A coma is nothing like the movies

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iol lif feb 10 coma . Coma, a US television mini-series based on the 1977 novel Coma by Robin Cook and the subsequent 1978 film Coma.

Countless times in TV shows or movies characters urge a wounded figure to stay with them, not to lose consciousness. Is there any medical basis for this? Doesn’t the body need to lose consciousness to cope with the emergency? Might these dramatic and good-hearted souls actually hasten the wounded character’s death?

No, no, and no. If someone is about to fall into a coma, there is nothing you can say to change his mind.

It may seem like unconsciousness would be a first step towards death, but that’s not true. As a general rule, whatever underlying problem causes a loss of consciousness – whether it’s a stroke, a drug overdose, blood loss, or something else – it will continue to unfold, irrespective of a patient’s state of awareness. Keep the patient awake or let him or her sleep, it doesn’t matter much.

An unresponsive patient may face some special risks, however. The muscles of the airway can relax in such a way as to hinder breathing, or a patient may be suffocated by his floppy tongue, or by his neck being tilted at a funny angle. Emergency room doctors and technicians are trained to keep the airway clear. They may do this by inserting a tube into the trachea. They don’t do this by slapping a victim across the face, or begging him to stay alert.

It’s often said that those who suffer head injuries should be kept awake by whatever means necessary, on the theory that dozing off could send them into a coma. Most doctors say that’s not the case.

But it may be a good idea to rouse a patient from time to time and make sure he or she is okay. When people are asleep they have no clear way to register distress, so waking them periodically may be a useful way for those around them to know if things are getting worse.

Even if it were a good idea to keep a patient from losing consciousness, it’s not clear how that could be accomplished. Spoken pleas won’t have a significant effect, nor will you gain much ground by telling your loved one to “Fight, dammit, fight!”

Other, more aggressive forms of stimulation may work better. When a doctor slides a tube into a wounded patient’s trachea, the eyes may snap open for second, and the breathing may be restored. But as far as doctors know, the jolt wouldn’t last.

The only time shouting may be useful is when doctors suspect a patient may be faking, or is in a psychogenic coma. If the patient responds to a loud noise, he or she is not unconscious.

“Stay with me” does make for dramatic scenes in movies, though, science notwithstanding.

In 2006, a pair of researchers in neurology at the Mayo Clinic reviewed dozens of Hollywood films, dating back to 1970, to see how comas were portrayed.

They found numerous inaccuracies, including what they called the “Sleeping Beauty phenomenon”: patients appeared to be sleeping peacefully, with their eyes closed, and in good health.

In real life, comatose patients often have a feeding tube or tracheotomy, as well as permanent muscular contractions that can make the body look deformed.

Of the movies they considered, just seven percent gave a “reasonably accurate presentation of prolonged coma”. – Slate / The Washington Post News Service

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