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Effective treatments for the condition include the use of morphine and high doses of the anticonvulsant medication gabapentin. Most individuals who remain comatose are intubated and placed on mechanical ventilation. After two weeks, if the patient can’t be easily weaned from intubation, a tracheostomy may be considered. This procedure facilitates breathing by creating an opening in the neck with windpipe access. The benefit of a tracheostomy is better airway clearance. A scan of the chest arteries may help to find the embolism. Treatment may also include placing of a filter into a large vein to prevent clots in the individual’s legs from migrating to the lungs. It’s important to begin physical therapy early and to focus attention on the positioning of the limbs. Increased muscle tension is expected with a severe brain injury, and the result is quick stiffening of the limbs. This can lead to shortening of the muscles and fixed positions that can’t be overcome with movement or stretching. Studies have shown comatose patients who receive fewer than four sessions per week of physical therapy are more likely to experience muscle contracture than those who receive at least four sessions. If contracture isn’t treated and a comatose patient awakens and becomes more mobile, stiff joints may complicate the patient’s rehabilitation and make it impossible to get out of a wheelchair. 
Tear It Down
That’s why positioning of the joints and range of movement should be very much on a physician’s radar screen from day one. Initial care involves physiotherapy, and it should start as soon as treatment won’t be functionally disruptive. This is true in individuals who are breathing spontaneously as well as those on mechanical ventilation, regardless of the cause of a coma. Early use of stretching exercises can help individuals who’ve been in a coma only a short time to maintain range of motion. Gentle, passive range of motion and stretching are the techniques most often used. The individuals tolerate soft splinting well, and it’s a technique that doesn’t require supervision. Motions in the upper limbs may prevent contracture, but the spastic state of legs in a vegetative state for months is so profound that it invariably leads to contractures. Unfortunately, no physical therapy program has been able to prevent major contractures in patients in a prolonged coma. The legs become rigid, and the feet take on a position similar to that of a classic ballet stance. Caring for an individual who’s comatose is complex and requires the skills of a multidisciplinary team that includes neuroscience nursing staff, pharmacists who specialize in intensive care drugs, respiratory therapists who specialize in ventilator management, social workers, chaplains and so on. Other physicians, such as a neurosurgeon, nephrologist and infectious disease specialist, also may be involved. In recent years, treatment options in intensive care have changed quite dramatically, and we’ve also realized the importance of early intervention in giving patients a chance for survival and successful rehabilitation. Hard To Believe
The body is complex, and the sum is more than its parts. In medicine, however, we try to isolate smaller systems, look at them first, and then apply what we’ve learned on a broader level, considering how everything is connected and how treatment for one condition can affect another. Immediately treating the primary cause of a coma is essential, but afterward an individual may enter a difficult period and experience major complications. Efforts to prevent and treat complications are equally essential. It’s no exaggeration to say we must tread carefully with all potential complications associated with acute brain injury. When can we expect awakening and recovery? We’ve noticed improvement in your daughter, and I’m sure you have, too. When you said she was opening her eyes briefly and looking at you, I wasn’t so sure. But now it’s clear that she’s coming around and more awake and likely aware. How do we know she’ll be fine? What should we look for when we visit her? How much longer will it be before she recognizes us? It will be very gradual, and there will be days when nothing much happens and other days when she’ll make good strides. Of course, each patient’s trajectory of improvement is different. When recovery does happen, it’s generally in stages. First, the person awakens and then becomes aware and begins to communicate. Black And Blue
Later, the individual becomes more energetic, dynamic and focused, and acquires motivation to reach new physical and mental objectives and goals. During early recovery of a comatose individual, medical staff often is careful to avoid labeling the severity of the patient’s condition so as not to affect the level of care the person receives. As we’ve seen during the opioid epidemic, naloxone induces an almost miraculous awakening in individuals who’ve overdosed on opioids. Unfortunately, not every individual who receives one of these antidotes recovers. A prolonged period of very low oxygen levels and reduced blood pressure can leave its mark. Over the years, several important observations have been made about patients who emerge from their comas. In part, this is due to family members’ constant attentiveness at the bedside, but it’s also because they know the loved one best and, thus, are more likely to notice an attempt to make contact. We take that very seriously and follow up when it occurs. Other changes in comatose individuals may not necessarily have much meaning. One is opening the eyes. In this situation, most families agree that their loved ones are not there, aren’t able to think independently, and aren’t participating in social interaction. During recovery from an acute brain injury, nothing can be predicted with certainty, and we shouldn’t harbor illusions. Nothing is predestined when it comes to neurologic recovery. No reliable tool can estimate the recovery of consciousness after coma. Recovery remains somewhat mysterious biologically, but we’re glad for it when it occurs. Many people recover after being in a coma, even if they’ve been comatose for some time. Recovery isn’t a cure, but it surely counts for something. Others will improve, but not back to their usual baselines.