Home treatment and care of comatose patients

  For vegetative patients, professional wake-promoting treatment in hospital is definitely the best choice, but in the current national situation, due to the long treatment period of vegetative patients, tight hospital beds and high treatment costs, many patients cannot be hospitalized for a long period of time, for these patients, my current approach is to let the patients under the guidance of professional doctors for in-home rehabilitation, in fact, nearly 70% of my patients are eventually adopted In fact, nearly 70% of my patients end up using this approach, leaving my assistant’s and my phone number for the patient upon discharge. The patient’s relatives can communicate with the doctor on the phone regularly about the patient’s condition, while I provide some advice and sometimes provide the patient with some home follow-up visits and help with changing tracheal tubes and gastric tubes. In recent years, we have accumulated a lot of experience under this model and achieved good social benefits and reputation.  Based on these years of experience, I would like to make the following suggestions for the home care and rehabilitation of vegetative patients in the hope that they will be helpful: 1. Electrophysiological tests such as EEG should be performed before discharge to predict the probability and possibility of awakening; the presence of electrophysiological indicators such as brain waves is a basic condition for awakening patients in long-term coma.  2, careful and scientific daily care to prevent various complications ——– This is a prerequisite for the awakening of patients in long-term coma. Turn and pat the patient’s back more often, the purpose is to prevent bed sores and lung infections, strengthen nutritional support, a variety of balanced nutrition, calories should be at 25 calories per kilogram per day, the consequences of malnutrition is the patient repeatedly infected and difficult to promote awakening, in addition, if there is a tracheal cannula, but also pay attention to airway management, air humidity and timely aspiration and other details. It is necessary to prepare aspirators and air beds at home; the room is regularly ventilated and disinfected with vinegar fumigation; 3. What drugs are normally taken to promote awakening? Mainly including four major categories, dopamine such as levodopa, bromocriptine, amantadine; psychostimulants such as pemoline, methylphenidate; antidepressants such as protriptyline and fluoxetine; naloxone. Currently we apply circulatory improvement and cholinergic drugs, which have some effect. But in fact, the role of such drugs is limited, there are also some complications, it is recommended to choose carefully, depending on the person, not arbitrarily take; 4, a variety of external stimulation: give the patient to listen to his usual interest in music and other sounds, parents, relatives and friends call, touch; odor stimulation; acupuncture stimulation and so on.  5.If there is skull defect and bone window, you should pay attention to observe whether it is depression or expansion to facilitate timely detection of sequelae – hydrocephalus.  6.Regular brain CT examination, for example, about six months.  7.If there is epilepsy, drugs such as Debagene and Oxcarbazepine should be administered intranasally, and the medication should be administered regularly, and should not be stopped or reduced at will, but blood should be drawn regularly to understand the liver and kidney function.