Guidelines for Coma Management

Posted on 4th March 2008 by Gordon Johnson in Brain Injury

Brain Injury Association, brain trauma association, coma, CT, intracranial pressure monitoring, MRI, severe brain injury

One of the most difficult challenges in being a brain injury attorney and an advocate, is struggling with what to tell people when they call up and their loved one is in a coma. The Brain Injury Law Group is here to a significant degree, because that was one of the challenges we faced when we first started doing web advocacy. We created http://waiting.com in 1997, with a sense of urgency to help those who were waiting for word as to whether their loved one would ever awake. The story of our frustration with the Brain Injury Association’s refusal to accept our offer of help to create such a page, and our decision to do it ourselves, is well explained on that page.

The Brain Trauma foundation is an organization which shares a similar advocacy to help those in a coma, and I received this email from them today, covering the guidelines to assist medical professionals dealing with coma patients. To get to those links, click here: http://www.guideline.gov/whatsnew/newthisweek.aspx#date

What these new guidelines don’t call for, which I believe they should, is the use of funtional imaging, such as PET scans or fMRI to tell the degree to which there is sufficient brain function going on in the comatose person, to predict any reasonable chance of recovery. Coma guidance from doctors is far too much “we will just have to wait and see” and most times, from a very pessimistic outlook. I believe that PET scans and fMRI should be routinely used to give guidance to the family, when they are trying to make that awful decision as to whether there is enough chance of a satisfactory recovery, to keep trying to save the life of the comatose person. We always counsel prayer and inner searching. But when there are tools out there that could be used to provide more meaningful information on what is going on inside of that skull, we believe they should be used. I have instructed the person who is my health care power of attorney to demand that I have a functional imaging test if I am ever in that situation, and there is no valid reason why doctors don’t do the same.

They Brain Trauma Association has guidelines on the following:

Anesthetics, analgesics, and sedatives.
Antiseizure prophylaxis.
Blood pressure and oxygenation.
Brain oxygen monitoring and thresholds.
Cerebral perfusion thresholds.
Deep vein thrombosis prophylaxis.
Hyperosmolar therapy.
Hyperventilation.

Indications for intracranial pressure monitoring.
Infection prophylaxis
Intracranial pressure thresholds.
Nutrition.
Prophylactic hypothermia.
Steroids.