Management of the comatose patient is in an intensive care unit and neurointensivists are very often involved. This chapter summarizes the principles of caring for the comatose patient and everything a neurologist would need to know.
Full Answer
What is the management of a comatose patient?
Management of the comatose patient is in an intensive care unit and neurointensivists are very often involved. This chapter summarizes the principles of caring for the comatose patient and everything a neurologist would need to know.
What would a neurologist need to know about the comatose patient?
This chapter summarizes the principles of caring for the comatose patient and everything a neurologist would need to know. The basic principles of neurologic assessment of the comatose patient have not changed, but better organization can be achieved by grouping comatose patients according to specific circumstances and findings on neuroimaging.
What should doctors do when a patient is in a coma?
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: Events leading up to the coma, such as vomiting or headaches.
What tests are done in a coma?
Testing reflexive eye movements to help determine the cause of the coma and the location of brain damage Squirting cold or warm into the affected person's ear canals and observing eye reactions Blood samples will be taken to check for: A spinal tap (lumbar puncture) can check for signs of infections in the nervous system.
What do doctors do when someone is in a coma?
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.
Who should decide end of life care?
If one family member is named as the decision-maker, it is a good idea, as much as possible, to have family agreement about the care plan. If family members can't agree on end-of-life care or they disagree with the doctor, your family might consider working with a mediator.
Who makes medical decisions if there is no advance directive?
If a person lacks the capacity to make decisions, the physician and health care team will usually turn to the most appropriate decision-maker from close family or friends of the person.
Who decides a patient is not for resuscitation?
doctorA do-not-resuscitate order, or DNR order, is a medical order written by a doctor. It instructs health care providers not to do cardiopulmonary resuscitation (CPR) if a patient's breathing stops or if the patient's heart stops beating.
Who is involved in end of life planning?
End-of-life planning refers to the steps a person takes to get their affairs in order and determine how they want to spend their last days. Also known as advance care planning, it typically involves a person completing a living will, a healthcare proxy, and a last will and testament.
Who decides when a patient is ready for hospice?
Patients, families, and healthcare providers make the hospice decision together. It's a healthcare decision. Healthcare providers use guidelines to help them decide whether a patient is eligible for Medicare-funded hospice care, which provides comfort-focused end-of-life care.
Who is responsible for making sure an advance directive is followed?
The patient is responsible for making sure an advance directive is followed.
Who decides when a patient can t?
We found that all 50 states and the District of Columbia have laws addressing decision making for incapacitated patients. The statutes, however, use diverse terminology in discussing alternate decision makers (whether court-appointed, patient-designated, or default).
Who decides decision making capacity?
Competency is a global assessment and legal determination made by a judge in court. Capacity is a functional assessment and a clinical determination about a specific decision that can be made by any clinician familiar with a patient's case.
Can doctors decide a DNR?
The most important factor to bear in mind is that the law does not require a patient, or their family to consent to a DNR order. This means a doctor can issue a DNR order, even if you do not want one (see section on what to do if there is a disagreement).
What happens if a doctor resuscitate a DNR patient?
Medical professionals who give CPR to people with a DNR order can potentially get into trouble—if they are aware of the DNR. The legal ramifications of giving CPR to someone with a DNR are complex. In some states, DNR orders are only valid within a hospital setting; outside of that, they don't apply.
Why do doctors push DNR?
' In some cases, as with your grandad, doctors may decide that there should be no attempt to resuscitate a person if they have a cardiac arrest or stop breathing. This is called a DNACPR (do not attempt cardiopulmonary resuscitation) order, often shortened to a DNR or DNAR.
When do doctors decide on end of life?
People are considered to be approaching the end of life when they are likely to die within the next 12 months, although this is not always possible to predict. This includes people whose death is imminent, as well as people who: have an advanced incurable illness, such as cancer, dementia or motor neurone disease.
Who can make decisions for someone who lacks capacity?
If the person can't make a decision because they lack mental capacity, someone else might have to make the decision for them. This could be: a health and social care professional. someone legally appointed to make decisions about treatment, care and where they live, like a Power of Attorney.
What is the role of the nurse in end of life decision making?
Nurses are at the bedside during the dying process; they spend entire shifts with patients and families, they develop trusting relationships, and they are competent to assess patient and family needs [1, 17].
What if the family disagrees with the DNR order?
What if the Family Disagrees with the DNR Order? If the family disagrees with the DNR order, then they have a right to speak with the attending physician. The physician should make a reasonable effort to explain the patient's prognosis and treatment options, along with the patient's wishes.
How is a coma treated?
How is Coma or Comatose Treated? The emergency care persons will carry and provide the basic essentials like glucose or antibiotics by injections even if the blood test is in progress and not yet returned. This is done to eliminate the situations of diabetic shock or brain infections. Coma or comatose which is classified as a medical emergency ...
How to help a patient come out of a coma?
Correction of electrolyte imbalance or toxic substances can help the patient come out of coma or comatose sometimes. Electrolytes are chemicals commonly like salts, such as chlorine and sodium salts, which can be found in the tissues and blood throughout the body and play a major role in most of the physiological mechanism. Depending on the reason of the coma or comatose, there may be necessity to correct any electrolyte abnormalities. For example a kidney dialysis which is a process that maintains normal electrolyte balance in the kidneys and removes toxins.
What is a coma cocktail?
Coma cocktail is a combined mixture of glucose (glucose can help diabetic patients with low blood sugar), naloxone (Naloxone is a chemical which is used in treating the patients who are overdosed) and thiamin (thiamin is a vitamin combination which helps who are deprived of nutrition, e.g. alcoholics).
What is the procedure to decrease the pressure on the brain due to brain swelling?
A medical procedure to decrease the pressure on the brain due to brain swelling, might be necessary. Doctors will provide medications as a treatment to the condition if coma or comatose occurs due to the over dosage of drug. Doctors will recommend and follow the medications to control seizures if the coma or comatose occurs due to seizures.
How long does a coma last?
A coma or comatose usually can last for few weeks, during which time the patient may recover slowly by gaining consciousness, gradual wakeup or the patient can progress into a different state of unconsciousness which is known as vegetative state or minimally conscious state.
What is the Glasgow Coma Scale?
Glasgow Coma Scale (GCS) is used before the decision making stage whether to use CT scan for coma or comatose. Severity of brain damage can be analyzed by the Glasgow Coma Scale (GCS) which helps doctors in case of a head injury. It scores patients according to, motor responses, how easily they open their eyes and verbal responses.
What is a coma score in GCS?
Brain Injury will be Classified in the Glasgow Coma Scale (GCS) As: Coma is the output when the score is 8 or less. Moderate is the condition when the score is ranging between 9 and 12. Minor when the score is 13 or higher.
What do coma patients get?
Coma patients may also receive electrolytes -- salt and other substances that help regulate body processes. 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 tracheotomy ).
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.
Why do nurses move their patients?
Nurses will also move them periodically to prevent bedsores -- painful skin wounds caused by lying in one position for too long. Because patients who are in a coma can't eat or drink on their own, they receive nutrients and liquids through a vein or feeding tube so that they don't starve or dehydrate.
Can you come out of a coma?
There is no one treatment that can cause someone to come out of a coma. Treatments can prevent further physical and neurological damage, however. 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, ...
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.
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 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.
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.
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 happens if you discuss your options with a doctor early?
Research has shown that if a person who has advanced cancer discusses his or her options for care with a doctor early on, that person’s level of stress decreases and their ability to cope with illness increases.
What does it mean when a caregiver is overwhelmed by caring for the patient?
The caregiver is overwhelmed by caring for the patient, is too sad, or is afraid to be with the patient. The caregiver doesn’t know how to handle a certain situation. Keep in mind that palliative care experts can be called upon by the patient’s physician at any point in the person’s illness to help with these issues.
How does a caregiver help a cancer patient?
The patient may have good days and bad days, so they may need more help with daily personal care and getting around. Caregivers can help patients save energy for the things that are most important to them. Appetite changes: As the body naturally shuts down, the person with cancer will often need and want less food.
Why is it important to have advance directives for cancer patients?
It’s important for people with cancer to have these decisions made before they become too sick to make them. However, if a person does become too sick before they have completed an advance directive, it’s helpful for family caregivers to know what type of care their loved one would want to receive.
Why is it important for a family caregiver to take care of their own body?
Family caregivers are affected by their loved one’s health more than they realize. Taking care of a sick person often causes physical and emotional fatigue, stress, depression, and anxiety. Because of this, it’s important for caregivers to take care of their own body, mind, and spirit.
What happens when cancer is no longer controlled?
When a cancer patient’s health care team determines that the cancer can no longer be controlled, medical testing and cancer treatment often stop. But the person’s care continues, with an emphasis on improving their quality of life and that of their loved ones, and making them comfortable for the following weeks or months.
Who can a caregiver contact?
There may be times when the caregiver needs assistance from the patient's health care team. A caregiver can contact the patient's doctor or nurse for help in any of the following situations: The patient is in pain that is not relieved by the prescribed dose of pain medication.
