The Comatose Patient

Hardcover | March 18, 2008

byEelco F. M. Wijdicks

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The Comatose Patient is a single authored entirely new work written by a practicing critical care neurologist. It includes a critical historical overview of the concepts of consciousness and unconsciousness, principles of neurologic examination of the comatose patients including instructionof a new coma scale, the 'FOUR Score', a new practical multistep approach to the diagnosis of the comatose patient, extensive coverage of interpretation of neuroimaging and its role in daily practice and decision making, management in the emergency room and ICU and long-term supportive care andapproach to communication with family members and end-of-life decision. It also discusses landmark legal cases and ethical problems and a chapter on the public perception of coma. The book is lavishly illustrated with over 300 illustrations throughout the book. Unprecedented, this book includes 75 comprehensive case vignettes covering the entire spectrum of causes leading to coma. In each case a specific cause is presented. Every example is fully discussed and explained with an emphasis on the mechanism of coma in that particular case and followed by asection on management and expected outcome. This monograph additionally includes a 45-minute DVD with 5 narrated chapters and an easy to use navigation menu. Included are 40 patient examples showing the instructions of the FOUR score Coma Scale, common neurological findings in coma, breathing patterns in coma, different types of prolongedcomatose states including a persistent vegetative state and a minimally conscious state. Using 3D animation, the DVD includes a comprehensive description of the determination of Brain Death and how to safely do the apnea test. There is an emphasis on pitfalls and common concerns. The DVD can alsobe used for neurology and neurosurgery residency programs, medical and nursing school curricula and physical therapy programs.

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The Comatose Patient is a single authored entirely new work written by a practicing critical care neurologist. It includes a critical historical overview of the concepts of consciousness and unconsciousness, principles of neurologic examination of the comatose patients including instructionof a new coma scale, the 'FOUR Score', a new ...

Eelco Wijdicks is a Professor of Neurology at the Mayo Clinic College of Medicine.

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Format:HardcoverDimensions:672 pages, 10.1 × 7.3 × 1.3 inPublished:March 18, 2008Publisher:Oxford University PressLanguage:English

The following ISBNs are associated with this title:

ISBN - 10:0195326261

ISBN - 13:9780195326260

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Table of Contents

Preface. Acknowledgments. Part I: Understanding, Diagnosing and Care of Comatose States1. A History of Coma: Evolution of ideasUnderstanding Brain HerniationConcepts and BenchmarksRevision of a Classic ConceptUnderstanding the Role of Increased Intracranial PressureUnderstanding Localization and Key Clinical Signs in ComaDecerebrate RigidityUnilateral Dilated PupilVestibular Ocular ReflexBreathing PatternsUnderstanding the Mechanisms of Metabolic EncephalopathiesUnderstanding Psychogenic UnresponsivenessUnderstanding the Spectrum of Prolonged Comatose StatesConclusions2. The Neuroscience of the Awake StateEarly StudiesThe Anatomy of the Awake StateThe Chemistry of the Awake StateThe Physiology of the Awake StateTranslation into Clinical PracticeConclusions3. Neurologic Examination of the Comatose Patient and Localization PrinciplesDefinitionsLocked-in SyndromeHypersomniaAcute Confusional State and DeliriumStupor and ComaThe Clinical Examination of a Comatose PatientFundamentals of Functional AnatomyPhysical ExaminationNeurological examination: Coma Scales and the FOUR ScoreNeurological Examination: Clinical ObservationsBreathing PatternsCranial Nerve ExaminationSpontaneous MovementsLocalization Principles and Brain Displacement SyndromesConclusions4. The Clinical Diagnosis of Prolonged Impaired ConsciousnessIntroductionCategories of OutcomePersistent Vegetative StateMinimally Conscious State and Akinetic MutismLaboratory InvestigationsPrediction of OutcomeConclusions5. The Clinical Diagnosis of Brain DeathIntroductionCode of practiceThe clinical examinationPrerequisites and major confoundersThe bedside examinationConfirmatory testsDocumentationSpecial topicsPathophysiological response to brain deathOrgan procurementConclusions6. Neuroimaging and NeuropathologyIntroductionNeuroimaging in ComaDiagnostic Imaging of Brain Tissue ShiftDiagnostic Imaging of Gray and White Matter DisordersNeuropathology of ComaSpecific Types of InjuryHypoxemia and IschemiaInfarction and HemorrhageTrauma and AbuseInfectionDemyelinationNeurotoxicityDisease StatesPathology of Brain HerniationPersistent Vegetative StateBrain DeathConclusions7. Clinical Decisions, Medical Management, and Supportive CareClinical Decisions in the Comatose PatientRespiratory and Hemodynamic StabilizationFurther Questions to Family or BystandersConsolidation of Neurologic FindingsInterpretation of Neuroimaging: Abnormal CT scan and its ConsequencesInterpretation of Neuroimaging: Normal CT scan and its ConsequencesComa with No Obvious CauseMedical care of the comatose patientInfection ControlBlood Glucose ControlTemperature ControlEye and Mouth CarePulmonary CareCardiac CareGastrointestinal CareBladder CareMedical Complications of ImmobilizationRehabilitationCommunication with the FamilyClinical Practice of Withdrawal of SupportConclusions8. Landmark Legal Cases and Ethical QuandariesThe Court Cases in the USThe Quinlan CaseThe Brophy CaseThe Jobes CaseThe Cruzan CaseThe Wendland CaseThe Schiavo CaseLessons Learned From the Court CasesLegal Aspects of Withdrawal of SupportEthical QuandariesSpirituality and HealthcareComatose States as a Bioethical ControversyEthics in Non-heart Beating Organ TransplantationConclusions9. Popular Culture and the Public's PerceptionIntroductionNews Writing On ComaThe Newspaper and Coverage of ComaTelevision and ComaThe Internet and ComaThe Screen Writer on ComaThe Portrayal of Coma in Motion PicturesConclusionsPart II: Clinical Approach to the Comatose Patient10. The Clinical Approach to the Comatose Patient in 75 VignettesIntroductionThe 75 Clinical Vignettes10-1. Comatose and Traumatic Brain Injury10-2. Comatose and Gunshot Wounds10-3. Comatose and Traumatic Brainstem Lesion10-4. Comatose After Shaken Impact Syndrome10-5. Comatose and Acute Epidural Hematoma10-6. Comatose and Acute Subdural Hematoma10-7. Comatose After Cerebral Hematoma10-8. Comatose and Aneurysmal Subarachnoid hemorrhage10-9. Comatose and Pontine Hemorrhage10-10. Comatose and Cerebellar Hemorrhage10-11. Comatose and Cerebral Venous Thrombosis10-12. Comatose and Hemispheric Stroke10-13. Comatose and Basilar Artery Occlusion10-14. Comatose and Bacterial Meningitis10-15. Comatose and Brain Abscess10-16. Comatose and Acute Herpes Simplex Encephalitis10-17. Comatose and Opportunistic CNS Infection10-18. Comatose and High Grade Astrocytoma10-19. Comatose and CNS Lymphoma10-20. Comatose and Metastasis10-21. Comatose and Gliomatosis10-22. Comatose and Paraneoplastic Limbic-encephalitis10-23. Comatose and Acute Hydrocephalus10-24. Comatose and Status Epilepticus10-25. Comatose and Acute Disseminated Encephalomyelitis10-26. Comatose and Fulminant Multiple Sclerosis10-27. Comatose and Osmotic Demyelination10-28. Comatose and Acute Necrotizing encephalitis10-29. Comatose in the Recovery Room10-30. Comatose After Organ Transplantation10-31. Comatose after Coronary Artery Bypass Surgery10-32. Comatose after Brain Biopsy and Craniotomy10-33. Comatose after Clipping of a Ruptured Cerebral Aneurysm10-34. Comatose after Endovascular Treatment of Ruptured Cerebral Aneurysm10-35. Comatose after Epilepsy Surgery10-36. Comatose after Cerebral Angiogram10-37. Comatose and Hypothermia10-38. Comatose and CO Inhalation10-39. Comatose and Heatstroke10-40. Comatose and Near Drowning10-41. Comatose after Cardiac Resuscitation10-42. Comatose after Near Hanging10-43. Comatose after Status Asthmaticus10-44. Comatose and Acute Uremia10-45. Comatose and Acute Hypertensive Crises10-46. Comatose and Fulminant Hepatic Failure10-47. Comatose and Chronic Liver Disease10-48. Comatose and Thyroid Disease10-49. Comatose and Sepsis10-50. Comatose and Endocarditis10-51. Comatose after Aorta Dissection10-52. Comatose and Hypoglycemia10-53. Comatose and Hyperglycemia10-54. Comatose and Hyponatremia10-55. Comatose and Hypernatremia10-56. Comatose and Hypercalcemic Crises10-57. Comatose and Hypercapnia10-58. Comatose and Pituitary Apoplexy10-59. Comatose and Systemic Lupus Erythematosus10-60. Comatose and Central Nervous System Vasculitis10-61. Comatose and Acute Leukemia10-62. Comatose and Thrombocytopenia10-63. Comatose and Acute Hyperammonemic Encephalopathy10-64. Comatose and Wernicke-Korsakoff Syndrome10-65. Comatose and MELAS10-66. Comatose and Acute Porphyria10-67. Comatose and Puerperium10-68. Comatose and Acetaminophen Overdose10-69. Comatose and Tricyclic Antidepressant Overdose10-70. Comatose and Ethylene Glycol Ingestion10-71. Comatose and Salicylate Overdose10-72. Comatose After a Rave Party10-73. Comatose and Rapid Dementing Illness10-74. Comatose and Malignant Catatonia10-75. Comatose and Conversion Disorder