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A coma is a deep state of prolonged unconsciousness in which a person cannot be awakened, fails to respond normally to painful stimuli, light, or sound, lacks a normal wake-sleep cycle and does not initiate voluntary actions. Coma patients exhibit a complete absence of wakefulness and are unable to consciously feel, speak or move. Comas can be derived by natural causes, or can be medically induced.
A head injury is any injury that results in trauma to the skull or brain. The terms traumatic brain injury and head injury are often used interchangeably in the medical literature. Because head injuries cover such a broad scope of injuries, there are many causes—including accidents, falls, physical assault, or traffic accidents—that can cause head injuries.
The Glasgow Coma Scale (GCS) is a clinical scale used to reliably measure a person's level of consciousness after a brain injury.
Neurotrauma, brain damage or brain injury (BI) is the destruction or degeneration of brain cells. Brain injuries occur due to a wide range of internal and external factors. In general, brain damage refers to significant, undiscriminating trauma-induced damage, while neurotoxicity typically refers to selective, chemically induced neuron damage.
The Apgar score is a method to quickly summarize the health of newborn children against infant mortality. Virginia Apgar, an anesthesiologist at New York–Presbyterian Hospital, developed the score in 1952 to quantify the effects of obstetric anesthesia on babies.
The AVPU scale is a system by which a health care professional can measure and record a patient's level of consciousness. It is mostly used in emergency medicine protocols, and within first aid.
A minimally conscious state (MCS) is a disorder of consciousness distinct from persistent vegetative state and locked-in syndrome. Unlike persistent vegetative state, patients with MCS have partial preservation of conscious awareness. MCS is a relatively new category of disorders of consciousness. The natural history and longer term outcome of MCS have not yet been thoroughly studied. The prevalence of MCS was estimated to be 112,000 to 280,000 adult and pediatric cases.
Nursing assessment is the gathering of information about a patient's physiological, psychological, sociological, and spiritual status by a licensed Registered Nurse. Nursing assessment is the first step in the nursing process. A section of the nursing assessment may be delegated to certified nurses aides. Vitals and EKG's may be delegated to certified nurses aides or nursing techs. It differs from a medical diagnosis. In some instances, the nursing assessment is very broad in scope and in other cases it may focus on one body system or mental health. Nursing assessment is used to identify current and future patient care needs. It incorporates the recognition of normal versus abnormal body physiology. Prompt recognition of pertinent changes along with the skill of critical thinking allows the nurse to identify and prioritize appropriate interventions. An assessment format may already be in place to be used at specific facilities and in specific circumstances.
Abnormal posturing is an involuntary flexion or extension of the arms and legs, indicating severe brain injury. It occurs when one set of muscles becomes incapacitated while the opposing set is not, and an external stimulus such as pain causes the working set of muscles to contract. The posturing may also occur without a stimulus. Since posturing is an important indicator of the amount of damage that has occurred to the brain, it is used by medical professionals to measure the severity of a coma with the Glasgow Coma Scale and the Pediatric Glasgow Coma Scale.
Glycine encephalopathy is a rare autosomal recessive disorder of glycine metabolism. After phenylketonuria, glycine encephalopathy is the second most common disorder of amino acid metabolism. The disease is caused by defects in the glycine cleavage system, an enzyme responsible for glycine catabolism. There are several forms of the disease, with varying severity of symptoms and time of onset. The symptoms are exclusively neurological in nature, and clinically this disorder is characterized by abnormally high levels of the amino acid glycine in bodily fluids and tissues, especially the cerebrospinal fluid.
The Revised Trauma Score (RTS) is a physiologic scoring system, designed for use in based on the initial vital signs of a patient. A lower score indicates a higher severity of injury.
The Blantyre coma scale is a modification of the Pediatric Glasgow Coma Scale, designed to assess malarial coma in children.
A coma scale is a system to assess the severity of coma. There are several such systems:
The National Institutes of Health Stroke Scale, or NIH Stroke Scale (NIHSS) is a tool used by healthcare providers to objectively quantify the impairment caused by a stroke. The NIHSS is composed of 11 items, each of which scores a specific ability between a 0 and 4. For each item, a score of 0 typically indicates normal function in that specific ability, while a higher score is indicative of some level of impairment. The individual scores from each item are summed in order to calculate a patient's total NIHSS score. The maximum possible score is 42, with the minimum score being a 0.
An altered level of consciousness is any measure of arousal other than normal. Level of consciousness (LOC) is a measurement of a person's arousability and responsiveness to stimuli from the environment. A mildly depressed level of consciousness or alertness may be classed as lethargy; someone in this state can be aroused with little difficulty. People who are obtunded have a more depressed level of consciousness and cannot be fully aroused. Those who are not able to be aroused from a sleep-like state are said to be stuporous. Coma is the inability to make any purposeful response. Scales such as the Glasgow coma scale have been designed to measure the level of consciousness.
Trauma in children, also known as pediatric trauma, refers to a traumatic injury that happens to an infant, child or adolescent. Because of anatomical and physiological differences between children and adults the care and management of this population differs.
The FOUR Score is a clinical grading scale designed for use by medical professionals in the assessment of patients with impaired level of consciousness. It was developed by Dr. Eelco F.M. Wijdicks and colleagues in Neurocritical care at the Mayo Clinic in Rochester, Minnesota.
Pain stimulus is a technique used by medical personnel for assessing the consciousness level of a person who is not responding to normal interaction, voice commands or gentle physical stimuli. It forms one part of a number of neurological assessments, including the first aid based AVPU scale and the more medically based Glasgow Coma Scale.
The Galveston Orientation and Amnesia Test (GOAT) is a measure of attention and orientation, especially to see if a patient has recovered from post-traumatic amnesia (PTA) after a traumatic brain injury. This was the first measure created to test post-traumatic amnesia, and is still the most widely used test. The test was created by Harvey S. Levin and colleagues (1979), and features ten questions that assess temporal and spatial orientation, biographical recall, and memory. Points are awarded for responses to each question, with a 100 points possible. A score greater than 78 for three consecutive days is considered the threshold for emergence from post-traumatic amnesia. This test is intended for patients aged 15 years or older. Younger patients are given a modified version of the test, known as the Children's Orientation and Attention Test (COAT).
The Westmead Post-traumatic Amnesia Scale (WPTAS) is a brief bedside standardised test that measures length of post-traumatic amnesia (PTA) in people with traumatic brain injury. It consists of twelve questions that assess orientation to person, place and time, and ability to consistently retain new information from one day to another. It is administered once a day, each and every day, until the patient achieves a perfect score across three consecutive days, after which the individual is deemed to have emerged from post-traumatic amnesia. PTA may be deemed to be over on the first day of a recall of 12 for those who have been in PTA for greater than four weeks. The WPTAS is the most common post-traumatic amnesia scale used in Australia and New Zealand.
References
- Merck Manual. "Modified Glasgow Coma Scale for Infants and Children" . Retrieved 2008-05-03.
- ↑ "Archived copy". Archived from the original on 2016-01-22. Retrieved 2020-04-29.CS1 maint: archived copy as title (link)