Disturbance of consciousness is a kind of severe brain dysfunction caused by many reasons. It is one of the common clinical symptoms. Consciousness refers to people’s perception of themselves and the surrounding environment, which can be expressed through words and actions.
Impairment of consciousness refers to a condition in which people perceive their own perceptions of the environment and the barriers to mental activity in which people perceive the environment. The content of consciousness includes “awakening state” and “awareness content and behavior.”
The awakening state depends on the integrity of the ascending and activating system of the brain-stem reticular structure of the so-called “switching” system. The content and behavior of consciousness depend on the integrity of the high-level neural activities of the cerebral cortex.
When the brainstem reticular structure activates the system to suppress or extensive damage to the cerebral cortex, the awakening state is weakened, and the consciousness content is reduced or changed, which can cause disturbance of consciousness.
a) Intracranial disease
1. Localized lesions
Cerebrovascular disease: cerebral hemorrhage, cerebral infarction, transient ischemic attack, etc.;
Intracranial space-occupying lesions: primary or metastatic intracranial tumors, brain abscesses, brain granulomas, cerebral parasite cysts.
Traumatic brain injury: brain contusion, intracranial hematoma and so on.
2. Diffuse brain lesions
Intracranial infectious diseases: various encephalitis, meningitis, arachnoiditis, ependymitis, and intracranial venous sinus infection;
Acute infectious diseases: various sepsis, infectious encephalopathy, etc.
Endocrine and metabolic diseases: such as hepatic encephalopathy, renal encephalopathy, pulmonary encephalopathy, diabetic coma, myxedema coma, pituitary crisis, thyroid crisis, adrenal insufficiency coma, lactic acidosis.
Exogenous poisoning: Including industrial poisons, drugs, pesticides, plant or animal poisoning.
Lack of normal metabolites
Disturbance of water and electrolyte balance. 6. Physical damage such as solar radiation, heat stroke, electric injury, drowning, etc.
1. Drowsiness Early manifestations of disturbance of consciousness, patients often fall asleep, can be awakened, consciousness is normal after waking up, or there are mild disorientation and unresponsiveness.
2. Confusion of consciousness Obvious obstacles to the patient’s time, space, and orientation of the person, incoherent thinking, often asked non-questioning, the illusion can be outstanding performance, rare hallucinations, emotional indifference.
3. Drowsiness, The patient, is in deeper sleep and cannot be awakened, unable to answer, and will avoid or be awakened by noxious stimuli such as acupuncture, pressure squeezing, etc., but will immediately fall asleep again.
4. Coma: Conscious activity is lost, and it is not possible to perceive various external stimuli or its own internal needs. There may be unconscious activities, and no stimulus can be awakened. According to the stimulus-response and reflex activity can be divided into three degrees:
Light coma: random action disappears, responds to painful stimuli, various physiological reflexes (swallowing, coughing, corneal reflex, pupil-to-light response, etc.) exist, and body temperature, pulse, and respiration do not change significantly and can be accompanied by spasms or agitation.
Deep coma: Random activity completely disappears, no response to various stimuli, various physiological reflexes disappear, there may be irregular breathing, blood pressure drop, incontinence, muscle relaxation, brain rigidity.
Extreme coma: also known as brain death. The patient was in a state of sudden death, without spontaneous breathing, and various reflexes disappeared. The electroencephalogram showed pathological electrical rest. The loss of brain function persisted for more than 24 hours, excluding the influence of drug factors.
5. A type of coma Many different behavioral states can show something similar to coma or be confused with coma, and patients who were initially coma can gradually develop into one of these states after varying lengths of time. These behavioral states mainly include locked-in syndrome (also known as a locked-in syndrome), persistent vegetative state, non-kinetic mutism (depression disorder), Abulia), catatonia, pseudo coma. Once the patient has a sleep-wake cycle, the real coma ceases to exist. These conditions are distinguished from a correct coma and are essential for proper treatment and prognosis. Of.
6. The delirium state is more ambiguous than the consciousness, the orientation and insight are all obstacles, and it can not be in regular contact with the outside world. It is often abundant in illusions and hallucinations. The vivid and realistic illusion can cause fear, escape or injury. The clinical features of sputum are characterized by attention deficits, low levels of consciousness, perceptual disturbances, and disturbances in the sleep-wake cycle.
What diseases can be induced by disturbance of consciousness?
Can be complicated by aspiration pneumonia, respiratory heartbeat, and other vital signs changes, but also cause traumatic damage due to coma. Aspiration pneumonia is caused by chemical pneumonia after inhalation of acidic substances such as animal fats, food, stomach contents, and other irritating fluids and volatile hydrocarbons. In severe cases, respiratory failure or respiratory distress syndrome may occur.
What are the ambulance measures for patients with disturbance of consciousness?
(1) When the patient has a disorder of consciousness such as confusion and drowsiness, he or she is closely watched and deepened into a coma.
(2) When in a coma, the head should be laterally positioned so that the mouth can be easily drained and the falling tongue pulled out with gauze. Because the patient will not swallow, do not feed water or medicine into the mouth.
(3) Keep the airway open. Undo the collar of the patient’s collar. If the patient’s mouth has secretions, it should be sucked out in time.
(4) To protect the eyes, if the patient’s eyes cannot be closed, eye ointment should be applied, wetted with sterile gauze on the eyes to prevent damage caused by the dry cornea.
(5) Prevention of pneumonia and acne, which is a fundamental principle for coma patients in home care. Turn over regularly, shoot back, suck and clean the mouth. Keep the bed clean and hygienic sheets replaced in time to prevent bedsores from occurring.
(6) Promptly sent to a hospital for diagnosis and rescue and treatment for the cause.
a) Identify the cause of the illness and treat it. Such as surgical removal of brain tumors, insulin for diabetes, hypoglycemia, supplementation of sugar, poisoning detoxification and so on.
(b) Symptomatic treatment.
1. Maintain airway patency, give oxygen, and inject respiratory stimulants. If necessary, perform tracheotomy or intubation with artificial respiration.
2. Maintain an active circulation function, provide a healthy heart, boost the medication, and correct the shock.
3. Patients with increased intracranial pressure are given dehydration, intracranial pressure drugs, such as corticosteroids, mannitol, furosemide and other diuretic dehydrating agents. If necessary, ventricle puncture drainage.
4. Antibacterial drugs to prevent infection.
5. Control of high blood pressure and upper body temperature.
6. Control convulsions.
7. Correct the balance of water electrolysis and supplement nutrition.
8. Give brain metabolism accelerators. Awakening agent and so on. The former include ATP, coenzyme A, citicoline, and the latter, such as chlorine esters, awakening the brain and so on.
1. Decalcify syndrome As cortical neurons in the cerebral cortex is destroyed or degenerated, their function is lost, and the subcortical function is relatively undamaged or restored. At this time, the patient is unconscious but has a wakeful sleep cycle. At the same time there is no language, can blink, eyes can rotate, high limb muscle tension, retraction and defensive movements, there is sucking, chewing, holding reflexes, appear to a cortical position. Common in the recovery period of coma, do not mistakenly believe that the patient is still in a coma.
2. Akinetic mutism is also called the coma. The brain stem rises partially due to the destruction of the activation system. The patient’s state of arousal is reduced, silent, no exercise, and incontinence, but the directional response exists, the autonomic response is normal, the pain partially disappears, and swallowing, chewing reflexes are often retained. Go to brain rigidity.
3. Locked-in syndrome (brain-injury) in the ventral side of the pons, which damages both the corticospinal tract and the cortical medullated tract, resulting in loss of motor function following the lesion. At this time, the patient can open his eyes and can’t move horizontally. , Can move vertically, answer “yes” or “no” by closing or vertical eyeball motion. Because it does not damage the ascending activation system and the patient is not aware of the obstacles but does not have natural language, it is also called a pseudo-coma.
4. Persistent autonomic disorders (a corruption of the cerebral cortex and subcortical lesions). Impaired consciousness, no language, no activity, and manifestations of autonomic dysfunction (vegetative humans).