The Care of the Unconscious Patient

James E. Eckenhoff, MD
JAMA. 1963;186(6):541-543. doi:10.1001/jama.1963.03710060027006.
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The patient who is unconscious from cerebral catastrophe must depend upon others to detect or anticipate his needs and to institute the appropriate measures to assure his recovery if the pathological insult can be overcome. Adequate pulmonary ventilation must be provided by verification of the minute volume of respiration, by respiratory assistance if required, by tracheostomy if indicated, and by periodic analysis of arterial blood for pO2, pCO2, and pH. The latter method is the most reliable index since an increased physiological dead space may vitiate a seemingly sufficient respiratory exchange. Arterial blood gas analysis will also reveal hypercarbia which can exist without concomitant cyanosis, and enhance coma. Tracheostomy will reduce respiratory dead space and facilitate removal of respiratory tract secretions; however the respiratory tract usually becomes infected due to poor aseptic technique. Hypothermia to 86 to 88 F (30.0 to 31.1 C) may increase survival from strokes.


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