CRACKCast E204 – Depressed Consciousness and Coma

Core Questions:

1. Define coma and differentiate coma from lethargy and stupor.

2. Name five neuroanatomic structures involved in maintaining arousal.

3. List five critical and five emergent causes of depressed consciousness. (see Table 13.1)

4. Describe your approach to the history and physical examination for the patient with depressed consciousness.

5. Outline your exam to accurately assess the Glasgow Coma Scale (GCS). (see Table 13.2)

6. What is the FOUR score, and how is it calculated? (see Table 13.3)

7. What ancillary tests should be ordered in the patient with depressed consciousness?

8. Outline your plan of management for the patient with depressed consciousness. (see Figure 13.2)

Wisecracks:

1. What is the best noxious stimulus to apply to evaluate GCS?

2. What are the oculocephalic and oculovestibular reflexes, and what information do they provide?

3. Describe decorticate and decerebrate posturing.

4. What is the utility of serum ammonia testing?