Oppression of consciousness

Oppression of consciousness

Consciousness is a meaningful perception of the inner and outer world as a result of higher integrative processes. Depression of consciousness is an unproductive form of impaired consciousness, characterized by a lack of mental activity with a decrease in the level of wakefulness, a distinct inhibition of intellectual functions and motor activity

    • Depression and altered consciousness are not specific to specific clinical forms of acute neurological pathology
    • Depression of consciousness occurs, as a rule, due to morphological changes or sharp disturbances in the metabolism of the brain.

Classification of disorders of consciousness

    • clear. Awake. The ability to pay attention. Full speech contact. Understanding and answering questions appropriately. Adequate and fast execution of commands. Spontaneous opening of the eyes. Fast and targeted response to any stimulus. Preservation of all types of orientation (in one’s own personality, in place, time, surrounding persons, situations, etc.). Correct behaviour. Retrograde and/or anterograde amnesia is possible. Full orientation, wakefulness, quick execution of all instructions.
    • Stun
    • Moderate (I). The ability to pay attention is reduced. Speech contact is maintained, but obtaining complete answers does not often require repetition of questions. Answers are slow, delayed, often monosyllabic. Commands are executed correctly, but slowly. Opens eyes to speech. The reaction of the extremities to pain is active, purposeful. Rapid exhaustion, lethargy. Impoverishment of facial expressions, inactivity, drowsiness. Motor-volitional reactions are slowed down. Control over the functions of the pelvic organs is preserved. Behavior is not always orderly. Orientation in the environment, place and time is incomplete, while orientation in one’s own personality is relatively preserved. Pronounced retro-and/or anterograde amnesia. Partial disorientation in place, time, situation, moderate drowsiness, slow execution of commands, especially complex ones.
    • Deep (II). Almost constant state of sleep. Possible motor arousal. Speech contact is difficult and limited, as a result of persistent demands, he can answer a yes-no type of appeal in monosyllables. Rarely, with perseverations, he can report his name, surname and some other data. Responds slowly to commands. Able to perform elementary tasks (open eyes, show tongue, raise hand, etc.), but is depleted almost instantly. Not often only tries to do this by performing the initial act of movement. To establish even a short-term contact, repeated appeals, a loud call are necessary, often in combination with the use of painful stimuli. The coordinated protective reaction to pain is preserved, the reaction to other types of stimuli is changed. Control over the functions of the pelvic organs is weakened. Disorientation in the environment
    • Sopor – complete disorientation, deep drowsiness. Execution of simple commands. Speech and mimic-manual contact is impossible. No commands are executed. Immobility or automated reflex movements. When painful stimuli are applied, protective movements of the hand directed to the source of irritation, turning over to the other side, and suffering grimaces on the face are found. May moan, make inarticulate sounds. Sometimes mindlessly opens his eyes to pain, a sharp sound. Pupillary, corneal, swallowing, cough and deep reflexes are traditionally preserved. Sphincter control is broken. Vital functions are preserved or there are non-threatening disorders in one or two parameters. Total failure to execute commands; the ability to localize pain is preserved (coordinated protective movements).
    • Coma
    • Moderate (I). Unwaking. Lack of reactions to any external stimuli, except for strong pain. In response to painful stimuli, extensor or flexion movements in the limbs, tonic convulsions with a tendency to generalization may appear. Sometimes the facial expressions of suffering. Unlike stupor, protective motor reactions are not coordinated, they are not aimed at eliminating the stimulus. Eyes do not open to pain. Pupillary and corneal reflexes are traditionally preserved. Abdominal reflexes are depressed, tendon reflexes are often elevated. There are reflexes of oral automatism and pathological foot reflexes. Swallowing is severely difficult. Protective reflexes of the upper respiratory tract are relatively preserved. Sphincter control is broken. Respiration and cardiovascular activity are relatively stable, without sharp deviations.
    • Deep (II). Unawakening of the probability of pain localization is absent (uncoordinated defensive movements). The absence of any reactions to any external stimuli, including severe pain. Complete absence of spontaneous movements. Various changes in muscle tone (from decerebrate rigidity to muscle hypotension) in the presence of Kernig’s symptom. Hyporeflexia or areflexia without bilateral mydriasis. Preservation of spontaneous respiration and cardiovascular activity in their severe disorders.
    • Beyond (III). Restlessness, lack of protective movements for pain. Bilateral limiting mydriasis, eyeballs are motionless. Total areflexia, diffuse muscle atony. The grossest violations of vital functions – disorders of the rhythm and frequency of breathing or apnea, severe tachycardia, blood pressure is sharply reduced or not detected. Catastrophic state of vital functions. Assessment of the degree of oppression of consciousness
    • Assessment of the degree of depression of consciousness according to the Glasgow scale, recommended by WHO (points)
    • eye opening
    • Arbitrary – 4
    • Inverted speech – 3
    • To a painful stimulus – 2
    • Missing – 1.
    • verbal response
    • Orientation is complete – 5
    • Confused speech – 4
    • Incomprehensible words – 3
    • Inarticulate sounds -2
    • No speech – 1.
    • motor response
    • Executes commands – 6
    • Focused on pain stimulus – 5
    • Non-targeted to a painful stimulus – 4
    • Tonic flexion to a painful stimulus – 3
    • Tonic extension to painful stimulus – 2
    • Missing – 1.
    • Only 3-15 points. 8 points and above – good chances for improvement, less than 8 – a life-threatening situation, 3-5 – potentially fatal, especially if fixed pupils are observed.
    • To assess the level of consciousness, the following (traditional) classification is also used.
    • Clear consciousness.
    • Stun:
    • Moderate (I)
    • Deep (II).
    • Sopor.
    • Coma:
    • Moderate (I)
    • Deep (II)
    • Beyond (III).
    • Correspondence of the characteristics of the state of consciousness on the Glasgow Scale to traditional terms
    • 15 points – clear consciousness
    • 13-14 – stun
    • 9-12 – stupor
    • 4-8 – coma
    • 3 – deep coma or brain death.

See also Hyperosmolar non-ketoacidotic kama, Myxedematous coma, Lactic acid coma, Terminal condition, ICD brain death. R40 Somnolence, stupor and coma

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