem
function is preserved .
 Brain stem in a comatose patient may be
functioning in the absence of Doll’s eye
reflex.
 Eg;If the eyes moves to the right when the
head is rotated to the left &vice versa-
Doll’s eye is present.

b) OCULOVESTIBULAR :-
 Performed to test cranial nerve
iii,iv,vi,viii.
 Nystagmus is the involuntary oscillation
of the eye ball.
 It may be horizontal, vertical and
oblique .
 Absence of an oculovestibular support
the diagnosis of brain death.
 Test performed only for comatose
patient .

 FIRST AID:-
 The most important function of the first
aid is to ensure that patient air passage
remains open and clear.
 Take note of any alteration in the state
of unconsciousness either improving or
deteriorating.
 Suppose if the patient is unresponsive no
breathing only gasping.
 Activate emergency response and get
defibrillator .
 Check pulse and high quality CPR
improves a victim’s chance of survival.

The critical characteristics of high
quality CPR include:
Start compression within 10 sec. of recognition of
cardiac arrest.
Push hard ,push fast: Compress at a rate of
100beats/min with a depth of at least 2 inches(5cm)
for adult and children, approximately 1 inch 1/2 (4 cm)
for infant.
Allow complete chest recoil after each compression.
Minimize interruption in compression.
Give effective breaths that make the chest rise.
Avoid excessive ventilation.
Begin cycles of 30:2

 AED/Defibrillator arrives.
 Check rhythm shock able give 1 shock and
resume CPR immediately for 2 min.
 If rhythm not shockable resume CPR
immediately for 2 min.
 Check rhythm every 2min, continue ALS
providers take over or victim start to move.

MEDICAL MANAGEMENT:-
 The goal of medical management are to
preserve brain function and to prevent
additional brain injury.
 The primary focus is on maintaining the
supply oxygen and glucose to the brain .
 The patient circulation, airway and
breathing must be maintained.

 The immediate intervention for the
patient in a coma include treatment of
common causes of coma .For comatose
patient who appear malnourished,
wernicke’s encephalopathy may occur
secondary to alcohol abuse.
 The patients are commonly given
thiamine for prevention especially if they
are given glucose.
 If the patient is having lorzepam
repetitive seizure, coma and brain
damage can follow. The patient iv
diazepam, or lorazepam to stop the
seizure.

 If the patient is not intubated ,closely
monitor the airway because of these
depressants effect of these medicine.
 If cerebral oedema is present ,osmotic
diuretic may used to promote shifting of
extracellular brain fluid back in to the
plasma.
 Steroid barbiturate (neuromuscular
blocking )decrease intracranial pressure.
 If the infection is suspected patient has
shivering then ICP increases.

 Use of vasoactive agents may be required
to keep systolic pressure at 100mmHg or
the mean systolic BP above 80 mmHg.
 Promote cerebral perfusion.

 Airway.
 Position.
 Pain and sedation .
 Temperature.
 Cornea.
 Food and fluid.
 Bladder.
 Anticonvulsant therapy.

 Environment and family.
 Physical care.
 Observation.
 Convalescence.
 End of life care.

 Ineffective airway clearance related to
upper airway obstruction by tongue and soft
tissue, inability to clear respiratory secretion.
 Ineffective thermoregulation related to
damage to hypothalamic centre.
 Self care deficit related to impairment of
musculoskeletal impairment.
 Imbalanced nutrition related to poor appetite
and unconsciousness.
 Interrupted family process related to
uncertain future or impending death of a
family member.

 Risk for fluid volume deficit related to
inability to ingest fluid.
 Risk for aspiration related to lack of
effective airway clearance and loss of gag
reflex.
 Risk for skin integrity related immobility.
 Risk for infection related to external factor.
 Risk for injury related to lack of safety.

• Respiratory function:-
Inability to maintain patent airway means
that aspiration of fluid, oral secretion,
blood in presence of trauma all this lead to
chest infection.
• Supine position comprise the mechanics
of breathing ,flat position causes reduction
in residual and functional residual capacity
of lung leads to complete collapse of lung
(atlectasis)and poor ventilation.

• Venous stasis decrease vasomotor tone.
Pressure in blood vessel hypercoaguable state
leads to venous thromboembolism, pulmonary
embolism.
• Pressure ulcer.
• Altered metabolism: increased excretion of
calcium from bone has a reduced weight.

The comatose client may remain in
hospital for a few days, month or year.
Some comatose patient awaken may
make a complete recovery while in the
hospital. Therefore some expected
outcomes have a brief time frame (e.g.;
airway obstruction) whereas other are
prolonged, requiring frequent re-
evaluation.

Unconsciousness presentation 1

Unconsciousness presentation 1

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Unconsciousness presentation 1