Hospice & Palliative Care

Comatose Patients 昏迷的/ Hospice Care (Reading & Sharing)

Coma Characteristics:

  • No eye opening or movement
  • No awareness of self or environment
  • No ability to follow commands
  • No response to voice or noxious stimuli
  • No normal sleep-wake cycles

Prognosis:

  • Depends on etiology of coma, age of patient, and severity of cause
  • Coma rarely lasts > 2-4 weeks, unless sedated or has severe sepsis, as patient either recovers, dies or evolves to another LOC: minimally conscious state, persistent vegetative state, or brain death

Comatose patients with any three of the following on day three of coma (any etiology) eligible hospice referral:

  • Abnormal brain stem response
  • Absent verbal response
  • Absent withdrawal response to pain
  • Serum creatinine >1.5 mg/dl

Documentation of the following factors will support eligibility for hospice care:

  1. Medical complications, in the context of progressive clinical decline, within the previous 12 months, which support a terminal prognosis
    • Aspiration pneumonia
    • Upper urinary tract infection (pyelonephritis)
    • Sepsis
    • Refractory stage 3-4 decubitus ulcers
    • Fever recurrent after antibiotics
  2. Diagnostic imaging factors which support poor prognosis after stroke include
    • For non-traumatic hemorrhagic stroke
      • Large-volume hemorrhage on CT
        • Infratentorial greater or equal to 20ml
        • Supratentorial greater or equal to 50ml
      • Ventricular extension of hemorrhage
      • Surface area of involvement of hemorrhage greater or equal to 30%of cerebrum
      • Midline shift greater or equal to 1.5cm
      • Obstructive hydrocephalus in patient who declines, or is not a candidate for, ventriculoperitoneal shunt
    • For thrombotic/ embolic stroke
      • Large anterior infarcts with both cortical and subcortical involvement
      • Large bihemispheric infarcts
      • Basilar artery occlusion
      • Bilateral vertebral artery occusion

 

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