d. Treatment of Disorders of Consciousness. The main goal in treatment is
to maintain life until diagnosis can be determined. Treatment consists of maintaining
the patient's airway, breathing, and circulation (the ABCs). Spinal injury is always
suspected in cases of disorders of consciousness. Immobilize the patient accordingly
so that he does not further injure himself. Maintain an IV until the patient's intracranial
status can be determined. Treatment of consciousness disorders should include a
baseline physical examination to include checking the baseline level of consciousness
(LOC) of the patient. Check his level of consciousness by asking him if he lost
consciousness at any time, how long he has been oriented since then, and if he feels he
is experiencing any personality changes. Another part of the rapid baseline physical
examination is an evaluation of vital signs. This evaluation should include:
Rechecking vital signs every 15 minutes.
(2) Checking temperature fluctuations. Fluctuations in temperature may
indicate a malfunction of the hypothalamus.
(3) Checking the pulse. Bradycardia would indicate increased cranial
(4) Checking respirations. Check for Cheyne-Stokes, central neurogenic
pattern, and hypoventilation. Initially, an increase in the depth of respirations with no
significant change in rate of respirations may be seen. Later the rate of respirations
may increase, but eventually respiratory depression occurs.
(5) Checking blood pressure. An increase in blood pressure may indicate
increased, intracranial pressure. Try to assess for evidence of trauma and intoxication.
Do this by inspecting the head and neck for injury. If trauma is suspected, use a clinical
(6) Establish baseline vital signs, pupil size, corneal reflex, and check for
the presence of movements, reflexes, and paralysis of the extremities.
3-10. COMMON NERVOUS SYSTEM DISORDERS
a. Vascular Headaches.
(1) Migraine headache. The exact cause of migraine headaches is
unknown. An individual may have inherited a tendency for migraine headaches. Other
possible causes include emotional stress, hypersensitivity, and the body's vascular
mechanism of dilation of extracranial and intracranial arteries.