Altered Mental Status and Coma

7,600 views

Published on

Altered Mental Status and Coma
意識不清與昏迷

Published in: Health & Medicine
0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
7,600
On SlideShare
0
From Embeds
0
Number of Embeds
4,891
Actions
Shares
0
Downloads
68
Comments
0
Likes
2
Embeds 0
No embeds

No notes for slide

Altered Mental Status and Coma

  1. 1. Altered Mental Status and Coma<br />意識不清與昏迷<br />Adapted from Rosen's Emergency Medicine, 7E<br />Chapter e14 Depressed Consciousness and Coma<br />
  2. 2. Glasgow Coma Scale (Teasdale & Jennett, 1977)<br />
  3. 3. 意識之成分<br />喚醒度(Arousal):意識之原動力<br />臨床現象:外表上呈醒的狀態<br />(能主動睜眼或對外界刺激有睜眼反應)<br />是腦幹之網狀系統(RAS)活動的表現<br />主為腦幹之功能<br />覺察能力(Awareness):意識之內容<br />綜合認知和情感之腦功能<br />臨床現象:有意義的動作和語言<br />主為大腦半球的功能<br />
  4. 4. Brainstem RAS (Mid-Pons Rostrally) and Its Projections to the Hemispheres<br />
  5. 5. Anatomic basis of coma (results from lesions that affect either the RAS or both hemispheres)<br />
  6. 6. Mnemonic for Treatable Causes of AMS (AEIOU-TIPS)<br />A Alcohol<br />E Endocrine Electrolytes Encephalopathy<br /> I Insulin<br />O O2<br /> Opiates<br />U Uremia<br />T Trauma<br />I Infection <br /> Intra-cranial<br />P Poisoning<br />S Seizure<br /> Stroke<br /> Sepsis<br /> Shock<br />
  7. 7. Reversible cause of altered mental status<br />Hypoglycemia, narcotic overdose, hypoxia, hypercarbia should be quickly investigation and treatment<br />If structural lesion etiology is indicated non-contrast head CT<br />
  8. 8. Delirium<br />Diffuse metabolic and multifocal cerebral lesion, generalized impairment of brain functions or at least a bilateral involvement <br />limbic structure<br />
  9. 9. Major brainstem reflexes used in coma examination<br />2進3出<br />5進7出<br />8進6出<br />
  10. 10. Pupils in comatose patients<br />
  11. 11. Caloric Test for Vestibular Function (30-100 cc ice water for oculovestibular reflexes in comatose patients)<br />
  12. 12. Brainstem pathways mediating conjugate horizontal eye movements<br />
  13. 13. Oculocephalogyric (caloric) responses to various central nervous system pathologic conditions. MLF, medial longitudinal fasciculus<br />
  14. 14. Oculocephalic and Oculovestiblar reflexes in comatose patients with:<br />Brainstem intact (doll’ head eye phenomenon)<br />Bil. MLF involvement<br />Low brainstem lesion<br />
  15. 15. Motor responses to <br /> noxious stimulation <br /> in acute cerebral <br /> dysfunction.<br /> A = Rt hemisphere<br /> B = Diencephalon<br /> C = Mibrain/Pons<br /> D = Medulla<br />
  16. 16. Sudden weakness or numbness of arm or leg especially on one side of the body<br />Sudden trouble in walking or dizziness, vertigo, loss of balance or coordination.<br />Facial Weakness/Numbness<br />Sudden severe headaches<br />Altered consciousness<br />

×