comas?

Specialties MICU

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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?

Specializes in CCRN, CNRN, Flight Nurse.

I sorry for your not so positive experiences. I do hope things begin to look up very soon.

He has a left temporal and left frontal lobe contusion.
To tell you honestly, I think that when my husband heard himself speak and realized that he had some difficulty, it scared him.

Don't forget, the traumatized areas are very near the speech centers (motor and recognition). Even if the actual speech areas were not damaged, they most certainally were effect by edema. It may be he has some receptive and/or expressive aphasia issues. Whether this will resolve or not, I couldn't tell you.

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".
Unfortunately, with brain injury patients, it is a 'wait-and-see' game. Each patient will recover differently despite having the same/very similar injury and each in their own time.

I tell my families something to this effect: "I can tell you a broken arm will heal in about 6-8 weeks, sometimes more; Open heart recovery can last 1-3+ months. With brain injuries we honestly don't have a time frame. The brain doesn't tell us its timetable. They may recover tomorrow, in a week or month or they may never recover. We just *don't know.* As with any illness, the patient's age and overall health prior to the event is a large factor........" yada, yada, yada...... (then we get into talking about PMHx and etc).

I hope this information helps. And I hope he has a speedy recovery!!

Roxan, RN

Neuro Critical Care Unit

Roxan,

With respect to his lack of eating, what do you think about getting a psych consult ASAP for him rather than waiting until rehab????

Specializes in CCRN, CNRN, Flight Nurse.
Roxan,

With respect to his lack of eating, what do you think about getting a psych consult ASAP for him rather than waiting until rehab????

While he passed a swallow study, he may still have pain and/or difficulty eating due to his mouth injuries. I know it's hard for me to eat when it feels like I have a golfball in my mouth :) Or he may just not like the consistancy of pureed food (and it's hospital food to boot :p ). For whatever the reason, I'd request to have a dobbhoff feeding tube placed to assist with his nourishment. Are you allowed to bring in things like smoothies or other soft, tasty, high caloric treats? He might be interested in those.......

Because depression can often accompany these types of brain injuries, a psych consult is not out of the question. If a DH is placed and he is proceeding well with it, the consult could probably wait until rehab.

Specializes in ICU.
Roxan,

With respect to his lack of eating, what do you think about getting a psych consult ASAP for him rather than waiting until rehab????

No, I would personally not suggest this route.

They describe neuro recovery as a "rollercoaster ride" for good reason. Sometimes it does feel like one step forward two back. Patients will have a varying response from day to day. Keep asking keep up your spirits. This is one of the most difficult things to do.

Hi all...

My husband's appetite had picked up just a bit. He is such a picky eater, and besides who really wants to eat pureed hospital food?

We start rehab in the morning 4/22/05, and they expect our stay to be 2-3 weeks. He will have PT for his leg fx as well as therapy for cognitive issues.

He now speaks at will...clearly and appropriately. He still has difficulty remembering some things and reconizing some people. His neuro surg is very optimistic that most of his memory will return in time and once the bruises on his L temporal heal.

In an attempt to pick up his appetite, I would mix chocolate ice cream and ensure. He thought that he was eating a regular McDonald's shake!!

He has made a stunning recovery and surpassed the expectations of many (think...he was in a coma for a week...in all this occured 2.5 weeks ago). I continue to pray and hope for the best...thank all of you for your concern and suggestions. I will keep you posted

shawnette

Hi

This will probably be the last time that I post on this thread. My husband is scheduled to come home on May 10. He has spent nearly two weeks in med rehab for a total hospital stay of 1 month. He is expected to make a complete recovery.

I find it amazing to watch his progress everyday; it is also amazing to watch his physicans,physical therapists, and nurses shake their heads in awe. I was told just yesterday that because of the severity of his brain injuries, he should have died. I was also told that it is amazing how he woke from a coma cognitivly intact. He can speak, read, write... execuative functioning completely intact...all in all, he is going to be okay.

The one problem that he does have is impaired short term memory, and even that improves everyday! His physican told me that the problem will resolve with time!

I want to thank all who posted with information and suggestions. I want to especially thank those who sent up prayers. It never ceases to amaze me how the Lord can work; once again I am humbled and stand in awe of his power! Thanks again...Shawnette

Specializes in Nephrology, Cardiology, ER, ICU.

Shawnette - I'm so happy for you and your wonderfully blessed husband. Take care.

I am so happy to hear your husband is doing well. I will continue to keep you in my prayers!

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