One of the fatalities on the Humboldt bus crash was in a medically induced coma for four days before she died of head trauma.
Why do the doctors induce a coma in some cases? And how is it done?
I don’t know the specifics of the Humboldt patient.
Paramedics and emergency doctors know the importance of the ABCs — to survive, you need an open airway, breathing to get oxygen into the lung, and circulating blood to carry the oxygen to tissues and organs. You need the same things to get rid of carbon dioxide.
Patients with severe head injury may be comatose. Practically, this measured on the Glasgow Coma scale which looks at best eye, vocal and motor responses. Or they may be at risk of deteriorating. A score of 8 or less, or risk of worsening, often means they can’t keep their own airway open. These patients generally need to be intubated and hooked up to a ventilator so they can safely breathe. This is more invasive than, say, a mask providing free flow oxygen, and people will fight having a tube shoved down their windpipe.
After a severe head injury, the patient may not be breathing or may be thought to be at risk of getting worse. They may also have a neck injury, require sedation for an operation or procedure, or have dangerous conditions like neurogenic pulmonary edema where the lungs fill with fluid. All of these would mandate intubation.
Keeping someone intubated involves making them comatose. This is done using medications that relax people and make them sleepy in addition to medicines which paralyze them temporarily so that they do not waste precious energy fighting the tube down their throat which allows them to breathe. Medicines for pain are also generally administered. These patients must be watched closely since medication dosage and frequency vary considerably from patient to patient.
This skips over a lot of specifics. If there are broken bones, these may need to be set in the ER or OR. If the lungs or heart are bruised or damaged, intubation becomes more urgent. Some patients whose heart stops beating and gets restarted benefit from body cooling, which may require inducing a coma. In a patient in pain who cannot swallow medicine, it may be a kind thing to do. If the patient is thought likely to die, inducing a coma helps control pain and may be thought to offer a young patient a better chance of survival (God heals but the doctor takes the credit, etc.)
Specific questions regarding which medicines are most appropriate for a given condition have been glossed over here but I could elaborate if you want.
Head injuries also can cause increased intracranial pressure. There may be intracranial bleeding or bruising. Depending on the location and severity of these lesions, inducing a coma may help reduce pressure or bleeding inside the head. A neurosurgical opinion may be needed.
Thank you. That’s helpful.
I was in such a coma for several weeks this past October. This was due to a perforated bowel leading to peritonitis and multiple organ failure.
https://boards.straightdope.com/sdmb/showthread.php?t=843266
They are usually induced with propofol and maintained with it for up to 72 hours, and midazolam after that if it’s still necessary. Other sedative and/or paralytic agents may be used if warranted.
As a regular watcher of fly-on-the-wall medical programmes, I have seen how a doctor can induce coma in a patient at the scene prior to transport (often by helicopter). In these circumstances, it is done firstly to allow intubation, but also if the patient/victim is thrashing around. Once the patient is delivered to A&E, it is up to them to decide when to bring them back.