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Discussion

Dumb Question - Coma

I feel stupid :imbar for not knowing but here goes and thanks for your help.

Does a comatose patient ever thrash, try to turn over and sit up, and appear to be struggling for breath? Or is the patient totally still?

Thank you.

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The only person in a coma I ever saw (I was helping the doctor with his hospitals rounds) had his eyes open, followed me with his eyes, and opened his mouth like he was about to talk. He gasped a couple of times too. He came out of the coma within a week and didn't remember any of it. (died soon after... cancer mets in the brain)

I suppose there are different types a comas that each have a different look.

Most of the time patients are completely still and do not seem to have any sense of "being". Some patients however, may twitch once and a while or make a weird noise.

As Carrie said, some patients can still see but just aren't able to do anything else (of course, this is the stages of "waking up") -- and they just follow you around with their eyes.

Funny, I just watched a documetary on comatose pts yesterday!! According to the brain injury specialists that were interviewed, true comatose pts do not have any response. Once the eyes open and they start to respond, the comatose state no longer exists. At that point the pt is either vegetative or in a minimally conscious state. The first has no hope of recovery, the second does.

  • Author

So, a patient who is thrashing, turning over, and struggling to breathe after being taken off the vent and put on comfort measure only - is the doctor correct to say the patient is "comatose"?

(Eyes were not open, patient made no sounds.)

  • Guides

Interesting discussion! Makes me realize that, in all of my med/surge experience, I never once took care of anyone in a true comatose state. I mean, I took care of plenty of patients that were pretty unresponsive due to either impending death or very advanced alzheimer's.... but I don't think I've ever taken care of anyone in a coma. Most likely I guess, because we were not a trauma hospital... severe trauma always got airlifted out... so I never took care of anyone with a very serious brain injury.

I guess if I ever DID take care of a comatose patient, it was either someone who had had a massive stroke, or someone with brain cancer. The former is possible, but I know for definate sure that I've never cared for someone with brain mets that were that severe.

Let me add that, as an RN I'm ABSOLUTELY sure I never took care of anyone in a true coma. In my years of being an AIDE, since I didn't always have *all* the details about a patient's condition... I MIGHT have taken care of someone who was comatose due to massive stroke.

  • Author

Thanks for those references, they both helped. I see that my question wasn't so dumb after all. I had always thought that a coma Dx required that someone was without movement, without speech, totally dependent. Not necessarily so, I see.

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