Transfers Between Medical Facilities

No one should be denied urgent medical care because they’re too incapacitated to consent or family isn’t present. This is viewed as a reasonable emergency exception to informed consent in a critically ill person on the verge of death or at risk of crippling permanent affliction if something isn’t done immediately. It follows naturally that the team caring for such a patient is expected to act in a manner that will provide the maximum possible benefit and the best outcome. Common causes include a drug overdose, brain trauma and interrupted blood flow, as well as swelling, infection, ongoing seizures and severe blood abnormalities. Some of these conditions can be quite destructive, and little can be done to treat them. In addition, each of these abnormalities can lead to brain swelling, adding more trauma to an already injured organ, particularly the brainstem. Depending on the nature of the injury, an individual’s outcome may deviate markedly from what we might expect, and they can be further disabled if another injury occurs. Once medical staff intervene, acutely comatose patients rarely awaken magically, and these individuals remain in a state of vulnerability. An estimated 1 in 3 patients with trauma to the brain will get worse after initial treatment. That’s a very high proportion. Remember, these individuals are critically ill, so there’s a real and immediate risk that their clinical condition will decline. This can also occur during transfers between medical facilities.

Luminous Times

Sending a comatose patient to a medical center without a neurosurgeon on call or an available neurointensivist not only may delay appropriate treatment but may result in a worse outcome if the person needs to be moved again. In some cases, transporting a patient by helicopter rather than by ground can make a major difference, reducing time to get to an operating room by hours. Another benefit of helicopter transport is more rapid application of medical procedures and the availability of a large number of emergency drugs. Early efforts to stabilize someone who’s comatose may include intubation to protect the airway and aid breathing, and steps to treat low or high blood pressure, blood loss, and abnormal blood values. This critical juncture often determines whether a person’s condition will improve or decline. That’s the time when prompt medical and surgical actions are most likely to prevent a bad outcome. We’ll also discuss complications. While there are standards for treating complications, in very young or very old individuals, we may deviate from them at times. Often, we need to weigh the specifics of the case to decide on the best approach. Treating an individual in a coma can be daunting. Of course, the health care staff wants a good outcome for every patient. Some brain injuries, however, can’t be treated, no matter what we try.

All I Need

There’s simply no way some individuals will improve, often leaving them with a devastating disability. A few of them may never awaken from their coma. But for many other patients, there are very good options, and it’s our job to help them recover. However, these vital signs have special importance in patients with an acute brain injury leading to coma, beyond what they mean in other individuals who are ill. In many comatose patients, neurologic injury makes it impossible for them to keep their airways open. As a result, they may have very superficial breathing and abnormal breathing rhythms. Once we know what we’re dealing with, effective treatment often is available. When caring for a comatose individual, physicians often ask themselves and the medical team the following questions. Is the coma caused by a blocked large artery to the brainstem, and can we unblock it? The improvement that follows is dramatic. A blocked brainstem artery always should be considered because the window for successful treatment closes quickly. Does the bleeding or tumor have a mass effect? Bleeding in the brain or a rapidly expanding tumor can compromise other regions, and the pressure created must be rapidly relieved. To do that, we use medication that reduces swelling, or we open the patient’s skull and remove the mass.

Burn That Candle

Some of these surgeries are comparatively simple and experienced neurosurgeons don’t hesitate to perform them. If that’s the case, circulation of cerebrospinal fluid has been blocked and a drain must be placed emergently to prevent the individual from rapidly getting worse. Does the patient have a brain infection? If a brain infection is likely, we immediately treat an individual with antibiotics and antiviral medication without waiting for test results. In the case of overdose, if there’s an antidote, we give it to the patient. If a patient’s coma was caused by a chemical imbalance, we correct it. They usually give glucose to a patient who’s been taking insulin, without waiting for results of blood tests. If coma is caused by organ failure other than the brain, the organ’s function may need to be taken over by a machine, such as dialysis, in the case of kidney failure. Is the patient having seizures? This is particularly true if one seizure follows another. Is the patient hypothermic? In rare circumstances, coma occurs because of a steep drop in core body temperature. When this happens, an individual may look stiff and blue and appear dead, but warming them often does wonders. The conditions we see most often are generally the easiest to manage. It’s more difficult to sort out treatment for a comatose patient when the cause is odd or something we encounter only occasionally. In some cases, however, there’s a painful realization that treatment and recovery will be prolonged, and the person’s true outcome may not be known for months or even years. The family of a patient in a coma, it can be very frustrating to hear a physician say, Everything was going in the right direction, but your loved one has had a serious setback. The result is more brain in one compartment, where it doesn’t belong, than in the other, causing increased pressure. All these parts help to regulate pressure underneath the skull.