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Examination program for patients with altered state of consciousness

An objective study begins with an assessment of the general condition of the child, which is the result of the examination, an assessment of the general appearance of the child, the degree of his activity, the adequacy of his reaction to the examination, position in bed, state of consciousness. When assessing the general condition, the complaints of the child are taken into account. The final conclusion about the patient’s condition is made at the end of an objective examination, however, when describing his status, this characteristic of an objective examination is put in first place.

The general condition of the patient may be:

1) satisfactory,

2) moderate

3) heavy

4) extremely difficult.

After recording the state, the main signs of its violation are decrypted.

A satisfactory condition is indicated when no significant complaints of the patient are detected, and with an objective examination, symptoms indicating the state of decompensation of vital functions. At the same time, the child is cheerful, mobile, is interested in surrounding people and objects. The state of moderate severity is in the presence of significant complaints and signs of subcompensation of the functions of vital organs. In severe condition, complaints are pronounced, loss of consciousness, limitation of mobility, pronounced decompensation of the main body systems can be observed. They speak of an extremely serious condition with the aggravation of these signs and the appearance of symptoms indicating a threat to the life of the child.

The next step is to assess the state of consciousness. There are so many types of state of consciousness: a clear and altered state of consciousness - doubtful, stuporous, soporous. They talk about the dubious state of consciousness when the child’s reaction to the environment is there, but it is slowed down and lowered, he reacts to crying with irritation, answers questions, but is very sluggish. With a soporous state of consciousness, stupidity is noted, the child does not react to the environment, but the reaction of the body is noted to painful effects.

With severe inhibition of the cerebral cortex, the child loses consciousness - a coma occurs (coma).
In this case, the child does not respond to speech, strong sound and light stimuli, unconditioned protective reflexes are reduced or absent. Rationally determine the degree of coma. At I degree (light coma) - there is no consciousness, movements of an arbitrary nature, however, corneal and corneal reflexes are present. Coma of the II degree is manifested by a complete lack of consciousness, depression of reflexes up to areflexion (only sluggish reflexes of the pupils are preserved, respiratory rhythm disturbances are often observed). In severe coma - III degree - there is a lack of all the main reflexes, severe respiratory rhythm and circulatory disorders, cyanosis, hypothermia appear.

Impairment of consciousness indicates a significant severity of the condition of the child

With a conscious mind, the child may be active, agitated, or lethargic; his reaction to the examination may be adequate or inadequate, his mood is even, calm, excited, unstable. Violation of the child’s activity, his reactions to the environment indicate a violation of the child’s condition.

Then proceed to assess the position of the child in bed. It can be active, passive or forced. Under the active position understand the position of the child in which he can take any position in bed, make active movements. A passive position is spoken of if the child cannot change his position without outside help. An involuntary position is a special position that a child takes to alleviate his condition (for example, the pose of a "Pointing Dog" with meningitis, a sitting position with emphasis on the edge of the bed or on his knees in an attack of bronchial asthma, etc.). The restriction of the regime according to therapeutic indications is not evidence of the patient's passive position.

Violation of the situation in bed also indicates a significant degree of severity of the patient's condition. When assessing the general condition of the child, the condition of the skin and their color are also of great importance.
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Examination program for patients with altered state of consciousness

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