The Comatose Patient

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 instruction of 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 and approach 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 200 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 a section on management and expected outcome. A companion website www.oup.com/us/thecomatosepatient (http://www.oup.com/us/thecomatosepatient) presents 5 narrated chapters, including 40 patient examples showing the instructions of the FOUR score Coma Scale, common neurological findings in coma, breathing patterns in coma, different types of prolonged comatose states including a persistent vegetative state and a minimally conscious state. Using 3D animation, the videos 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 companion website also includes a PDF of the FOUR Score Instruction Guide for easy reference.

Table of Contents:
Preface: Acknowledgments: Part I: Understanding, Diagnosing and Care of Comatose Patients 1: A History of Coma: Evolution of ideas Understanding Brain Herniation Concepts and Benchmarks Revision of a Classic Concept Understanding the Role of Increased Intracranial Pressure Understanding Localization and Key Clinical Signs in Coma Decerebrate Rigidity Unilateral Dilated Pupil Vestibular Ocular Reflex Breathing Patterns Understanding the Mechanisms of Metabolic Encephalopathies Understanding Psychogenic Unresponsiveness Understanding the Spectrum of Prolonged Comatose States Conclusions 2: The Neuroscience of the Awake State Early Studies The Anatomy of the Awake State The Chemistry of the Awake State The Physiology of the Awake State Translation into Clinical Practice Conclusions 3: Neurologic Examination of the Comatose Patient and Localization Principles Definitions Locked-in Syndrome Hypersomnia Acute Confusional State and Delirium Stupor and Coma The Clinical Examination of a Comatose Patient Fundamentals of Functional Anatomy Physical Examination Neurological Examination: Coma Scales and the FOUR Score Neurological Examination: Clinical Observations Breathing Patterns Cranial Nerve Examination Spontaneous Movements Localization Principles and Brain Displacement Syndromes Conclusions 4: The Clinical Diagnosis of Prolonged Impaired Consciousness Categories of Outcome Persistent Vegetative State Minimally Conscious State and Akinetic Mutism Laboratory Investigations Prediction of Outcome Conclusions 5: The Clinical Diagnosis of Brain Death Code of Practice The Clinical Examination Prerequisites and Major Confounders The Bedside Examination Confirmatory Tests Documentation Special Topics Pathophysiological Response to Brain Death Organ Procurement Conclusions 6: Neuroimaging and Neuropathology Neuroimaging in Coma Diagnostic Imaging of Brain Tissue Shift Diagnostic Imaging of Gray and White Matter Disorders Neuropathology of Coma Specific Types of Injury Hypoxemia and Ischemia Infarction and Hemorrhage Trauma and Abuse Infection Demyelination Neurotoxicity Disease States Pathology of Brain Herniation Persistent Vegetative State Brain Death Conclusions 7: Clinical Decisions, Medical Management, and Supportive Care Clinical Decisions in the Comatose Patient Respiratory and Hemodynamic Stabilization Further Questions to Family or Bystanders Consolidation of Neurologic Findings Interpretation of Neuroimaging: Abnormal CT scan and its Consequences Interpretation of Neuroimaging: Normal CT scan and its Consequences Coma with No Obvious Cause Medical care of the Comatose Patient Infection Control Blood Glucose Control Temperature Control Eye and Mouth Care Pulmonary Care Cardiac Care Gastrointestinal Care Bladder Care Medical Complications of Immobilization Rehabilitation Communication with the Family Clinical Practice of Withdrawal of Support Conclusions 8: Law and Bioethics The Court Cases in the US The Quinlan Case The Brophy Case The Jobes Case The Cruzan Case The Wendland Case The Schiavo Case Lessons Learned From the Court Cases Legal Aspects of Withdrawal of Support Applied Ethics Spirituality and Healthcare Comatose States as a Bioethical Controversy Ethics in Non-heart Beating Organ Transplantation Conclusions 9: Media and Popular Culture Introduction News Writing On Coma The Newspaper and Coverage of Coma Television and Coma The Internet and Coma The Screen Writer on Coma The Portrayal of Coma in Motion Pictures Conclusions Part II: Clinical Approach to the Comatose Patient 10: The Clinical Approach to the Comatose Patient in 75 Vignettes Introduction The 75 Clinical Vignettes 10-1: Comatose and Traumatic Brain Injury 10-2: Comatose and Gunshot Wounds 10-3: Comatose and Traumatic Brainstem Lesion 10-4: Comatose and Shaken Impact Syndrome 10-5: Comatose and Acute Epidural Hematoma 10-6: Comatose and Acute Subdural Hematoma 10-7: Comatose and Cerebral Hematoma 10-8: Comatose and Aneurysmal Subarachnoid hemorrhage 10-9: Comatose and Pontine Hemorrhage 10-10: Comatose and Cerebellar Hemorrhage 10-11: Comatose and Cerebral Venous Thrombosis 10-12: Comatose and Hemispheric Stroke 10-13: Comatose and Basilar Artery Occlusion 10-14: Comatose and Bacterial Meningitis 10-15: Comatose and Brain Abscess 10-16: Comatose and Acute Herpes Simplex Encephalitis 10-17: Comatose and Opportunistic CNS Infection 10-18: Comatose and High Grade Astrocytoma 10-19: Comatose and CNS Lymphoma 10-20: Comatose and Metastasis 10-21: Comatose and Gliomatosis 10-22: Comatose and Paraneoplastic Limbic-encephalitis 10-23: Comatose and Acute Hydrocephalus 10-24: Comatose and Status Epilepticus 10-25: Comatose and Acute Disseminated Encephalomyelitis 10-26: Comatose and Fulminant Multiple Sclerosis 10-27: Comatose and Osmotic Demyelination 10-28: Comatose and Acute Necrotizing encephalitis 10-29: Comatose in the Recovery Room 10-30: Comatose After Organ Transplantation 10-31: Comatose After Coronary Artery Bypass Surgery 10-32: Comatose After Brain Biopsy and Craniotomy 10-33: Comatose After Clipping of a Ruptured Cerebral Aneurysm 10-34: Comatose After Endovascular Treatment of Ruptured Cerebral Aneurysm 10-35: Comatose After Epilepsy Surgery 10-36: Comatose After Cerebral Angiogram 10-37: Comatose and Hypothermia 10-38: Comatose and Carbon Monoxide Poisoning 10-39: Comatose and Heatstroke 10-40: Comatose and Near Drowning 10-41: Comatose and Cardiac Resuscitation 10-42: Comatose and Near Hanging 10-43: Comatose and Status Asthmaticus 10-44: Comatose and Acute Uremia 10-45: Comatose and Acute Hypertensive Crises 10-46: Comatose and Fulminant Hepatic Failure 10-47: Comatose and Chronic Liver Disease 10-48: Comatose and Thyroid Disease 10-49: Comatose and Sepsis 10-50: Comatose and Endocarditis 10-51: Comatose and Aorta Dissection 10-52: Comatose and Hypoglycemia 10-53: Comatose and Hyperglycemia 10-54: Comatose and Hyponatremia 10-55: Comatose and Hypernatremia 10-56: Comatose and Hypercalcemic Crises 10-57: Comatose and Hypercapnia 10-58: Comatose and Pituitary Apoplexy 10-59: Comatose and Systemic Lupus Erythematosus 10-60: Comatose and Central Nervous System Vasculitis 10-61: Comatose and Acute Leukemia 10-62: Comatose and Thrombocytopenia 10-63: Comatose and Acute Hyperammonemic Encephalopathy 10-64: Comatose and Wernicke-Korsakoff Syndrome 10-65: Comatose and MELAS 10-66: Comatose and Acute Porphyria 10-67: Comatose and Puerperium 10-68: Comatose and Acetaminophen Overdose 10-69: Comatose and Tricyclic Antidepressant Overdose 10-70: Comatose and Ethylene Glycol Ingestion 10-71: Comatose and Salicylate Overdose 10-72: Comatose and a Rave Party 10-73: Comatose and Rapid Dementing Illness 10-74: Comatose and Malignant Catatonia 10-75: Comatose and Conversion Disorder

Review :
"...provides a comprehensive and contemporary look at the understanding and management of the comatose patient...In contrast to several texts on this topic that focus mainly on pathophysiology and diagnosis, this book is more comprehensive and relevant to the clinician at the bedside because it provides not only pathophysiologic and diagnostic approaches but also detailed management options for common and uncommon etiologies of coma."--Mayo Clinic Proceedings "...an important and valuable book..."--Journal of Neuroscience Nursing "The book has an attractive uniformity of style and organization...Concepts are well presented, and the illustrations, many of which are in color, are well presented and clear."--New England Journal of Medicine "In The Comatose Patient Dr. Wijdicks does an excellent job in bringing new concepts to the longstanding knowledge base of this patient population... The Comatose Patient is an excellent reference for the many different types of coma one encounters, even esoteric ones, and belongs in every intensive care unit that cares for patients with neurologic disease."--Anesthesiology "...a tour de force..."--Neurology "...an exceptionally helpful text...The book's format is unique, modern, and highly effective....Clinicians can easily go from the bedside to the text to look at a specific clinical vignette that will help them approach the patient they are caring for with greater expertise and will help them to be more thorough in their evaluation. This book is a must..."--Critical Care Medicine Received the Honorable Mention award in the Physician's Category of the American Medical Writers Association book awards for 2008!