5PowerPointPresentation.pdf
The Unconscious StatesAwareness of self and the environment: internal / external (difficulties)
(lack of response to painful stimulus)
clinical definitions of:
• coma (Glasgow Coma Scale) (induced coma)
• persistent vegetative state (PVS)
• traumatic head injury
• brain hypoxia
• epileptic seizure
• syncope
• other unconscious states (ex. Locked-in syndrome)
CONSCIOUSNESS:
Awareness of self and the environment: internal / external
(difficulties; how to measure?)
UNCONSCIOUSNESS:
Lack of response to painful stimulus
Coma (Glasgow Coma Scale) (induced coma)
persistent (permanent) vegetative state (PVS)VS MCS
MAGNETIC RESONANCE IMAGING (MRI)
Traumatic Brain Injury (TBI)
• complex injury
• broad spectrum of symptoms
• and disabilities
Mayo Clinic: TraumaticBrainInjury.com
TBImild
severe~ 30 min.
Brain Hypoxia (anoxia)
3 PAIRS OF ARTERIES TO THE HEAD:
• 1 PAIR VERTEBRAL
• 2 PAIRS CAROTID
Epileptic Seizure (epileptic fit)
Neuronal activity:
• Abnormal• Excessive• Generalized• Synchronous
Electro-EncephaloGram (EEG)
Syncope (fainting):
• Temporary loss of consciousness
• Sudden drop in blood pressure
Other unconscious states:
• Non-epileptic seizure
• Locked-in syndrome
• Etc.
LOCKED-IN SYNDROME:
• Aware
• cannot move or communicate verbally
• complete paralysis of nearly all voluntary muscles
• Except for vertical eye movements and blinking
Damage to specific portions of the lower brain
and brainstem, with no damage to the upper
brain (cerebral cortex).
MAGNETIC RESONANCE IMAGING (MRI)
POSITRON EMISSION TOMOGRAPHY (PET)
COMPUTED TOMOGRAPHY (CT)
VEGETATIVESTATE
MINIMALLYCONSCIOUSSTATE
LOCKED-INSYNDROME
(MRI)
DIAGNOSIS -> PROGNOSIS
MANAGEMENT, RELIEF: PAIN / SUFFERING
BIOETHICAL ANALYSIS: BENEFIT / BURDEN
BIOETHICAL MEANS OF LIFE SUPPORT:
• ORDINARY (PROPORTIONATE) / EXTRAORDINARY (DISPROPORTIONATE)
CLINICAL MEANS OF LIFE SUPPORT:
• STANDARD MEDICAL PRACTICE / EXPERIMENTAL TREATMENT
ETHICAL OBLIGATION RE. VITAL ORGANS: ASSIST / SUBSTITUTE
WHEN TO WITHHOLD OR WITHDRAW LIFE SAVING TREATMENT?
ERD
32. While every person is obliged to use ordinary means to preserve his or her health, noperson should be obliged to submit to a health care procedure that the person has judged,with a free and informed conscience, not to provide a reasonable hope of benefit withoutimposing excessive risks and burdens on the patient or excessive expense to family orcommunity.
33. The well-being of the whole person must be taken into account in deciding about anytherapeutic intervention or use of technology. Therapeutic procedures that are likely tocause harm or undesirable side-effects can be justified only by a proportionate benefit tothe patient
56. A person has a moral obligation to use ordinary or proportionate means of preserving his or her life. Proportionate means are those that in the judgment of the patient offer areasonable hope of benefit and do not entail an excessive burden or impose excessiveexpense on the family or the community.
57. A person may forgo extraordinary or disproportionate means of preserving life.Disproportionate means are those that in the patient’s judgment do not offer a reasonablehope of benefit or entail an excessive burden, or impose excessive expense on the familyor the community.
