Evaluation of the Obtunded Patient
Anesthesia Central is an all-in-one web and mobile solution for treating patients before, during, and after surgery. This collection of drug, procedures and test information is derived from Davis’s Drug, MGH Clinical Anesthesia Procedures, Pocket Guide to Diagnostic Tests, and MEDLINE Journals. Explore these free sample topics:
-- The first section of this topic is shown below --
First Things First (assess & treat for the following)
- Airway assessment
- Altered mental status may indicate compromised ability to protect airway.
- GCS 8 or less requires airway protection (eg, ETT).
Glasgow Coma Scale
- 6 = Appropriate
- 5 = Localizes to pain
- 4 = Nonpurposeful
- 3 = Decorticate posturing: upper extremities flex, lower extremities extend
- 2 = Decerebrate posturing: fully extends
- 1 = No movement
- Eye Opening
- 4 = Spontaneous opening
- 3 = Opens to stimulation
- 2 = Opens to strong stimulation
- 1 = Does not open
- 5 = Appropriate
- 4 = Confused
- 3 = Inappropriate words
- 2 = Incomprehensible sounds
- 1 = No response
- Alterations in breathing pattern may indicate site of lesion.
- Mechanical support may be required to maintain adequate ventilation & oxygenation.
- Circulation (see Circulation)
- Goal is to maintain cerebral perfusion pressure (CPP) at least 60 mmHg.
- If ICP is unknown, then goal of MAP >90 mmHg until ICP can be determined
- General physical exam
- Other clinical exams as directed by clinical suspicion
- Focused history & general medical exam
- ICU neuro exam
- This MUST be performed w/ attention to detail!
- Treat immediate conditions.
- Seizures, herniation, malignant hypertension, etc.
- Appropriate diagnostic tests
- Neuroimaging (eg, CT or MRI), EEG, labs, etc.