Disorders of consciousness

Terminology

100

Patient is drowsy but awakens, although not fully- to stimulation. Will answer questions and follow commands, but slowly and inattentively 

Lethargic 

200

Pt does not respond to continuous or painful stimulation. Does not move- except, possibly, reflexively - and does not make any verbal sounds

Comatose

300

Pt is alert, attentive, follows commands. If asleep, responds prompty to external stimulation, and once awake, remains attentive 

Full consciousness 

400

Pt difficult to arrouse and needs constant stimulation in order to follow a simple command. May respon verbally with 1 or 2 words, but will drift back to sleep between stimulation

Obtunded

500

Pt arrouses to vigorous and continuous stimulation. Typically painful stimulation is required. May moan briefly but does not follow commands. Only response may be an attempt to withdraw from or remove the painful stimulation

Stuporous 

Definitions

100

Another form of altered consciousness in which the person appears to be awake but does not respond meaningfully to the outside world “wakefullness without awareness“

Vegetative state

200

Reflex that causes straightening (extension) of the arms and legs

Deceberate

300

Reflex that causes bending of the arms and straightening (plantar flexion) of the legs

Decorticate 

400

The reticular activating system controls what? 

Arousal and awareness

500

Semiconsciousness is when…

A pt has an impaired state of consciousness characterized by obtundation, stupor, or hyperSonia, from which a pt can be aroused only by energetic stimulation

Behavior/ response GCS

100

BEHAVIOR: eye opening response

4. Spontaneously

3. To speech

2. To pain

1. No response 

200

BEHAVIOR: Verbal response

5. Oriented to time, person and place

4. Confused

3. Inappropriate words

2. Incomprehensible sounds

1. No response

300

BEHAVIOR: Motor response

6. Obeys command 

5. Moves to localize pain

4. Flex to withdrawal from pain

3. Abnormal flexion

2. Abnormal extension 

1. No response

400

Head injury classification: GCS of 8 or less

Severe injury 

500

GCS of 13 to 15: classification?

Mild head injury

Enter Category Name

100

People in a _____ state do things inconsistently 

Minimally conscious state. This makes it difficult to distinguish the vegetative state from the minimally conscious state 

200

In this state, the pt has partial arousal rather than true awareness

Vegetative state. They can open their eyelids occasionally and demonstrate sleep wake cycles but completely lack cognitive function 

300

What is the last sensory lost?

Hearing 

400

This is an obvious sign of neuro change and should be reported immediately. 

Change in eye tracking and emotional response

500

This test confirms the absence of consciousness by demonstrating levels of oxygen and glucose metabolism in the cerebral cortex

PositRon emission tomography 

Random

100

GCS of 9 to 12: classification?

Moderate head injury

200

Localized response is…

Movements in response to sound, touch, or site

EX. Pressing their Hand and they retract

300

Following simple commands is….

Opening and closing eyes, sticking tongue out, gripping or releasing when asked

400

True or False A coma lasts longer than several weeks

False it rarely lasts longer than several weeks ,it can transition to a persistent vegetative state if it is 

500

Characteristics of the minimally conscious state

Sometimes follows simple instructions , may communicate yes or no by talking or gesturing , may speak some understandable words or phrases

Crying, smiling, making sounds, or gesturing