Disorders of Consciousness Presented By: Joseph S. Ferezy, D.C.
-
Upload
derrick-bridges -
Category
Documents
-
view
219 -
download
0
Transcript of Disorders of Consciousness Presented By: Joseph S. Ferezy, D.C.
Disorders of Consciousness
Presented By:
Joseph S. Ferezy, D.C.
Levels of Consciousness
Clouding (Confusion) Irritable And Slow, But Accurate Hypoxic Increase BUN Encephalopathy
Levels of Consciousness
Delirium D.T.’s (2nd Most Common Alcoholic Encephalopathy) Like A Drunk Arousable Irritable Psychotic Confused Hallucinations
Levels of Consciousness
Obtundation One Step Worse Then Delirium
Levels of Consciousness
Stupor Like Deep Sleep (Different On EEG) Arousal Only With Deep Stimuli Organic Brain Dysfunction
Coma
Unarousable
Unresponsive
Glasgow Coma Scale
CNS vs Metabolic Coma
Syncope (Fainting, Vapors)
Common ComplaintBrief Loss of Consciousness and Muscle ToneRapidly Restored With Recumbency.Commonly Caused by Impaired Cerebral Circulation, Metabolism, or Psychosomatic.Seizures May Occur, Especially If the Patient Remains Erect.Associated With a Drop in Peripheral Blood Pressure (at Least to 75 Mm Hg) and a Slowed Heart Rate.
Syncope
Vasodepressor Commonest Precipitated by
Fear Anxiety Pain Other Psychological
Usually Occurs When Patient Is Standing Causative Stimuli
Sensory Emotional
Physiological Mechanisms
Fight or FlightTissue DamagePain (Deep)Reflex to Injury of Certain Areas (Testicles, Blood Vessels, Alimentary Canal)Blood Vessel StenosisReduced Blood VolumePeripheral VasodilatationAbnormal Blood Constituents
Prodroma
Motor WeaknessEpigastric DistressSympathetic Autonomic Activity Perspiration Pallor of Face Cold, Moist Extremities Lightheadedness Blurred Vision
EEG Changes After Onset of Unconsciousness
Treatment
Patient Must Remain Recumbent Until Well After Consciousness ReturnsRegular ExerciseGentle, Broad Contact, Thoracic AdjustmentsOccipital and Upper Cervical AdjustmentsAvoid Offending ActivityPsychological Evaluation If Recurrent
Carotid Sinus
Types Cardio Depressor (Vagal)
Pressure on the Carotid Sinus Causes Heart Rate Slowing and Subsequent Decrease in Blood Pressure.
Vasodilator (Vasomotor) Drop in Blood Pressure Without Decrease in Heart Rate.
Central (Cerebral) Loss of Consciousness Following Carotid Sinus Pressure Is
Not Associated With Fall in Blood Pressure. Pressure Below Receptors May Cause Syncope.
Treatment
Patient Education
Differentiate From Hysteria by Pressing Elsewhere on the Neck and Noting Symptoms
Occipital, Upper Cervical and Thoracic Adjustments
Orthostatic Hypotension
Characterized by Repeated Syncopal Episodes Associated With a Sudden Drop in Blood Pressure When the Patient Stands up After Sitting or Being Recumbent
Orthostatic Hypotension
Causes Prolonged Convalescence Faulty Postural Reflex Adaptation Sympathectomy Peripheral Venous Stasis Anxiety Anti-hypertensive Medication
Orthostatic Hypotension
Treatment Aerobic Exercise Patient Education Coordinate With MD Regarding Medications Brisk Specific Adjustments to Thoracic
Subluxations Elastic Stockings Abdominal Belt
Cardiac Problems
Various Cardiac Syndromes Resulting in Decreased Cerebral Perfusion May Result in Syncope, and a Cardiac Examination Is Essential for an Accurate Diagnosis. Some Are Listed Below:Stokes-Adams SyndromeReflex Heart BlockCoronary/myocardial InsufficiencyParoxysmal TachycardiaAortic StenosisCongenital Heart Disease
Impaired Brain Metabolism
Anoxemia
Anemia
Hypoglycemia
Acidosis
Drug Intoxication
Acute Alcoholism
Hyperventilation
Other Causes of Impaired Brain Circulation
Arteriosclerotic DiseasePost Head Injury With Abrupt Head MovementsHypertensive EncephalopathyMigraine (Rarely)Intracranial NeoplasmsA-V MalformationsMaturationCough
Hysteria
Usually a Repressed, Adolescent or Elderly Female. Look for Other Signs of Hysterical Illness.
Coma
Longer and More Profound Loss of Consciousness Than Syncope. Primitive or No Reaction to Painful Stimuli. Milder Grades Are Termed Semi Coma, and Even Lesser Grades As Stupor or Confusion.
Coma
Examination Motor Responses to Pain Respiration Pattern Pupil Size, Equality and Reactivity Fundoscopy Vestibulo-ocular Reflexes
Persistent Vegetative State (PVS)
Commonly, when coma lasts for a month or more, the individual's eyes may be open and may blink even though the person's stare is vacant, no purposeful responses occur, and no signs of awareness appear. At this state, most physicians will say that the individual is in a "persistent vegetative state" or PVS.
Persistent Vegetative State (PVS)
This term was developed by Drs. Brian Jennett and Fred Plum, an outstanding neurosurgeon and a well recognized neurologist respectively.
The intent was to describe a condition in which the vegetative or anatomic functions, such as breathing, maintaining a normal blood pressure, digesting and eliminating foods were maintained and would persist indefinitely in the absence of awareness.
Persistent Vegetative State (PVS)
Drs. Jennett and Plum, originators of the term PVS, to wait three months before making a determination.
Persistent Vegetative State (PVS)
Many physicians will solemnly announce to a family two or three days after onset of coma that their loved one is in a persistent vegetative state and declare unambiguously that nothing can be done, adding insult to injury and preventing treatment at the most treatable stage. Only brain death is untreatable in the spectrum of brain functions.