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🚴 | Collision with a roadside tree by bicycle


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Collision with a roadside tree by bicycle A high school boy is seriously injured in Kanazawa

 
If you write the contents roughly
The boy was taken to the hospital, but he was hit hard on his head and was unconscious.
 

On the morning of the XNUMXth, a high school boy who was riding a bicycle on the "Yamagawa Loop Road" in Kanazawa collided with a roadside tree and became unconscious. → Continue reading

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Consciousness disorder

Consciousness disorderDisturbance of consciousness is a condition in which understanding of things correctly and proper reaction to surrounding stimuli are impaired. ConsciousnessThere are three elements in the composition of "clearness", "spread", and "qualitative". Among them, the general term "consciousness disorder" refers to a decrease in "clearness".[Source required]The decrease in "spread" (constriction of consciousness)Hypnosis,lethargy,coma,syncopeAnd the "qualitative" change (change in consciousness) isDelirium,Let's goEtc.

Consciousness disorder is divided into consciousness clouding and consciousness change. The former is coma, drowsiness, somnolence, coma, and ill-recognition in order of weight. Judgment of this symptom is used in the field of emergency medical care.3-3-9 degree method (or Japan Coma Scale, abbreviation: JCS)At. The latter is a state in which excitement, wandering, and abnormal behavior are manifested pathologically (delirium).[1].

Mechanism of consciousness disorder

Current,ConsciousnessThere is no clear answer to the question what is. Since ancient times哲学Various studies have been made in the field of, but it remains a big mystery. So-calledMental illnessExcept for the fields called consciousness disorders, two types of mechanisms of consciousness disorder, which are consciousness (clarity) and cognitive (qualitative, content) disorders, are well studied.

The main awakening is said to be in. this isBrainstemIt is believed to consist of The ascending reticular activation system has inputs for all sensory stimuli. That is, it is considered that the pain stimulus and the call stimulus increase the degree of arousal through the ascending reticulum activation system. AnotherCognitionaboutCerebral cortexIt is said to exist throughout. Basically, if you have a consciousness disorder, either or both are considered to be impaired. However, even if the brain itself does not have an organic disease, it is possible to damage both if it is a systemic disease. That is, basically, when looking at a person with impaired consciousness, the brain stem, cerebral cortex, and systemic disease should be considered.

Consciousness management

When looking at patients with impaired consciousness, the most important thing is to save lives, not to make a diagnosis. this isBLS,ACLSPlease refer to.

What to watch out forHypoglycemiaBe sure to deny. Hypoglycemia tests can be performed instantly and treated (GlucoseThis is because rapid recovery can be expected by intravenous administration of the liquid) and there is a risk of death if not properly treated. A hypoglycemic attack can also cause hemiplegia and can lead to incorrect treatment.

またhysteriaIt is better to deny the reason. Hysteresis should be diagnosed from the patient's appearance, but if in doubt, perform an arm drop test. When the test is performed at a position where the hand hits the face, the hysterical patient often drops the face unconsciously to avoid the face.

The medical history also helps the diagnosis. If the medicine bottle is at hand, suspect overdose.

If these basic information gathering and life-saving measures such as BLS have been completed, the next consideration is whether there is a brainstem disorder. this isBrainstemToRespiratory centerTherefore, if you have a brainstem disorder, you cannot breathe.Tracheal intubationBecause it is necessary. It is good to use, for example, to judge brainstem disorders. This is also called the eye sign of a doll. If the eyeball does not gaze at one point even when the head is swayed and the head gazes in the direction in which the head is turning (negative eyeball reflex), it is considered a brain stem disorder.brain deathIt is also included in the judgment criteria of. It should be noted that brainstem disorders should be determined by physical examination,CT,MRIDo not make a judgment based on such image diagnosis. Although CT shows compression or bleeding in the brainstem, if brain head reflexes are seen and brainstem function is maintained, there is no brainstem disorder at that time.

When the necessity of tracheal intubation is judged, it is diagnosed as supratentorial lesion (cognitive disorder), subtentorial lesion (wakefulness disorder), or systemic lesion. It is important that the examination for trauma be performed as well.vital signsIf Cushing's sign (hypertension and bradycardia) is found in, suspected hypertension (on the contrary, systemic lesions are more suspected in hypotension), and if there is trauma and hypotension,Neurogenic shockIn addition to bleeding from the pelvic fracture and in the chest cavity,Intraabdominal bleedingAlso search. Also often due to drugs,Benzodiazepines,Organic phosphorusYou must be conscious of poisoning. Children and the elderly are more likely to take the wrong drug or overdose, and a small number of drugs or drugs for criminal purposes are also administered. Blood drug levels and urinary triage[2]Should also be done if necessary.

In Japan, there are not so many consciousness disorders due to drug poisoning, but in the United States and the like, there are cases where a coma cocktail is used because it is so common. What is a Coma CocktailThiamine hydrochloride(Vitamin B1, Trade name Metabolin, 50mg/1ml/A) 2A, ie 100mg and 50% glucose solution 20ml 2A (40ml) and hydrochloric acidNaloxone(0.2mg/1ml/A) is 2A (0.4mg) IV injection. Thiamin isWernicke encephalopathyIt is administered to prevent It is necessary to note that the administration of glucose initially exacerbates Wernicke's encephalopathy. Drug addiction is positively suspected when there are miosis and injection marks. Benzodiazepine antagonistsFlumazenilDo not necessarily administer (brand name such as annexate). this isEpilepsyIf you have a history ofSleeping pillsPatients taking痉挛This is because there is a risk of causing

Glasgow Coma Scale (GCS) Is 8 points or less, in principleTracheal intubationOrAirway securityThere is an adaptation of. However, this does not apply if prompt recovery of consciousness can be expected as in acute alcohol poisoning. In cases where it is difficult to intubate, raise the lower jaw and perform mask ventilation. Consciousness disorderVomitingIf this occurs, antiemetics are given, but if no improvement is noted, tracheal intubation is indicated.

Carpenter classification

Emergency medicineInConsciousness disorderIt is famous to remember aeioutips as a differential disease. This is because if the diagnosis cannot be made due to a disorder of consciousness for which the cause is unknown, it is for scrutinizing one by one and scrutinizing one by one. In Japan, some people remember it as aio chips.

A: alcoholism:Acute alcoholism
E: endocrine:Endocrine
I: insulin:Insulin
O: oxygen, opiate: hypoxemia,drug
U: uremia:Uremia
T: trauma, temperature:Trauma,
I: infection:Infection
P: psychiatric, porphyria:Mental illness,Porphyria
S: syncope, stroke, SAH:syncope,stroke,subarachnoid hemorrhage

Evaluation criteria

Qualitative measure

Mayo Clinic classification andlethargy,coma,SomnolenceThere is a scale called.

Quantitative measure

JCS and GCS are measures of unintended consciousness disorders such as trauma.麻 酔,Artificial respiratorsIf you intentionally create consciousness disorders such as during use, there are scales such as Ramsay scale and SAS.

Japan Coma Scale (JCS)
Evaluation criteria mainly used in Japan. Also called 3-3-9 degree method. Although it is simple, it has a weak point that it cannot accurately evaluate changes in consciousness such as addicted patients and mental illness, and changes in consciousness.
I (Awake without being stimulated)Ⅱ (Awakening when stimulated)Ⅲ (state that does not awaken even if stimulated)
0. Ching Ming  
1, not clear consciousnessEasy to open your eyes with a normal call100、Responsive to pain stimulus
2, disorientation20, open your eyes by shaking a loud voice or body200, Pain stimulus causes slight limb movements and frowns
3. I can't say my name or date of birth30, barely opening the eyes when repeatedly calling while applying pain stimulus300, no reaction to pain stimuli
Glasgow Coma Scale (GCS)
An evaluation standard widely used in the world.
It is displayed by the total of the respective scores of "eye opening function E", "language function V (verbal response)" and "motor function M (motor response)".
Eye opening function ELanguage function VMotor function M
4, open eyes naturally5, Oriented6, can be done as ordered
3, open eyes when ordered4, have a meaningless conversation5、Understand the site of pain stimulation
2, open eyes for pain3, emit meaningless words4, withdraw limbs
1, do not open eyes2, only meaningless utterances3, pathological flexion
 1, no reaction2, extension reaction
  1, no reaction
Emergency Coma Scale (ECS)
An evaluation standard that was developed in Japan, mainly using JCS as a prototype and introducing GCS elements.

Special consciousness disorder

Decerebrate rigidityとDecorticate rigidity
If you have a consciousness disorder, be sure to dopainWhen judging the level of consciousness given a stimulus,Posture reflexMay be triggered.DiencephalonWhen the level is damaged, the upper limbs flex and the lower limbs extend. thisDecorticate rigidityThat.midbrainRed nucleus- bridgeWhen the lesion extends, the postural reflex, in which the limbs extend to the painful stimulus, is induced. This is called decerebrate rigidity. When the consciousness level is repeatedly judged, the postural reflex, which was decorticate rigid, may become decerebral rigid. This means that the lesion extends from the diencephalon to the upper brain stem, that is, the lesion progresses. Further progressMedulla oblongataIf the lesion extends toMuscle tensionBecomes completely relaxed and no postural reflex is evoked.
Mandibular mandibular syndrome
He is akinetic and silent with a widespread disorder of the cerebral cortex or white matter, does not gaze or follow, has increased muscle tonus, and takes a decorticate posture.
Akinesia
It is a vegetative state in the world. Bilateral cerebral widespread consciousness disorder with advancedCognitive impairmentIt is in the state of falling into. It can be distinguished from normal consciousness disorder in that there are sleep-wake patterns, eyes open and gaze, and swallowing.Head injuryIt is said that irreversible may be judged if this state continues for 3 months in anoxic brain state for XNUMX year.brain deathIt is a word that often appears when explaining the difference between and.
Confinement syndrome
Although he was conscious of clearness, he was unable to communicate his intentions due to bilateral disorders of the bridge bottom, resulting in quadriplegia, pseudobulbar paralysis, bilateral facial palsy, and abducens nerve palsy. Since the oculomotor nerve is normal, it is possible to communicate through vertical eye movements and eyelid elevation. It is common in basilar artery thrombosis.
Transient amnesia
A person who was healthy suddenly suffers from anterograde amnesia and cannot remember new things at all. The person is confused because he cannot grasp the situation around him and asks the same question again.

It usually recovers within 24 hours and often does not require active treatment. It is more likely to occur in people with a lot of stress, and it is thought that the decrease in blood flow in the temporal lobe is involved.

Hysteria seizures
Unconscious emotional conflict is a mental disorder that is usually expressed as a change or loss of physical function that is regulated by the voluntary nervous system. The possibility can be considered to some extent by exclusion of organic diseases and hand drop test. It usually recovers naturally, so at a later datePsychiatricConsider a medical examination.
syncope
Unlike consciousness disorder, consciousness recovers immediately. Mostly due to cardiovascular disorders and autonomic reflexes. Neurological symptoms in the area of ​​control of the basilar artery are the main symptoms. Since ischemia occurs from the upper part of the brain, occipital lobe disorders cause anterior darkness, upper brainstem reticular disorders cause consciousness disorders, and medullary vestibulospinal tract disorders result in insufficiency. In many cases, the sympathetic nerve is reflexively stimulated and a cold feeling is felt at the same time.

Conscious consciousness disorder

Consciousness disorder associated with systemic disease
septicemia,Legionella pneumonia,Fat embolismCan be given. Especially for Legionella pneumoniaMeningitisIt is easy to make a mistake. ChestX-ray photographIt is important to confirm at.
Cirrhosis
Hepatic encephalopathyThere is a suspicion of. It is rhythmical when the upper limbs are extended during shallow consciousness disorderInvoluntary movementHappens. Although it includes flapping tremors,MyoclonusIt is also called.
Disquiet
HypoglycemiaOr cerebral blood flow failure may be considered.
Fluctuating consciousness disorder
Vertebrobasilar insufficiency may be considered.
When shock is associated with consciousness disorder
Acute aortic dissection is possible. EspeciallyInternal carotid arteryDissociation ofcerebral infarctionIt is easy to make a mistake. Blood pressure in the left and right armsMediastinumEnlargement and echocardiography to check heart tamponade. With cerebral infarctionMisdiagnosisIf thrombolytic therapy is performed, it will be disastrous. Hypoglycemia may cause cerebral infarction-like symptoms.

footnote

  1. ^ Color diagram Encyclopedia to understand the basics of pharmacology p88
  2. ^ A test kit that quickly determines drug reactions in urine.Commentary page of National Institute of Health Sciences

References

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