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Coma Awakening Chances

Discussion in 'Neurosurgery' started by bigbody, Mar 10, 2005.

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  1. bigbody

    bigbody Member

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    I have a friend who was involved in a car accident last saturday. He was tossed from the car, and cracked his skull. I'm not sure of all the details, but from what I understand, he is in an induced coma, and has not woken up since saturday. Could anyone please elaborate on the chances of coming out of a coma, I know there isn't enough information to go on, but from what I understand he needs some sort of brain surgery. Is there much chance that he will come back to normal, or is he closer to death?
  2. doc05

    doc05 2K Member

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    sorry to hear about your friend. please talk with the docs about his condition, as every case is different. best wishes.
  3. carrigallen

    carrigallen 16th centry dutch painter

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    This must be a rough time for you and your friend's family. From what I understand, the outcome of comas often becomes apparent within two weeks after the injury. Recovery is one of the possible outcomes.
  4. bigbody

    bigbody Member

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    I recently found out that my friend is in an "induced coma" and that doctors are seeking photographs to reconstruct his face as it is not recognizable. Does anyone know why doctors would induce a coma, and also if they are thinking about reconstructing the face, isn't it okay to deduce that doctors are only doing so thinkign that he will wake up?
  5. banner

    banner Senior Member

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    Bigbody,

    Sorry to hear about your friend. I understand your desire to find out more about what is happening.

    However, you should really talk to his doctors. Nobody on this forum can give you the information you seek since we know nothing about his case and are unable to examine him.
  6. ecpiii

    ecpiii Member

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    Big body,
    This is not the place to get anything other than med student blabber, so always question the veracity of what you hear, including mine. It sounds like was a severe trauma, and I am sorry for the patient's, family's and friend's pain. The doctors most likely have a concern for the swelling within the brain tissue and resultant increased pressure that commonly develops after such bad injuries. As a result, he may be in what is called a pentobarbital coma, which is an effort to decrease brain swelling/pressure by distributing blood flow to damaged areas of the brain, thereby reducing the "non-swollen" brain metabolism. It seems extreme to lay-people, but if pressure inside the skull can be controlled with out making the systemic blood pressure too low, it is quite striking how it can work. I would guess the plan is that he will wake up when reconstructive operations would be safer.
    #1 way for information: get the family to talk to the doctors.
  7. Pitt Panther

    Pitt Panther The Best Baller in PA

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    I'm speaking from a med student's perspective. I have had around 6 years of neurotrauma experience prior to the start of medical school.

    Comas are sometimes pharmacologically induced (usually a drug like phenobarbital is used) in order to keep brain swelling in check (intracranial pressure) as well as decrease the metabollic demands of the potentially injured brain.

    If it's the pharmacologically induced coma that you are questioning about, he "should" emerge from the coma when the phenobarb is shut off. Regarding brain injury (if there is one), it's impossible to know how long the coma will ensue. Comas are usually due to whiplash-like injuries with a rotational component resulting in shearing injury of tiny neurons within the brain. This is called a Diffuse Axonal Injury. Again, it is impossible to know if this was the cause or not. Just be patient and follow the advice of his physicians.

    Please keep in mind that this website is not intended for clinical advice, it is a forum for medical students to correspond regarding their experiences in PURSUING a medical education. I would suggest conducting a search for a reliable website dedicated to this topic. They are usually hospital affiliated or .gov websites.

    That being said, you and your friend are in my thoughts and prayers.

    Panther
    PCOM 2007
  8. NSGYResident

    NSGYResident Junior Member

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    Generally, waking from a coma depends on why the person is in a coma. Strictly defined a coma could be considered any GCS score of 8 or less.

    Pharmacologically induced comas (with pentobarbital) are used by most trauma neurosurgeons as a late option for medical treatment of elevated intracranial pressure trying to prevent secondary injury. Earlier treatments include raising head of bed, sedation, paralytics, hyperventilation, ventriculostomy (drain CSF), and Mannitol or hypertonic saline (osmotic agents). If these options fail, then at least at my hospital, we would consider a barbituate coma. So, if your friend got to the point where he is in a barb coma, MOST likely he was already in coma from the traumatic brain injury itself (primary injury, rotational/angular injury with Diffuse Axonal Injury likely) and is having a lot of cerebral edema with elevated intracranial pressure that was likely being treated with other earlier options as above, but these options likely were not completely successful. The barb coma will likely be a deeper coma (hopefully) than the coma that was secondary to the trauma itself. Barb coma helps lower intracranial pressure (ICP) and reduces the metabolic demands of the brain, decreasing the brain's oxygen requirements. It can take several days to have the effects of the barbs wear off after the barb drop has been stopped. Most patients are monitored with continuous EEG's to prove the patient is in burst-supression.

    Now, assuming the patient did not herniate, stroke a large segment of their brain, have a large intracerebral hemorrhage, and did not have severe diffuse axonal injury involving the brainstem or midbrain, and he doesn't have diffuse bilateral cerebral injury... then he has a chance of recovering from the coma that the trauma itself is causing. Also assuming there isn't any secondary injury from the elevated intracranial pressure.

    2 weeks is not usually enough time to see if a person is going to "wake" up from a coma, although it sometimes happens this fast. It also depends on what level of coma they are in. If they are withdrawing or better (Motor score of 4 or 5) then they have a MUCH better chance of recovering to consciousness than if they are posturing (motor score of 2 or 3). In fact it is very rare from someone to regain consciousness with decerebrate posturing.

    I have seen many people regain consciousness with a motor score of 4 or higher, but not all do. Sometimes it takes MONTHS even up to a year or two. Generally, you will have the maximal recovering from the traumatic injury within 2 years. After 2 years it is highly unlikely to make any siginificant improvements in neurological function. Of those that do wake up, many are never the same, and are never able to live "normal" lives... but some do. Even the higher functioning of them typically have cognitive deficits including concentration difficulties, memory problems, and higher order executive functioning.

    Regarding the doctors looking for pictures for reconstructing his face, they are likely not neurosurgeons and may or may not be aware of the severity of his brain injury and the likelihood of him regaining consciousness.

    As others have stated, you should talk directly with the neurosurgeons responsible for his care to get the most accurate prognosis of your friend, but many times even the neurosurgeon taking care of the patient can't know for sure.

    This was mostly a little medical candy for the med students on this site.
  9. Docgeorge

    Docgeorge Bent Over and Violated

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    I have a question that I cant find an anwser to. What is the MOA of hypocapnia producing decreased ICP? I've looked in Anes and Pulmonology texts and I cant find the anwser. It's driving me bonkers.
  10. punjabiMD

    punjabiMD I pity the foo'

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    vasoconstriction
  11. Docgeorge

    Docgeorge Bent Over and Violated

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    Yeah I know it' causing vasoconstricition, but why? the closest that I get to is that the Le Chatelier will kick HCO3 and H+ to the left, and there for cause decreased serum H+ and and that somehow causes (maby d/t K+ loss from cells into plasma (but I'd expect sm flacidity with that one) or by causing more binding of Ca2+ to albumin decreasing the FF and causing Vasoconstriciton. But I really think that I'm streatching things a bit far with that. or by causing more binding of Ca2+ to albumin decreasing the FF and causing Vasoconstriciton. But I really think that I'm streatching things a bit far with that.
  12. NSGYResident

    NSGYResident Junior Member

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    Smooth muscle cells in cerebral arterioles have L-type Calcium channels. These calcium channels when open cause an influx of calcium, contractions of smooth muscle and vasoconstriction. H+ ions partially inhibit the L-type Calcium channels causing decreased action of these channels and relative vasodilation. Therefore Hyperventilation (blowing off C02, leading to hypcapnia) decreases the H+ ion availability to impede the L-type Calcium channel resulting in better activation of these channels and vasoconstriction. The vasoconstriction decreases the blood volume in the head and thereby decreases the ICP. Too much hyperventilation can be bad because you can decrease the blood supply soo much that you can cause ischemia to the brain. They recommend PC02 valuses 30-34 for ICP control. Never below 30.
  13. Pitt Panther

    Pitt Panther The Best Baller in PA

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    The only time that you will see PCO2's less than 30 is when you hyperventilate (vasoconstrict) the patient to reduce ICP. This is extreme hyperventilation however.

    Maintaining the patient at that level is probably not a good idea ;)
    ----

    NSGY resident... that is some sweet candy, seriously... :) Do you mind if I PM you with some questions?

    Take care.

    Panther
    PCOM 2007
  14. NSGYResident

    NSGYResident Junior Member

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    Just to clarify, and I think this is what you meant.

    Normal PCO2 is around 40-44
    30-36 is already hyperventilating the patient to reduce ICP
    Less than 30 is over-hyperventilating the patient and usually doesn't do much for ICP in addition to the previous affect in the 30's and has negative effect on outcome. Hyperventilation for ICP control only lasts between 40minutes and 2-3 hours at the most. Then its effects don't work.

    You can see PCO2's less than 40 with numerous disease processes and do not always represent "on-purpose" hyperventilation by the physican. Just look through your texts on toxins, acid-base disorders, and pulmonary diseases
  15. NSGYResident

    NSGYResident Junior Member

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    PCOM 2nd year med student eh, I used to live near philly, like the city a lot. Good Luck. Not sure what the issues for neurosurgical training are with a DO degree though. I'm sure you know better than I.
  16. Pitt Panther

    Pitt Panther The Best Baller in PA

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    Exactly what I ment. :thumbup:
  17. Meagan

    Meagan Meagan

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    Hey, im sorry to hear about your friend. I truthfully understand what u are going through, as myself also have many questions about this topic because i too have had a freind in an accident this past weekend. He is aslo in a comma he has brain damage many broken bones, hes fighting against pnemonia and lung infection that is causing him much grief. I have looked all over on the internet for information and the most that i could possible tell u is that even after one comes out of a coma there is a period of days to weeks where the individual is not responcive to their surrondings.I have also been on another chat line to talk to people who themselves have been in car accidents and many similar situations and many of these people i have talked to have been also in critical conditions, and have came out of thee coma's and are now oviously able to function in their daily lives. If u get the chance to go in a see ur freind make sure u talk to them as if u would on a regular bases and be positive dont let them know u are worried and unsure be positive make refrences to when they wake up, and not if they wake up. One more thing to remember your freind ( along with mine) will have both good and bad days, so with every little step in the right direction there will be steps back and that anything is possible. One last question where abouts is your freind or at what hospital? I would like to keep close tabs on your situation as it is simular to mine and as i hope i can help you, im hoping you can lead me to more inforamtion also.
  18. kken2know

    kken2know

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    One of my very close relative had a motor cycle accident on 23rd November 2009. He is diagnosed to have been suffered from Diffused Axonal Injury. He is in Coma right from the time of the accident. Doctors have assessed his GCS to be in the range of 5-6. Trying to open the eye lids but can't do that. Some response to light in the right eye, not much in the left eye. He can react to pains. When he is being suctioned or new saline channel is being done, he jerks his upper part of the body. Also some movements of the legs and hands are observed. He has four small blood cloting in the brain including one in the center. He has been taken out of ventillation from the 8th day. He can sustain the respiration well (oxygen consumption is around 2 liter). He is maintaining the vitals pretty well right from the begining. He is also a pretty strong built man of age 44 years. No surgery of brain has been carried out. Also not much of treatment apart from life support and antibiotics.

    Can any one please tell me about the chances of coming back from coma? If there are chances, how long it GENERALLY takes? I would appreciate if you can please help or refer me to some better web site, where I can more relevant information.
  19. mpp

    mpp SDN Moderator Moderator Emeritus

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    The nature of brain injury is that there are no easy ways to get the answers to your questions.

    Nobody knows the chance of full recovery but at this point it is not zero. Therefore, you just must be patient.

    It can be anywhere from days to years to, unfortunately, never. Just take it one day at a time and hope for the best.

    Not the answer you're hoping for but it's just the nature of brain injury. Take care.
  20. SOLDIER

    SOLDIER

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    We really arnt allowed 2 give medical advise etc sorry like mmp said take it day by day
    Talk to the doctors
    Take care
  21. JeffLebowski

    JeffLebowski Just got Nard-dogged

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    Guys I hate to say it because I would love for people to get information to help them understand their friends/families' health tragedies, but this is exactly why this forum is not used for medical counsel.

    Like we all would, they suffer tragedy and wanting information, Google "chances of coming out of coma after accident" and 4th down the list is this thread.

    I want everyone to get answers to their questions and I'm sure people here all mean well and are likely pretty legit, but there's no way to tell and I think it's a potentially harmful slippery slope from both our perspective and theirs.
  22. kken2know

    kken2know

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    MPP, Jeff - Thanks for your help. i got some more information from the forum you mentioned. Will appreciate if anyone can please provide some more info on this.

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