comas?

suzanne4, RN · Apr 11, 2005

my husband had a motorcycle accident this past wednsday. Along with numerous broken bones, he suffered a brain injury. He has a left temporal and left frontal lobe contusion. Inital assessement (at scene) GCS of 7. HE was dx as being in a coma.
He has very purposeful movement ( sometimes to commands, always localizes and withdraws from pain) he opens his eyes on occassion and will sometimes squeeze my hands if asked. He is on a vent and 10mcg of fentanyl for sedation. My question is what type of coma is this? I have looked up info about them, and nothing is specific. Any suggestions? Help?

That is a brain injury but not a coma. He is repsonding at times to you or others. In a coma, they normally do not respond. What is his GSC now?

MelRNNC · Apr 11, 2005

I work in an MSICU and a GCS below 8 indicates a coma here, that's probably why they told you that, even if he is responsive in some respects.

sockov, ADN, ASN, BSN, CNA, LVN · Apr 11, 2005

wow.

sorry to hear about your husband. How is he doing now? Hope he will be ok.

There are differen't grades of coma's, and differen't systems to measure it.

Usually the Glascow Coma Scale, GCS, is widely used.

He probably automatically gets a "1T" next to the verbal score, even though he may try to talk and is coherent. Can he write? Does he follow commands all the time? Sometimes the sedation can fog his mind as well.

Do a search on coma scales. That might help.

ShawnetteRN05 · Apr 11, 2005

wow.
sorry to hear about your husband. How is he doing now? Hope he will be ok.
There are differen't grades of coma's, and differen't systems to measure it.
Usually the Glascow Coma Scale, GCS, is widely used.
He probably automatically gets a "1T" next to the verbal score, even though he may try to talk and is coherent. Can he write? Does he follow commands all the time? Sometimes the sedation can fog his mind as well.
Do a search on coma scales. That might help.

Last night I was told that his GCS was 8. He automatically gets a 1 in comm b/c he is intubated. We haven't tried to get him to write b/c he is in and out of it. (He is sedated) he also has increased ICP the highest was at 24 (treated with Mannitol) but they usually hover around 15-18. I was also told by his neuro surgeon that the swelling and ICP will peak at 3-5 days and that we will have to wait to see the extent, if any, of the damage. Just pray for us.

LindaMarie76 · Apr 19, 2005

Does anyone else think that the GCS is a bunch of crap? It truly does not provide a true reflection of the patient. As Laura Gasparis says, if nursing administration was rated with the GCS, most of them would be classified as being comatose (verbal commands = no response = 0).

As for your husband, it certainly sounds positive that he has purposeful movement. Regardless of the numbers, look at your husband. Level of consciousness is so terribly important it is often overlooked. If he is squeezing your hand when asked despite being in a Fentanyl drip, I'd say that was a pretty darn positive sign.

Linda

Websites:

http://www.waiting.com/comabasics.html

ShawnetteRN05 · Apr 19, 2005

Does anyone else think that the GCS is a bunch of crap? It truly does not provide a true reflection of the patient. As Laura Gasparis says, if nursing administration was rated with the GCS, most of them would be classified as being comatose (verbal commands = no response = 0).
As for your husband, it certainly sounds positive that he has purposeful movement. Regardless of the numbers, look at your husband. Level of consciousness is so terribly important it is often overlooked. If he is squeezing your hand when asked despite being in a Fentanyl drip, I'd say that was a pretty darn positive sign.
Linda
Websites:
http://www.waiting.com/comabasics.html

Alot has happened since I last posted on this thread. My husband woke from his"coma" 6 days later (the day they stopped the fentayl drip) he was extubated the next day. He follows commands, speaks (on occassion, he had a terrible tongue lac), and moves around. We have since been transferred out of ICU and up to step-down where we soon hope to start rehab. THe consult for rehab was placed today. I am still confused about the whole coma situation, I tried to approach the staff and his nurses about it, but they were so reluctant to divulge info partly b/c of the fact that he has head trauma and the fact that they know I am a nsg student. We just keep hoping and praying for the best...Thank you for your comments

shawnette

Trauma Columnist · Apr 19, 2005

Shawnette - you and your dear husband continue to be in my thoughts and prayers.

live4today, RN · Apr 19, 2005

Shawnette, I am so sorry to hear of your husband's accident. Thankfully, he is alive and seems to be making good progress so far. That's a good sign. :icon_hug: Yes, I will remember you both in prayer. :)

ShawnetteRN05 · Apr 19, 2005

Like I previously stated, alot has happened in the last 12 days. Most recently, when my husband was extubated, he was speaking some. He went to surjury last friday( they fixed a broken nasal septum and a split tongue) and he has uttered very little since. I was told that it may be attributed to the fact that he is still sore, but when I ask him if he hurts he denies pain (via headshakes) I am concered about the fact that he has quit talking, but his nurses seem unconcerned ( they say that the fact that he follows commands and comprehends is very positive). My aunt (she is a trauma nurse and a ortho nurse) says that he is trying to maintain a sense of control, and this is the only way that he still can. He had a repeat CT and it showed no changes from the previous film.

I am just confused (again) about the situation. I don't know if I should be concerned about the fact that he hasn't spoken since his surjury 3 days ago. Does anyone have any info or experience dealing with these type of situations? Thanks...Shawnette

LindaMarie76 · Apr 19, 2005

It could very well be a control issue.

My best advice is to push for a psychiatric consult and a speech therapy evaluation.

Always remember one thing....this is your husband. You are not out to make friends with the nurses or docs. That would be the ideal situation, but often times health care professionals become intimidated by lots of questions by other health care professionals/students. Push, push, push - keep asking those questions. Do you have a camarderie with any of the staff? If not, then go down to administration and tell them that you have a lots of questions and would like to arrange a conference with the doctors, nurses, etc. AT LEAST, get social services involved. You need someone on your side. We're all here for you.

Linda

Like I previously stated, alot has happened in the last 12 days. Most recently, when my husband was extubated, he was speaking some. He went to surjury last friday( they fixed a broken nasal septum and a split tongue) and he has uttered very little since. I was told that it may be attributed to the fact that he is still sore, but when I ask him if he hurts he denies pain (via headshakes) I am concered about the fact that he has quit talking, but his nurses seem unconcerned ( they say that the fact that he follows commands and comprehends is very positive). My aunt (she is a trauma nurse and a ortho nurse) says that he is trying to maintain a sense of control, and this is the only way that he still can. He had a repeat CT and it showed no changes from the previous film.
I am just confused (again) about the situation. I don't know if I should be concerned about the fact that he hasn't spoken since his surjury 3 days ago. Does anyone have any info or experience dealing with these type of situations? Thanks...Shawnette

ShawnetteRN05 · Apr 19, 2005

It could very well be a control issue.
My best advice is to push for a psychiatric consult and a speech therapy evaluation.
Always remember one thing....this is your husband. You are not out to make friends with the nurses or docs. That would be the ideal situation, but often times health care professionals become intimidated by lots of questions by other health care professionals/students. Push, push, push - keep asking those questions. Do you have a camarderie with any of the staff? If not, then go down to administration and tell them that you have a lots of questions and would like to arrange a conference with the doctors, nurses, etc. AT LEAST, get social services involved. You need someone on your side. We're all here for you.
Linda

He had a consult with speech therapy today to do a swallow eval...he passed and they put him on a pureed diet (which he won't eat anything). It is so hard trying to deal with his nurses ( I communicate better with his physicians, if you can believe that!!). THis whole experience has changed the way that I will practice nursing personally, and it has also changed the way that I view some practicing RNs. If it was my choice, it would have never been revealed that I am a future grad nurse (May 14), I can thank my mother-in-law for divulging that tidbit of info!! I know that she is proud, I just don't think that she realized the position that she has put me in.

It is so hard to get answers to my questions, and when I do the answer is usually the same "you never know with head injuries" or "we'll just have to wait and see".

To tell you honestly, I think that when my husband heard himself speak and realized that he had some difficulty, it scared him. Tomorrow I am going to explain his situation to him and see if that can bring him out of his shell.

When we were in the MSICU they told me that depression was a big issue with patients with his type of injuries...they will address the issue if need be when we get to rehab. I just worry about him.