ular Accident
2023 ACDIS POCKET GUIDE EXCERPT
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Coma/Persistent Vegetative State
u Coma/Persistent Vegetative State Codes R40.21- through R40.24- distinguish coma as scored on the Glasgow Coma Scale (GCS) to capture severity.
Definitions Coma describes a deep state of unconsciousness in which patients are unable to move or respond to their environment. Coma may occur as a complication of an underlying illness or as a result of injuries, such as head trauma. Individuals in a coma lose their thinking abilities and awareness of their surroundings but retain non-cognitive function and normal sleep patterns. The level of coma measured with the GCS is predictive of outcome. The longer patients remain in a coma, the poorer their chance of recovery and the greater the chance that they will enter a vegetative state. It is rare for a coma to last longer than 2–4 weeks. The outcome for coma depends on the cause, severity, and site of the damage. People may emerge from coma with physical, intellectual, and psychological deficits. For those who remain in a coma for an extended period of time, the most common cause of death is infection, such as pneumonia. Persistent vegetative state is a condition of complete unawareness of the self and the environment, accompanied by sleep-wake cycles, with either complete or partial preservation of hypothalamic and brain stem autonomic functions. These patients show no evidence of sustained, reproducible, purposeful, or voluntary behavioral responses to visual, auditory, tactile, or noxious stimuli; show no evidence of language comprehension or expression; have bowel and bladder incontinence; and have variably preserved cranial-nerve and spinal reflexes.
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