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Vegetative state (Management (If vegetative state permanent, ethically and…
Vegetative state
Management
Cause of injury and time elapsed important for prognosis (persistent if > 1month, permanent if > 6 months for non traumatic and >1 year for TBI
Proxy consent / decision maker (advanced directives must be respected, effort to establish pt.s views and preferences)
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If vegetative state permanent, ethically and legally difficult
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Deliberations about withdrawing or witholding life support (nutrition, hydration)
Support for carers: GP, respite, nursing homes
Diagnosis
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Structured, repeated examinations at different times of day
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Lack of;
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Sustained, reproducible purposeful or voluntary response
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Diagnosis
May develop suddenly (TBI or non traumatic - anoxia, infection, haemorrhage)
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Ddx: coma, minimum consciousness / severely disabled, locked in syndrome, brain death
Coma: unrousable state of unresponsiveness (absence of eye mvmt, no evidence awareness, duration > 1 hour)
Veg state: wakefulness accompanied by the absence of any sign of awareness (eye opening and closing, absence of purposeful behaviour)
Minimal conscious state: wakefulness accompanied by inconsistent but reproducible signs of awareness (eye opening and closing, signs of awareness)
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Clinical condition of unawareness of self and environment in which the patient breathes spontaneously, has a stable circulation and shows cycles of eye closure and opening which may simulate sleep and waking