Journal of Forensic Psychology

Prophesies of Outcome in Patients with Coma after Acute Brain Damage

Lynne Harms^* Department of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
^*Correspondence: Lynne Harms, Department of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany, Email:

Received: 01-Mar-2022, Manuscript No. JFPY-22-16306; Editor assigned: 03-Mar-2022, Pre QC No. JFPY-22-16306(PQ); Reviewed: 17-Mar-2022, QC No. JFPY-22-16306; Revised: 21-Mar-2022, Manuscript No. JFPY-22-16306(R)0; Published: 31-Mar-2022, DOI: 10.35248/2475-319X.22.7.215

Description

Coma is a stage of unconsciousness in which a patient does not react with the surrounding activity. Someone who is in a coma is unconscious and has negligible brain activity. It is not possible to wake a coma patient using physical or auditory stimulation. They’re alive, but can’t be woken up and show no signs of being conscious. The person appears to be unresponsive and the eyes of the patients’ will be closed. They won’t normally respond to pain or sound, or be able to communicate or move voluntarily. Additionally a person in a coma fails to respond normally painful stimuli, light, or sound; lacks a normal sleep-wake cycle and, does not initiate voluntary actions, being unable to consciously feel, speak, hear, or move. Someone in a coma will also have very reduced common reflexes such as coughing and swallowing. They may be able to breathe on their own, but some people need a machine to help them breathe.

Over time, the person may start to slowly regain consciousness and become more alert. Some people will wake up after a few weeks, while others may go into a conscious state. Patients can exhibit different levels of unconsciousness and unresponsiveness depending on which brain regions have been damaged and how much or how little of the brain is functioning.

Coma can happen for a number of reasons, such as:

• Intoxication

• Metabolic abnormalities

• Central nervous system diseases

• Acute neurologic injuries

• Traumatic injuries caused by falls or vehicle collisions etc.

In some cases, coma may be purposely induced using pharmaceutical agents in order to preserve higher brain functions following brain trauma, or to save the patient from severe pain during healing of diseases or injuries. All of these factors will impact the path through treatment and recovery.

Preliminary treatment will depend on the cause of the coma and will be directed at avoiding further damage to the brain. In the short term, a person will usually be looked after in an Intensive Care Unit (ICU). If the patient is having trouble in breathing, they may be placed on a respirator while the underlying cause is treated. After a head injury, surgery may be compulsory to stop bleeding and reduce swelling. If there is an underlying illness, or poisoning, then treatment will be directed at the underlying cause. The patient’s respiration and circulation must be maintained and checked, using intubation and ventilation. Intravenous fluids or blood and other supportive care must be provided as required.

Once stable and no longer in immediate danger then further treatment will be directed at maintaining the patient’s physical state and checking complications. For example, this could involve providing adequate nutrition, and preventing infection such as pneumonia, bed sores.

A person in a coma may become restless, requiring care to prevent them from hurting themselves or attempting to pull on dressings or tubes. In these situations, medication may be given to calm the patient. Side rails on the bed should be kept up to prevent the patient from falling. While not empirically validated, families have reported benefits from arousal regimes, such as those implemented by Dr Ted Freeman. The therapy includes family members taking the patient through a routine of controlled auditory, visual and physical stimulation for up to six hours a day, every day.

Conclusion

Comas can last from days to weeks while some severe cases have lasted more than a few years. Regaining consciousness depends, to a significant extent, on the original cause of the coma and on the severity of any brain damage. Some exceptional cases such as patients in a diabetic coma will make a complete recovery while others, mainly those who have suffered a head trauma, may have some physical, intellectual or psychological damage that will require further treatment. They may need physiotherapy, occupational therapy, psychological assessment and support during a period of rehabilitation and may need care for the rest of their lives.