comatose patient report

Clinical report A 15-year-old, male, comatose patient with tracheostomy in situ and having a Glasgow coma scale score of 6T (E4VTM2) was referred to the Department of Prosthodontics from the Department of Neurosurgery for the rehabilitation of his left calvarial defect.

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How to evaluate the comatose patients?

The evaluations of the comatose patients require a stepwise approach starting with a history, physical examination and laboratory evaluation. The causes of coma may be reversible when detected early.

Is there a second edition of the comatose patient?

The comatose patient. Second edition. Oxford University Press, 2014. 50. . Machine learning in medicine. Circulation 2015;132:1920–30. Contributors EFMW is the sole author of this manuscript.

Who should call the bedside of a comatose patient?

The call to the bedside and the prognostication of a comatose patient—telling family members what to expect—commonly falls to neurologists. The assessment is often confounded by the treatment paradigms of modern intensive care (ie, drugs, drug interactions and targeted temperature management).

What happens in a comatose person?

What happens in a comatose person? The brain is so heavily damaged that neither of the networks functions correctly anymore. This malfunction can occur as a result of serious injury, a brain hemorrhage, cardiac arrest or a heart attack. At most, a coma lasts for a few days or weeks.

How would you describe a comatose patient?

The signs and symptoms of a coma commonly include: Closed eyes. Depressed brainstem reflexes, such as pupils not responding to light. No responses of limbs, except for reflex movements. No response to painful stimuli, except for reflex movements.

How do you assess an unconscious patient?

To determine if the patient is unconscious and unable to follow commands, use the Glasgow Coma Scale (GCS) to test eye opening, best motor response, and best verbal response. An unconscious patient is likely to open her eyes only in response to pain, if at all; obviously, you can't test her best verbal response at all.

How do you test for comatose patients?

Vision (Cranial Nerve II)The test is done by passively opening the eyes of the patient without stimulation to trigger the eye opening.Then, look for spontaneous eye movement, or eye movement on command. If there was no response, then proceed for visual pursuit.

What are indicators that someone is coming out of a coma?

Signs of coming out of a coma include being able to keep their eyes open for longer and longer periods of time and being awakened from “sleep” easier—at first by pain (pinch), then by touch (like gently shaking of their shoulder), and finally by sound (calling their name).

How do you document level of consciousness?

The tool we use to assess the level of consciousness is the Glasgow Coma Scale (GCS). This tool is used at the bedside in conjunction with other clinical observations and it allows us to have a baseline and ongoing measurement of the level of consciousness (LOC) for our patients.

What is the GCS of unconscious?

A person's GCS score can range from 3 (completely unresponsive) to 15 (responsive). This score is used to guide immediate medical care after a brain injury (such as a car accident) and also to monitor hospitalized patients and track their level of consciousness.

Can a comatose person hear?

They cannot speak and their eyes are closed. They look as if they are asleep. However, the brain of a coma patient may continue to work. It might “hear” the sounds in the environment, like the footsteps of someone approaching or the voice of a person speaking.

Can coma patients open eyes?

So one of the things that defines coma is that your eyes are closed. At some point, usually within a week, two weeks, if they remain in that state, they will start to open their eyes. They will start to be slightly more reactive and responsive.

Why do coma patients cry?

A comatose patient may open his eyes, move and even cry while still remaining unconscious. His brain-stem reflexes are attached to a nonfunctioning cortex. Reflex without reflection. Many professionals speak of this condition as a ''persistent vegetative state.

How long is recovery after a coma?

Most comas don't last more than two to four weeks. Recovery is typically gradual, with patients gaining awareness over time. They may be awake and alert for just a few minutes the first day, but gradually stay awake for longer and longer periods.

How long can a coma last?

Typically, a coma does not last more than a few days or couple of weeks. In some rare cases, a person might stay in a coma for several weeks, months or even years. Depending on what caused the person to go into a coma, some patients are able to return to their normal lives after leaving the hospital.

What part of the brain is damaged in a coma?

Comas are caused by damage to the brain, especially if there's bilateral damage to the cerebral cortex (which means damage on both sides), or damage to the reticular activating system. The reticular activating system controls arousal and awareness of the cerebral cortex.

How long does a coma last?

At most, a coma lasts for a few days or weeks. As soon as patients open their eyes, they are said to “awaken” from the coma. This does not, however, mean that a person is conscious. Most patients who awaken from a coma soon recuperate.

What is it called when a patient does not respond to a question?

If patients do not respond, the condition used to be called “vegetative”; they appear to be unconscious. If a patient responds but is unable to communicate, we categorize the consciousness as “minimal.”. Such patients may, for example, follow a person with their eyes or answer simple questions.

What does the physician say when a patient is in a brain scanner?

Well, of course, the physician will say, “Squeeze my hand” —but this time while the patient is in a brain scanner. If the motor cortex is activated, we know that the patient heard and understood and therefore is conscious.

Why is it so difficult to diagnose a cerebral symtom?

This is why diagnosis is so difficult. Just because patients cannot move does not mean they are unconscious.

Where do doctors send unconscious patients?

Doctors from all over Europe send their apparently unconscious patients to Laureys—a clinician and researcher at the University of Liège—for comprehensive testing. To provide proper care, physicians and family members need to know whether patients have some degree of awareness.

Can a locked in patient move?

In other words, their motor and mental abilities are limited. Locked-in patients can’t move either, but they are completely conscious. They have suffered a particular type of injury to the brain stem.

What is the examination of a comatose patient?

Much of the examination of the comatose patient focuses on. assessing brainstem function. This is because most structural brainstem. processes causing coma produce easily identified abnormalities on examination, but structural disorders of the hemispheres or diffuse metabolic disorders.

What is coma in medical terms?

Coma, the absence of consciousness, can occur. only due to dysfunction of both cerebral hemispheres, dysfunction of the upper. brainstem, or a combination of bilateral hemisphere and upper brainstem. dysfunction. Much of the examination of the comatose patient focuses on. assessing brainstem function.

How long to wait to instill ice water in a comatose patient?

After waiting at least 5 minutes, perform the same maneuver on. the other side. In a comatose patient whose brainstem is intact, instilling ice. water into the ear canal should result in conjugate deviation of both eyes. toward the side of the irrigated ear. In other words, instilling ice water.

Can a brainstem stroke cause a coma?

the brainstem is functioning normally, a structural brainstem process (such as a. brainstem stroke or brainstem compression) is unlikely to be the cause of coma ; the process causing coma would then most likely be due to structura l lesions. affecting both of the hemispheres or a diffuse metabolic process.

What is a coma?

Share on Pinterest. A coma is a state of deep unconsciousness. A person who is experiencing a coma cannot be awakened, and they do not react to the surrounding environment. They do not respond to pain, light, or sound in the usual way, and they do not make voluntary actions. Although they do not wake up, their body follows normal sleep patterns. ...

What are the symptoms of a coma?

Symptoms. During a coma, a person cannot communicate, so diagnosis is through the outward signs. These include: closed eyes. limbs that do not respond or voluntarily move, except for reflex movements. lack of response to painful stimuli, except for reflex movements.

How long does a coma last?

Levels of consciousness and responsiveness will depend on how much of the brain is functioning. A coma often lasts for a few days or weeks. Rarely, it can last for several years. If a person enters a coma, this is a medical emergency. Rapid action may be needed to preserve life and brain function.

Why is coma different from sleep?

Coma is different from sleep because the person is unable to wake up. It is not the same as brain death. The person is alive, but they cannot respond in the normal way to their environment.

What happens to a person in a coma?

Without treatment, their ability to think clearly will gradually decrease. Finally, they will lose consciousness.

How to determine if you have carbon monoxide poisoning?

These will be taken to determine: 1 blood count 2 signs of carbon monoxide poisoning 3 presence and levels of legal or illegal drugs or other substances 4 levels of electrolytes 5 glucose levels 6 liver function

Can you wake someone from a coma?

If the cause of the coma can be successfully treated, the person may eventually awaken with no permanent damage. They are likely to be confused at first, but then they usually remember what happened before the coma, and be able to continue their life. Typically, some rehabilitation therapy is necessary.

What to check for in a coma exam?

The exam is likely to include: Checking the affected person's movements and reflexes, response to painful stimuli, and pupil size. Observing breathing patterns to help diagnose the cause of the coma. Checking the skin for signs of bruises due to trauma.

How does a coma test work?

This measures the electrical activity inside the brain through small electrodes attached to the scalp. Doctors send a low electrical current through the electrodes, which record the brain's electrical impulses. This test can determine if seizures might be the cause of a coma.

What is a coma in medical terms?

A coma is a medical emergency. Doctors will first check the affected person's airway and help maintain breathing and circulation. Doctors might give breathing assistance, intravenous medications and other supportive care. Treatment varies, depending on the cause of the coma.

Why do doctors need to rely on physical clues?

Because people in a coma can't express themselves , doctors must rely on physical clues and information provided by families and friends. Be prepared to provide information about the affected person, including: Details about how the affected person lost consciousness, including whether it occurred suddenly or over time.

How to know if you are in a coma?

Speaking loudly or pressing on the angle of the jaw or nail bed while watching for signs of arousal, such as vocal noises, eyes opening or movement. Testing reflexive eye movements to help determine the cause of the coma and the location of brain damage.

What to do if you are in a coma?

If you are with a person who develops signs and symptoms of a coma, call 911 or your local emergency number immediately . When you arrive at the hospital, emergency room staff will need as much information as possible from family and friends about what happened to the affected person before the coma.

Can you give antibiotics to a diabetic in a coma?

Emergency personnel might administer glucose or antibiotics intravenously, even before blood test results return, in case of diabetic shock or an infection affecting the brain. If the coma is the result of drug overdose, doctors will give medications to treat the condition.

What is a coma?

Definition of coma. A traditional, but simple and useful distinction, is to separate states by the degrees of wakefulness and awareness ( figure 1 ). This distinction allows us to separate coma from a persistent vegetative state (and severe forms of minimally conscious state, MCS).

What is the principle of prognostication in a coma?

Principles of prognostication in coma. Accurate prognostication is based on good judgement, and the key to good judgement is good evaluation of all the information. In some situations, it is coming to terms with it; in others, it is better to deflect a request to make a final decision.

What are the outcomes of hydrocephalus?

Outcome has to be linked to time of intervention and acting quickly. Untreated hydrocephalus, prolonged pressure effect from a mass, untreated large-vessel occlusion and untreated (or inadequately treated) seizures or infection can all impede recovery.

What causes a coma to deepen?

Deepening or emerging coma from a lesser state of impaired consciousness can result from a unilateral lesion displacing other structures from mass effect and causing those structures to become dysfunctional, either from a pressure effect or through ischaemia when the feeding arteries are threatened.

Can a neurologist predict the outcome of a surgical procedure?

No neurologist should entertain an outcome prediction if the results of a medical or surgical treatment are not yet known. An additional important, seldom mentioned or acknowledged factor is the early recognition of the cause of coma. Outcome has to be linked to time of intervention and acting quickly.

Can a bithalamic infarct cause a coma?

Bithalamic infarcts (from the top-of-the-basilar artery clot) are associated with coma at presentation, but patients may awaken, often after a period of marked fluctuation in alertness. An acute embolus to the basilar artery is devastating (causing infarction of the pons, midbrain and cerebellar haemispheres).