QI have a character who suffers blunt force trauma to the head. Would the doctors put him into an induced coma, and if so, why? What is the benefit of an induced coma? If not, under what circumstances would doctors use this treatment method? Essentially, I’m using an induced coma to keep a character on ice for a few chapters.
Simon Wood
Author of Paying the Piper
Bay Area, California
AIn a head injury with loss of consciousness, any form of sedative or narcotic is usually avoided. The reason is that the victim’s neurological and mental status must be continually assessed, so any complications from the injury can be recognized before permanent damage is done. Sedatives of any type will depress brain function and interfere with these evaluations.
However, there are circumstances when a medically induced coma is desirable. These are when the patient cannot be controlled, and this lack of control is causing a worsening of his situation. One example would be uncontrollable seizures, which we call status epilepticus. It’s a series of powerful and recurrent seizures that can last for minutes or hours. They can occur after head injuries and with other conditions and when present can interfere with the person’s ability to breathe, which can be deadly. Seizure medications such as phenobarbital and phenytoin might be given intravenously to control the seizures, but sometimes it takes hours to work or doesn’t work at all. If so, it is best to completely paralyze the patient and put him on a ventilator until the anticonvulsant medications take effect.
Also, some brain injuries are associated with depression of the breathing drive, and the victim must be placed on a ventilator to prevent death from asphyxia. Sometimes these victims are disoriented and constantly fight against any form of treatment. This combative behavior can manifest as attempts to remove IVs and ventilator tubes and everything else they can get ahold of. Restraints will help, but the person might fight the ventilator, and this can interfere with breathing. The doctor would use morphine and perhaps a neuromuscular paralytic agent such as curare or succinylcholine to completely paralyze the patient, so respiratory control can be maintained.
Either of these situations can result from blunt head trauma. The injury would not be a simple concussion but could be a slightly less simple cerebral contusion. This is basically a brain bruise. More sinister things could also cause it such as bleeding into and around the brain. It’s much more sophisticated and would require surgery and a long recovery period. From your question, I get the sense that this is not what you want. I would go with a cerebral contusion and either seizures or combative behavior or both.