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Need ETT - Endotracheal Intubation

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Lack of awareness and arousal

vs. PVS - Persistent Vegetative State

vs. Lock-in syndrome → Horizontal Gaze Palsy w/t Vertical Gaze Palsy

vs. Neurological Determined Death

Physiology

• Arousal: Decreased LOC

  • Localize to the ascending reticular arousal system (diencephalon, paramedian region of upper brainstem

    

    Red: ascending arousal system

• Awareness: cerebral activities, e.g. Confusion

  • Localize to the cerebral cortex

Etiology

Presentation

• Pupillary Dysfunction

  

  • High-yield: !Uncal herniation due to mass effect

• EOM Dysfunction

  

• Signs of trauma

  • Racoon Eye, Battle’s sign → Indicate skull-base fracture

• Signs of !Meningitis

  • Meningeal signs

• Signs of systemic illness related to coma

  • See ‘associated links’

• Signs of drug use

• Signs of seizure

• Decreased LOC → assessed by GCS (3-15) (≤ 8)

  • Requiring ETT - Endotracheal Intubation