Altered Mental Status and Coma: Introduction

by Carlo Raj, MD

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    Here, we have altered mental status and coma. There are so many different times through a pathology that you’ve have heard the term altered mental status. What the heck does that mean? Well, before we get into any of that, these are some of the important questions that you want to ask your patient, or ask yourself when you’re going through level of consciousness versus cognition. So, please pay attention. What do you need to be “awake”? Bilateral cortices. The brainstem, specifically, the reticular activating system, the RAS. What do you need for intact cognition? You need to be awake and functional networks. The first question with awake would then determine your level of consciousness. You need your cortices and you need your brainstem. If it’s cognition, you need functioning. These are two important questions you ask yourself to see whether or not you’re on the side of consciousness or cognition. Here, we’ll take a look at a particular scale known as a Glasgow coma scale. Take a look at the points, eye opening, verbal and motor. If the patient is able to obey commands, points here will be 6. If the patient is oriented, localizes the pain, 5. Spontaneous, confused, withdrawing to pain gives you 4. To speech, inappropriate verbal, and decorticate posturing, which we’ll talk about in great detail next, is 3. To pain, meaning to say, that’s when the eye would open, verbal absolutely incomprehensible, and here we have de-, not corticate, but decerebrate posturing. And I’ll walk you through these in great detail upcoming. On a scale of 1 to 6, if it’s 1, nothing. Developed mainly for trauma -- Developed mainly for trauma issues, but a useful quick way to convey information as well. So, the above scale, below 8 has profound predictive value in...

    About the Lecture

    The lecture Altered Mental Status and Coma: Introduction by Carlo Raj, MD is from the course Altered Mental Status and Coma. It contains the following chapters:

    • Altered Mental Status and Coma
    • Delirium, Encephalopathy, Altered Mental Status

    Included Quiz Questions

    1. Bilateral cortices, reticular activating system and function.
    2. Wakefulness and brainstem.
    3. Cerebral cortex.
    4. Brainstem.
    5. Sleep and functionality.
    1. Withdrawal to pain, localizing pain and obeying commands.
    2. Obeying commands, localizing pain and withdrawal to pain.
    3. Localizing pain, withdrawal to pain and obeying commands.
    4. Decorticate posturing.
    5. Decerebrate posturing.
    1. Electrolyte imbalance.
    2. Uremia.
    3. Hepatic encephalopathy.
    4. Adrenal insufficiency.
    5. Hyperthyroidism.
    1. Carbon monoxide poisoning.
    2. Alcohol intoxication.
    3. Organophosphate poisoning.
    4. COPD.
    5. Carbondioxide poisoning.
    1. Thiamine deficiency.
    2. Pneumonia.
    3. Urinary tract infection.
    4. Viral meningitis.
    5. Subarachnoid hemorrhage.
    1. Laboratory screen.
    2. CT scan brain.
    3. MRI brain.
    4. Drug toxicology.
    5. EEG.

    Author of lecture Altered Mental Status and Coma: Introduction

     Carlo Raj, MD

    Carlo Raj, MD

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