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Coconuts
04-10-2015, 01:20 PM
Hey everyone!

I've had this idea in my head for the last few months and it absolutely refuses to leave! I've done all kinds of research however I still have some questions. I apologize if any of them are stupid.

First of all, can a gunshot wound to anywhere other than the head put someone in a coma? I would imagine the answer would be yes, if the person lost enough blood. Is that correct? How long would that coma last? I want the main character to be in a coma for about a day or two, however I'm uncertain as to whether this is even possible.

If not, I was also considering having him get into a bad car accident and suffering a head injury or perhaps get shot in the head, however I wanted him to come out of it relatively mentally unharmed, but from everything I've read it doesn't seem like this is possible after after sustaining a brain injury severe enough to put you in a coma for that long (especially a gunshot to the head). Is it entirely unbelievable? If so, I may have to add a supernatural element into the story to fix this (but this isn't the place for that ;) ).

Also, is it normal for coma patients to have seizures? I haven't found a lot regarding this. I read that when the coma is induced by the doctors the drug(s) they use prevents seizures and sometimes when they start weening the patient off they'll start seizing. I was going for a "natural" coma though and I can't find any information regarding that. Do "natural" coma patients receive the same anti-seizure drugs as the induced coma patients? If so, wouldn't that be counterproductive since the same medications can put them in a coma? While we're on the topic of medicine, what medicines would a coma patient normally be on? They would be on some kind of painkiller, right?

I've read that one of the initial tests doctors do is use a penlight to measure the response of the pupils and no response is very bad and you're basically on your way out. Is it possible to regain pupil response as you recover or is it a case where once it's gone it's never coming back?

Also wanted to have a moment where something goes wrong while he's still in the coma leading the doctors to adopt a grim(er) prognosis if whether he will survive or not. Basically I want his friends and family to think the worst, but I don't want him to actually die. Is there a medical emergency that could accomplish this?


I think I've asked enough for right now. ;)

Thanks in advance for any replies! They are much appreciated!

melindamusil
04-10-2015, 09:50 PM
First of all, can a gunshot wound to anywhere other than the head put someone in a coma? I would imagine the answer would be yes, if the person lost enough blood. Is that correct?

Sure. Could be blood loss. Could be that it caused him to fall and hit his head. Could be a stroke or infection caused by the initial gunshot wound. There's also the medically induced coma.



How long would that coma last? I want the main character to be in a coma for about a day or two, however I'm uncertain as to whether this is even possible.

Depends. How badly was he injured? For example - how long was his brain deprived of oxygen due to blood loss? Or, how severe was the stroke? Also what was his condition prior to the gunshot wound - are we looking at an Olympic-level athlete in ideal physical condition, or a 100 year old man who can barely move or think in the first place?



If not, I was also considering having him get into a bad car accident and suffering a head injury or perhaps get shot in the head, however I wanted him to come out of it relatively mentally unharmed, but from everything I've read it doesn't seem like this is possible after after sustaining a brain injury severe enough to put you in a coma for that long (especially a gunshot to the head). Is it entirely unbelievable? If so, I may have to add a supernatural element into the story to fix this (but this isn't the place for that ;) ).

Brain injuries are finicky and weird. He could be severely injured and in a vegetative state for the rest of his life, or he could fully recover. I was in a coma for 11 days following a car accident, but now I'm basically totally recovered. What does your story need?



Also, is it normal for coma patients to have seizures? I haven't found a lot regarding this. I read that when the coma is induced by the doctors the drug(s) they use prevents seizures and sometimes when they start weening the patient off they'll start seizing. I was going for a "natural" coma though and I can't find any information regarding that. Do "natural" coma patients receive the same anti-seizure drugs as the induced coma patients? If so, wouldn't that be counterproductive since the same medications can put them in a coma?

Depends on the patient, depends on the coma. To my knowledge I was never given anti-seizure medicines while I was in a coma. Today I am still *technically* at a higher risk for seizures, but I've never had one and I don't have to take any ongoing anti-seizure medicine.



While we're on the topic of medicine, what medicines would a coma patient normally be on? They would be on some kind of painkiller, right?

This goes back to the cause of the coma and what other injuries were sustained. For example, at one point I was on a very hard core antibiotic because I developed pneumonia secondary to being on a ventilator. Not sure about what other medicines I was on. PM me, and I will check my records later.

Remember also you're going to have all kinds of tubes going in and out. In addition to probably needing a ventilator, you'll have a feeding tube going in, IVs to help with saline/hydration, and a catheter in the bladder to remove urine, at the least.



I've read that one of the initial tests doctors do is use a penlight to measure the response of the pupils and no response is very bad and you're basically on your way out. Is it possible to regain pupil response as you recover or is it a case where once it's gone it's never coming back?

One of the medical peeps on this board will have to answer this question. But for a bit of reference, look up the Glasgow Coma Scale.
http://en.wikipedia.org/wiki/Glasgow_Coma_Scale



Also wanted to have a moment where something goes wrong while he's still in the coma leading the doctors to adopt a grim(er) prognosis if whether he will survive or not. Basically I want his friends and family to think the worst, but I don't want him to actually die. Is there a medical emergency that could accomplish this?

Not sure about a specific medical emergency, but going back to the glasgow coma scale - basically, every day they will test the patient's responsiveness based on eye, verbal, and motor responses. And, according to what I've been told, some days the patient can definitely get "worse".

My accident was nearly 15 years ago (egad!) and I know that medical science has improved a lot since then - BUT - there were certainly a handful of therapists who were very negative about my prognosis. They didn't say I would die, but they did say that I wouldn't get better... even as I was getting better. :) For example they said I would be in a vegetative state... then I woke up from my coma. They said I wouldn't be able to walk... then I did. And so on. This was NOT the doctors but other people my parents encountered in the hospital and rehab.

PM me if you have any other questions.

asroc
04-11-2015, 02:52 AM
Hey everyone!

I've had this idea in my head for the last few months and it absolutely refuses to leave! I've done all kinds of research however I still have some questions. I apologize if any of them are stupid.

First of all, can a gunshot wound to anywhere other than the head put someone in a coma? I would imagine the answer would be yes, if the person lost enough blood. Is that correct?

Yes, that's possible. After a too large amount of blood is lost, the brain can no longer be supplied with oxygen, resulting in unconsciousness and death shortly after. If the patient does not die the brain can still be damaged.


How long would that coma last? I want the main character to be in a coma for about a day or two, however I'm uncertain as to whether this is even possible.

It's not really possible to give a general answer to that.


If not, I was also considering having him get into a bad car accident and suffering a head injury or perhaps get shot in the head, however I wanted him to come out of it relatively mentally unharmed, but from everything I've read it doesn't seem like this is possible after after sustaining a brain injury severe enough to put you in a coma for that long (especially a gunshot to the head). Is it entirely unbelievable? If so, I may have to add a supernatural element into the story to fix this (but this isn't the place for that ;) ).



Also, is it normal for coma patients to have seizures? I haven't found a lot regarding this. I read that when the coma is induced by the doctors the drug(s) they use prevents seizures and sometimes when they start weening the patient off they'll start seizing. I was going for a "natural" coma though and I can't find any information regarding that. Do "natural" coma patients receive the same anti-seizure drugs as the induced coma patients? If so, wouldn't that be counterproductive since the same medications can put them in a coma?

The dose makes the poison. The drugs we use to relieve seizures, like lorazepam, are also powerful sedatives, but the dose is different.


While we're on the topic of medicine, what medicines would a coma patient normally be on? They would be on some kind of painkiller, right?

Usually not. Coma patients have no pain response.


I've read that one of the initial tests doctors do is use a penlight to measure the response of the pupils and no response is very bad and you're basically on your way out. Is it possible to regain pupil response as you recover or is it a case where once it's gone it's never coming back?

Not necessarily never, but it does indicate a very serious brain injury, generally involving the brain stem. The outcome is usually very poor.


Also wanted to have a moment where something goes wrong while he's still in the coma leading the doctors to adopt a grim(er) prognosis if whether he will survive or not. Basically I want his friends and family to think the worst, but I don't want him to actually die. Is there a medical emergency that could accomplish this?

Again, it is very hard to predict that. Traumatic brain injuries tend to have a better prognosis than hypoxic brain injuries, but brain injuries are difficult in general.

MDSchafer
04-11-2015, 08:24 PM
First of all, can a gunshot wound to anywhere other than the head put someone in a coma? I would imagine the answer would be yes, if the person lost enough blood. Is that correct? How long would that coma last? I want the main character to be in a coma for about a day or two, however I'm uncertain as to whether this is even possible.

Well, in the world of fiction it's possible, and happens regularly. In real world waking up from a coma is not like waking up from a deep sleep. There's a significant recovery time with even a short coma.


Also, is it normal for coma patients to have seizures? I haven't found a lot regarding this. I read that when the coma is induced by the doctors the drug(s) they use prevents seizures and sometimes when they start weening the patient off they'll start seizing. I was going for a "natural" coma though and I can't find any information regarding that. Do "natural" coma patients receive the same anti-seizure drugs as the induced coma patients? If so, wouldn't that be counterproductive since the same medications can put them in a coma? While we're on the topic of medicine, what medicines would a coma patient normally be on? They would be on some kind of painkiller, right?

No, it is not normal for a coma patient to seize. If a coma patient is seizing it's rather likely that someone will call a code.

As far as meds go. With medically induced comas they use a barbiturate. What other meds given will probably depend on the circumstance of the specific injury. Whether or not they have a pain killer is typically a MD call. A lot of MDs don't use pain killers with low GCS patients because pain is a diagnostic tool, and it can mask the reaction we're looking for. So it depends on the patient and the MD's conceptualization of treatment.

Also, not all antiseizure drugs have sedative effects.


I've read that one of the initial tests doctors do is use a penlight to measure the response of the pupils and no response is very bad and you're basically on your way out. Is it possible to regain pupil response as you recover or is it a case where once it's gone it's never coming back?

I've had patients whose pupils were nonreactive made full recoveries. Also, you can lose response in one eye, but not the other. It's not a good sign, but there are more definitive


Also wanted to have a moment where something goes wrong while he's still in the coma leading the doctors to adopt a grim(er) prognosis if whether he will survive or not. Basically I want his friends and family to think the worst, but I don't want him to actually die. Is there a medical emergency that could accomplish this?

Neurologically this doesn't happen in comas. There is a whole host of things that could go wrong, but neurologically there aren't any quickly corrected, yet scary things.

WeaselFire
04-11-2015, 08:27 PM
Okay, forget about researching a gunshot wound coma. The effects and causes of a coma don't depend on a gunshot, or the type of implement causing the wound to any real extent. Just treat this as any other coma.

By the way, the beauty of comas is that they can defy all known medical knowledge and most surgeons and coma specialists have come to expect that whatever they predict just may not happen. The mind is a funny organ.

Jeff

melindamusil
04-14-2015, 10:39 PM
By the way, the beauty of comas is that they can defy all known medical knowledge and most surgeons and coma specialists have come to expect that whatever they predict just may not happen. The mind is a funny organ.


Seconded. Comas suck for people going through them, but they're fantastic for writers because there are so many (plausible) outcomes.

Coconuts
06-22-2015, 10:06 AM
Thanks for your replies, everyone! They've definitely been helpful! I'm sorry I haven't been around for awhile, my laptop decided it would stop working so I had to get it repaired several times. However I'm back now!

I was writing a bit ago and realized something, I don't know exactly what happens in the ER after the accident. Would the doctors focus more on the head injury / coma or any wounds first? Say the patient had a wound that required surgery and was bleeding extensively (internal or external), would doctors want to send them to surgery for that first or would they try to figure out the extent of the head injury first? Using my own common sense, I would assume they'd want to fix the wound first however I'm not at all sure that would be correct.

I apologize if this is completely stupid, I once again attempted to Google for information on this and didn't find anything.

Edit: Also just thought of another question. I've read that patients are sedated when they're put on a ventilator so they can tolerate it. Would someone in a coma be sedated? I mean, it makes sense that they would be because I've read that coma patients can move and pull tubes out sometimes while still in a coma.

WeaselFire
06-22-2015, 07:45 PM
I apologize if this is completely stupid, I once again attempted to Google for information on this and didn't find anything.

Edit: Also just thought of another question. I've read that patients are sedated when they're put on a ventilator so they can tolerate it. Would someone in a coma be sedated? I mean, it makes sense that they would be because I've read that coma patients can move and pull tubes out sometimes while still in a coma.

First, Googler "Emergency Room Triage Procedure" and you'll find a lot of background for your story. Injuries are basically treated in an order based on the likelihood of resulting death or permanent trauma. Just bleeding, in itself, doesn't take priority but uncontrolled blood loss leading to shock does. First process is to stabilize, someone who dies from blood loss isn't a good candidate for coma diagnosis. :)

The second part is that patients are not put on a ventilator on a whim, it's because they are/will be unable to breath on their own. Full sedation has nothing to do with tolerating the intubation tubes and everything to do with the fact that normal breathing is the issue under sedation. Google "Intubation Procedure" for decent background there.

By the way, under full sedation and in leather restraints, I managed get out of the restraints and extubate myself in the ICU. Don't ask me how, I wasn't there. But my mind tends to work outside of normal time and space. Also pisses off the anesthesia techs. :)


Jeff