General Care of the Comatose Patient

1. Airway protection: adequate oxygenation, ventilation and
prevention of aspiration are the most important goals; most
patients will require endotracheal intubation and frequent
orotracheal suctioning.
2. Intravenous hydration: stuporous patients should receive
nothing by mouth; use only isotonic fluids in these patients to
avoid increasing the size of the cerebral edema or increased
intracranial pressure (ICP).
3. Nutrition: enteral feeds via a small bore nasogastric tube.
4. Skin: the patient must be turned every 1-2 hours to prevent
pressure sores; an inflatable or foam mattress and protective
heel pads may also be beneficial.
5. Eyes: prevent corneal abrasion by taping the eyelids shut or
by applying a lubricant.
6. Bowel care: constipation and gastric stress ulcers should be
avoided.
7. Bladder care: indwelling urinary catheters are a common
source of infection and should be used judiciously; intermittent
catheterization every 6 hours when possible.
8. Joint mobility: passive range of motion daily exercises to
prevent contractures.
9. Deep venous thrombosis prophylaxis: subcutaneous
anticoagulants and external pneumatic compression stockings or
both (Upchurch 1995).
To complete this important critical situation, we will discuss
two other categories, the permanent vegetative state and lockedin
syndrome.