• Derick T Wade.
• Practitioner. 2014 Mar 1;258(1769):25-30, 3.

AbstractAfter acute severe brain damage, many people are rendered unconscious or comatose for more than 24 hours. Although a significant number can still recover fully, some will not and a substantial minority remain unconscious for days, weeks or longer. These patients have a prolonged disorder of consciousness. A specialist multidisciplinary team should be closely involved in the management of every patient from the outset. Assessment of a patient's level of awareness is not straightforward, and requires a team with suitable experience and expertise. The underlying neurological damage, whether or not there is an intact primary sensory input and motor output, and if there are reversible causes such as a high level of a sedating drug, or a subdural haematoma have to be established. If recovery of awareness has not occurred by six months after hypoxic or hypoglycaemic brain damage and 12 months after most other causes of brain damage, then the patient is very unlikely to recover any awareness and is described as being in a permanent vegetative state. The family must be closely and fully involved from the outset. Families legally cannot, and should not be asked to, make decisions concerning healthcare, unless a family member is a legally appointed deputy or has been given power of attorney in relation to healthcare matters. Family members can, and should be asked to, give information about the patient's wishes, life choices etc as part of the best interests decision-making process, and they should be involved in best interests meetings.

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