typical medical report of a coma patient

Medication

Doctors will consider a variety of factors when assessing a coma’s severity. One of the most common tools a doctor might use is the Glasgow Coma Scale (GCS). The Glasgow Coma Scale is a simple test that gauges the degree of impaired consciousness in acute medical and trauma patients.

Therapy

1 During a coma, a person does not react to external stimuli and they will not show normal reflex responses. 2 Comatose patients do not have sleep-wake cycles. 3 Reasons for a coma include intoxication, nervous system disease, metabolic disease, infections, or a stroke. More items...

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These studies identified four important clinical features that help to determine prognosis: aetiology, depth of coma, duration of coma, and clinical signs. The outcome of coma is related to the cause independent of the physical signs, depth of coma or length of coma.

How do doctors assess coma severity?

A coma refers to a state of deep unconsciousness that can occur after a brain injury. When an individual is comatose, they do not show intentional responses or movement, their eyes remain closed, and they cannot be awakened. Having a loved one fall into a coma can be extremely frightening, but there is hope for them to regain consciousness.

What are the symptoms of a coma?

What factors determine the prognosis of coma?

What is a coma and how is it treated?

What does a coma patient see?

Usually, coma patients have their eyes closed and cannot see what happens around them. But their ears keep receiving sounds from the environment. In some cases, the brains of coma patients can process sounds, for example the voice of someone speaking to them [2].

What does a patient in a coma look like?

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.

What tests are done after a coma?

Blood samples will be taken to check for:Complete blood count.Electrolytes, glucose, thyroid, kidney and liver function.Carbon monoxide poisoning.Drug or alcohol overdose.

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).

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 can a person be in a coma and still recover?

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.

Do you age slower in a coma?

the cellular mechanism for ageing has been associated with progressive shortening of telomere length on the ends of each chromosome with each cell cycle.. in the contect of this, a coma wouldnt necessarily keep you young, but you would age just the same.

What happens to the brain during a coma?

1:375:01What Happens in the Brain During a Coma? - YouTubeYouTubeStart of suggested clipEnd of suggested clipBrain doesn't go through the regular cycles of sleep normally. During sleep your brain goes throughMoreBrain doesn't go through the regular cycles of sleep normally. During sleep your brain goes through periods of rapid eye movement or REM sleep.

What happens to your body in a coma?

The person's eyes will be closed and they'll appear to be unresponsive to their environment. They won't normally respond to sound or pain, or be able to communicate or move voluntarily, and basic reflexes, such as coughing and swallowing, will be greatly reduced.

How long does a coma usually 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.

Can a person hear in coma?

Can Your Loved One Hear You. During a coma, the individual is unconscious, meaning they are unable to respond to any sounds. However, the brain may still be able to pick up on sounds from loved ones. In fact, some studies suggest talking and touching a loved one while they are in a coma may help them recover.

What are the stages of coma?

Three stages of coma DOC includes coma, the vegetative state (VS) and the minimally conscious state (MCS).

Why is a thorough examination of a comatose patient important?

A thorough examination of a comatose patient is essential given the spectrum of clinical diagnoses. The most immediate threat to patients is airway, breathing and circulation. All attending physician should employ a structured and focused approach in dealing with a comatose patient. It is important to recognise the urgent steps needed at the time to prevent further deterioration, followed by the final diagnosis of patient’s neurologic status. Here we provide the essential practical guide to the neurological exam of a comatose patient that would assist to determine the aetiology, location and nature of the neurological lesion.

How to check for trauma in intensive care?

The examiner must have a systematic and thorough examination. The general examination starts with observing the stationary position of the patient on the bed and attitude of the limb. It should be documented if there is any spontaneous motor behaviour or semi-purposive movements of all four extremities, breathing pattern and oropharyngeal reflexes such as coughing, swallowing, hiccupping or yawning. Inspection for clues for trauma such as bleeding, scars, track marks and post-operative drainage catheters may indicate the site of injury. In intensive care environment, all connected intravenous infusion is checked for sedative agents and or vasopressors. This is important if there is a question as to whether a drug or intervention has an effect to patient’s conscious level. When the patient is on a mechanical ventilator, the settings give a clue if any spontaneous breaths are taken by the patient.

What is a confused document?

Confused-document the questions and answer given by patient

When are medically induced/iatrogenic complications reported?

While medically induced/iatrogenic complications may be reported when they are unintended consequences, the rules are different when the condition is essentially a therapeutic state. Coding Clinic has not specifically addressed this scenario, though they have addressed similar scenarios where the condition was intentionally precipitated.

What is a coding clinic p. 14?

Coding Clinic, Second Quarter 2009, p. 14, addresses a scenario where ventricular fibrillation was purposefully induced. It advised against reporting a condition that was intentionally precipitated, unless that condition is one the patient would naturally have, such as a stimulated seizure in patients with established seizure disorders and known issues with a stimulated ventricular tachycardia.

General principles of the survey

When examining patients who are in a coma, it is advisable to follow the following steps.

Evaluation of vital functions

The vital functions are primarily respiration and circulation. Assess the patency of the respiratory tract, the characteristics of breathing, heart rate and blood pressure. The results of such an assessment are extremely important for timely correction of the revealed violations.

Blood pressure and pulse

Reduction in blood pressure can occur not only because of the pathological conditions that led to coma (internal bleeding, myocardial infarction ), but also due to oppression of the medulla oblongata (alcohol and barbiturate poisoning).

Estimation of the depth of coma

The most famous rapid quantitative method for determining the depth of coma is the use of the Glasgow coma scale. In accordance with this approach, the definition of the severity of oppression of consciousness is based on an assessment of the patient's reactions: eye opening, speech reaction, motor reaction to pain.

Clarification of the development of coma

Find out from relatives or people surrounding the patient information about the circumstances of the development of coma, the rate of impairment of consciousness and the diseases that the patient suffered. This information is important for determining the cause of coma.

General examination of the patient

Examination of the skin and mucous membranes, as well as the examination of the chest, abdomen and extremities, conducted according to general rules, are aimed at identifying specific for certain manifestations.

Evaluation of neurological status

The neurological examination is aimed at assessing the general motor reactions, stem reflexes and the detection of symptoms of irritation of the meninges.

What are the complications of a coma?

Complications that can occur from medically induced coma include: 1 Blood clots 2 Infection, particularly pneumonia and other lung infections 3 Heart problems 4 Pressure sores and weakness from immobility 5 Vivid nightmares and hallucinations

What to expect after a coma?

What to Expect Afterwards. When doctors see improvements in a person’s condition, they will bring them out of the medically induced coma. The process is the reverse of inducing it. Doctors gradually withdraw the drugs while monitoring brain activity and other vital signs.

What is a medically induced coma?

A medically induced coma uses drugs to achieve a deep state of brain inactivity. It is a deep, but reversible unconsciousness that doctors purposely induce. Medically induced coma vs. sedation for general anesthesia differs in the level of unconsciousness. In fact, general anesthesia is a type of medically induced coma. However, what most people think of as a medically induced coma serves a different purpose than general anesthesia.

Why is medically induced coma performed?

The most common reasons for medically induced coma involve traumatic brain injuries. These brain injuries often result in significant swelling of the brain. The swelling puts pressure on the brain. This reduces blood flow and oxygen supply to the brain, which can damage brain tissue. Inducing a coma allows the brain to rest. It decreases the brain’s electrical activity and metabolic rate. Ultimately, this state helps decrease brain swelling and protects the brain from further damage. Stroke, status epilepticus, and drug overdose are other potential reasons for medically induced coma.

Why is a coma not a common procedure?

Ultimately, this state helps decrease brain swelling and protects the brain from further damage. Stroke, status epilepticus, and drug overdose are other potential reasons for medically induced coma. A medically induced coma is not a common procedure. It is usually a last resort when other options for reducing brain swelling have failed.

How long does it take to get out of a coma?

In most cases, medically induced comas are only necessary for a short period of time. Doctors typically use the procedure for a couple of days or for as long as two weeks.

Is general anesthesia a coma?

In fact, general anesthesia is a type of medically induced coma. However, what most people think of as a medically induced coma serves a different purpose than general anesthesia. The goal of a medically induced coma is to reach a level of sedation called ‘burst suppression.’. In this state, the brain is completely quiet for several seconds, ...

What is the role of a neurologist in a coma?

T he neurologist is often required to evaluate the unconscious patient from both the diagnostic and prognostic perspective. Knowledge of the anatomical basis of coma is essential for competent evaluation but must be combined with an understanding of the many, often multi-factorial, medical conditions that result in impaired consciousness.

What is coma arousal?

These are dependant upon separate physiological and anatomical systems. Coma is caused by disordered arousal rather than impairment of the content of consciousness, this being the sum of cognitive and affective mental function, dependent on an intact cerebral cortex.

How long after knee replacement can you go into a coma?

You are called to the HDU to see a 78 year old patient in a coma 24 hours after undergoing knee replacement surgery. There is a history of progressive memory failure and deterioration in other cognitive function over the past few years. Preoperatively the patient was taking digoxin and a diuretic.

Can a brain stem infarction cause a coma?

The speed of onset, site, and size of a brainstem lesion determine whether it results in coma, so brain stem infarction or haemorrhage often causes coma while other brain stem conditions such as multiple sclerosis or tumour rarely do so. Lesions below the level of the pons do not normally result in coma.

What is the assessment of a patient in a coma?

The assessment of patients in coma is a medical emergency. The cause should be identified and, where possible, corrected and the brain provided with appropriate protection to reduce further damage. It then becomes important to identify those patients for whom the prognosis is hopeless and in whom the institution or persistence ...

Why is prolonged survival important in a coma?

The prolonged survival of patients in coma usually indicates the development of a vegetative state and the avoidance of the persistent vegetative state is frequently given as an important reason for the use of predictors in coma.

What are the five grades of EEG abnormality in a coma?

Five grades of EEG abnormality in coma are internationally accepted: alpha rhythm, dominant theta, diffuse dominant delta, burst suppression, and isoelectric. 9 At 48 hours these grades provide prediction with an accuracy of about 88% and to date it seems that the evaluation of compressed spectral arrays with a “brain monitor” is unlikely to improve upon that provided by clinical assessment or standard EEG.

How many people recover from a vegetative state?

The Multi-Society task force 16 17 considered 159 patients in a vegetative state one month after non-traumatic injury; by three months 11% had recovered consciousness, 89% remained vegetative or had died; by six months only two more patients had recovered consciousness, and one year after the injury 15% of the patients had recovered consciousness, 32% were in a vegetative state, and 53% had died. Of those 15% of patients who regained consciousness, only one patient made a good recovery. The task force recommended further epidemiological studies to improve information about incidence, prevalence, and natural history of the vegetative state; they also recommended more careful clinical studies and future positron emission tomography studies to examine regional cerebral blood flow and glucose metabolism in response to visual, auditory, and somatosensory stimulation.

Why do people with drug overdoses appear comatose?

Patients with drug overdose coma frequently appear deeply comatose with depressed brain stem reflexes because of the effects of the drugs upon the brain stem, yet may show disproportionately high levels of motor activity. In general, metabolic causes of coma have a better prognosis than anoxic–ischaemic causes.

What are the clinical signs of poor outcome?

Clinical signs. The most important clinical signs identifying those patients with a poor outcome are the brain stem reflexes, and the simple tests of corneal reflexes and pupillary responses, as identified by Jorgensen, 5 remain important (table 4 ).

What are the clinical features that help to determine prognosis?

These studies identified four important clinical features that help to determine prognosis: aetiology, depth of coma, duration of coma, and clinical signs.

How to tell if someone is in a coma?

When your loved one first starts to “wake up” from or come out of the coma, he may not be able to focus his eyes. He may or may not be able to respond to you. He may look as if he is staring off into space. Part of this is from the injury; part of it may be from medicine. Movement can be another sign of improvement. At first, movements may be random like flailing arms, then may progress to semi-purposeful (such as pulling at tubes) and possibly moving in response to instructions (“Squeeze my hand.”). The patient’s awareness of self and his surroundings increases as he improves and gets better.

What is the Glasgow Coma Scale?

The Glasgow Coma Scale or GCS is a universal tool used by medical professionals to grade the level of an individual’s coma. The scores collected with use of the GCS helps doctors and health care providers understand the extent of brain damage and the possible prognosis for a particular case.

What is coma in 2021?

Matthew E. Bain. Coma is common with severe brain injuries, especially injuries that affect the arousal center in the brain stem. Understanding coma can be difficult because there are many levels of coma. In general, coma is “a lack of awareness” of one’s self and surroundings.

What does it mean when someone follows commands intermittently?

Following commands intermittently means they won’t “squeeze your hand” every time you ask. As they get better, they will follow commands more regularly. “When someone on television comes out of a coma they’re just fine. We thought that would happen for Sam.

Can you wake someone up from a coma?

But you can’t do the same to someone in a coma. Because the individual won’t have control of his or her system, they won’t respond to the typical methods people use to wake someone up from sleep. They cannot follow directions or communicate because their brain doesn’t process information the way it used to.

Is there a pattern of recovery from a coma?

It is also common for breathing and blood pressure to be affected; if so, proper care will be needed to help control breathing or blood pressure for them. There is no set pattern of recovery from coma, but there are signs that may mean improvement (coming out of a coma).

Can you move in a purposeful way in a coma?

A person in a coma: • May or may not have their eyes closed all the time. • Cannot communicate. • Cannot move in a purposeful way, such as following instructions like “squeeze my hand, or open your eyes.”. Because their eyes may be closed, many of us liken the comatose state to sleeping.

What are the symptoms of a coma?

Some neurological reflexes that a doctor may look for in coma patients include: 1 Pupillary reactivity. The pupils should shrink in response to a light being shone in the eyes. 2 Oculocephalic response. The eyes should turn to the right when the individual’s head is turned to the left, and vice versa. 3 Gag reflex. The individual should gag or cough if a cotton swab or endotracheal tube is placed down their throat.

What are the Signs of Recovery from a Coma?

Most individuals that recover from coma exhibit signs of preserved brain function, such as the presence of neurological reflexes.

How Long Will It Take for Someone to Awaken from Coma After Brain Injury?

Every brain injury is unique and as a result, every individual will regain consciousness from a coma at a different rate. Generally, the more severe the brain damage, the longer it will take for the individual to recover.

What happens when you fall into a coma?

Generally, the loss of consciousness that occurs when an individual falls into a coma is associated with damage to the brainstem. However, there are various events that can cause a coma after brain injury.

What is the Glasgow Coma Scale?

The Glasgow Coma Scale is a simple test that gauges the degree of impaired consciousness in acute medical and trauma patients. It can indicate the severity of a TBI and is used to predict the outcome of an injury.

How long does a coma last?

Lack of speech or other forms of communication. No purposeful movement. An actual coma rarely lasts over four weeks. Instead, most patients who remain unconscious for long periods have progressed to the next stage of consciousness.

How long does it take to recover from a coma?

In fact, patients who transition from a coma to minimal consciousness within eight weeks are the most likely to reach this state and regain higher functions.

What is the best way to diagnose a coma?

Doctors may use imaging studies, such as magnetic resonance imaging (MRI), or computed tomography (CT) scans, to look inside the brain and identify a tumor, pressure, and any signs of damage to the brain tissue. Electroencephalography (EEG) is a test used to detect any abnormalities in the brain's electrical activity. This can also show brain tumors, infections, and other conditions that might have caused the coma. If the doctor suspects an infection such as meningitis, he may perform a spinal tap to make the diagnosis. To perform this test, a doctor inserts a needle into the patient's spine and removes a sample of cerebrospinal fluid for testing.

How to get out of a coma?

First, doctors ensure that the patient isn't in immediate danger of dying. This may require placing a tube in the patient's windpipe through the mouth, and hooking up the patient to a breathing machine, or ventilator. If there are other serious or life-threatening injuries to the rest of the body they will be dealt with in order of decreasing severity. If excess pressure in the brain caused the coma, doctors can relieve it by surgically placing a tube inside the skull and draining the fluid. A procedure called hyperventilation, which increases the rate of breathing to constrict blood vessels in the brain, can also relieve pressure. The doctor may also give the patient medication to prevent seizures. If a drug overdose or condition such as very low blood sugar is responsible for the coma, doctors attempt to correct this as soon as possible. Patients with acute ischemic strokes may undergo procedures or receive special clot-busting medication in an effort to restore blood flow to the brain.

How to relieve a coma in the brain?

If excess pressure in the brain caused the coma, doctors can relieve it by surgically placing a tube inside the skull and draining the fluid.

Can a spouse be in a coma?

Watching a spouse or family member in a coma or vegetative state is difficult enough, but when the condition persists for a long time, the family may have to make some very difficult decisions . In cases where people do not recover quickly, the families must decide whether to keep their loved one on a ventilator and feeding tube indefinitely, or to remove these aids and allow the person to die.

Can you breathe in a coma?

If a coma patient continues to be dependent on a ventilator to breathe, they may receive a special tube that goes directly into their windpipe through the front of the throat (a trache otomy ). The tracheotomy tube can be left in place for extended periods of time because it requires less maintenance and does not injure the soft tissues of the oral cavity and upper throat. Because patients who are in a coma can't urinate on their own, they will have a rubber tube called a catheter inserted directly into their bladder to remove the urine.

General Principles of The Survey

Evaluation of Vital Functions

Blood Pressure and Pulse

Estimation of The Depth of Coma

Clarification of The Development of Coma

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General Examination of The Patient

Evaluation of Neurological Status

Motor Sphere

Muscle Tone and Spontaneous Movement