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Day 3
Published in Bertha Alvarez Manninen, Dialogues on the Ethics of Abortion, 2022
Well, I want to push back a bit here. Wouldn’t we consider it wrong to kill someone who is suicidal and therefore does not desire continued existence? If someone is in a temporary coma, say a medically induced coma, and cannot desire their continued life at that moment, that does not mean it would be permissible to kill them while they’re in that coma. What makes killing someone like Maynard permissible, under this theory, is not that she no longer desires life, but that her future is fraught of pain and suffering before her inevitable death.24
Reflections on a life-changing accident
Published in Alyson Norman, Life and Suicide Following Brain Injury, 2020
It was Tom’s side of the car that had crashed into the lamp post, causing a large indentation in the driver’s door that made it impossible to get out of that side of the car, not that Tom was physically capable of doing so. The force of the impact had caused Tom’s brain to reverberate in his skull. It impacted at force against the left-hand side of his skull, causing a blood clot to form. Tom was drifting in and out of consciousness and was clearly very seriously injured. The fire brigade, police and ambulance services arrived but were unable to do anything until the local electricity board had managed to make the lamp post safe. The fire brigade then cut open the roof of the car in order to get Tom out. He was then taken by ambulance to the nearby hospital. Tom had sustained severe swelling to his brain and they operated later that night to reduce the pressure. He was admitted to intensive care and placed in an induced coma.
Management of poisoning
Published in Bev-Lorraine True, Robert H. Dreisbach, Dreisbach’s HANDBOOK of POISONING, 2001
Bev-Lorraine True, Robert H. Dreisbach
Coma due to poisoning results from interference with brain cell function or metabolism. Administering stimulants to treat poison-induced coma is not effective; it is contraindicated. The exact mechanism of action of central nervous system stimulants is unknown, but these drugs presumably act by depressing some inhibiting function in the cell. There is no evidence that any stimulant specifically opposes the cellular effects induced by depressant drugs (barbiturates) or poisons.
Addressing Therapeutic Nihilism in Alcohol-Related Liver Disease: A Hepatology Perspective to Terminal Illness and Palliative Care
Published in Alcoholism Treatment Quarterly, 2023
To minimize that price, we must strive to recognize when optimism transforms to a willful denial of reality. This occurs when the patient in the intensive care unit fails to improve after several days or weeks of complex supportive therapy. They do not die because they are being kept alive artificially, but that failure to improve means that with every passing day the chance of survival shrinks. Clinical calculators tell us that even at the outset, that chance was perhaps in the region of 5%, and when it falls to one or two percent, we must ask ourselves, is this right? We would have been honest with their families, telling them that the chance of survival is remote but and unless the patient had previously expressed a wish not to be treated, or unless there were factors such as coexisting cancer or other diseases of the heart or kidneys that brought that calculation close to zero, we will have “thrown the dice” for them. But now, now that they have failed to improve, we must begin to talk about withdrawing care. Gently, sensitively, but with honesty and clarity. This is our opinion; this is what we think is right for them. Waiting another week or two weeks might look harmless enough, for the patient is in an induced coma, but we do not know what it’s like to be interfered with night and day on the intensive care unit. If it is futile, then it cannot be justified. We do not talk about resources or money, but it is probably in the back of our minds. That bed is required by somebody else, undoubtedly. The decision is based on what we think is best for the patient, alongside the family.
Prediction and analysis of weighted genes in isoflurane induced general anesthesia based on network analysis
Published in International Journal of Neuroscience, 2020
Yue Chen, Zhen-Feng Zhou, Yu Wang
General anesthesia is a medically induced coma with loss of protective reflexes, which is carried out to allow medical procedures that would otherwise be intolerably painful for the patient. Isoflurane is a commonly used inhalation anesthetic for general anesthesia, which can be used to start or maintain anesthesia [1]. Although isoflurane has been gradually replaced by sevoflurane and desflurane in developed countries, it is still wildly used in the developing countries and animal anaesthesia due to its low price [2]. It has been known that the side effects of isoflurane include respiratory depression, irregular heartbeat, low blood pressure, malignant hyperthermia and high blood potassium [3]. Moreover, animal studies have raised a current significant health concern of anesthetic-induced neurotoxicity (including with isoflurane, and especially with children and infants certain general anesthetics) [4].
Prolonged coma resulting from massive levothyroxine overdose and the utility of N-terminal prohormone brain natriuretic peptide (NT-proBNP)
Published in Clinical Toxicology, 2019
Ophelia Wong, Anselm Wong, Shaun Greene, Andis Graudins
Given previous reports of its utility as a brain injury biomarker, serum NT-ProBNP was retrospectively measured to evaluate its relationship to this patient’s conscious state. Serum NT-ProBNP concentration was increased during coma and peaked while the patient had a GCS of 3. Concentration fell prior to the patient’s GCS improving. T4 concentration fell prior to improvement in the conscious state. However, the change in NT-ProBNP concentration more accurately correlated with the improvement in the conscious state in terms of the time course (Figure 1 (ii) and (iii)). As a result, an increase in NT-ProBNP concentration may correlate with acute brain injury and normalising concentration may indicate recovery [9–11]. Consequently, the serial NT-ProBNP assay could have utility in reducing the frequency of neuroimaging during episodes of prolonged drug-induced coma and may assist in preventing premature extubation when concentrations are still high. Further studies could examine its utility in the drug-induced coma prognosis.