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Is it advisable to do an EEG for a 90 year old patient who is in coma for 2 weeks ?

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Practicing since : 2002
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What reason may a physician have to refuse to order an EEG for a 90 year old patient who has been in a coma for 2 weeks due to lack of oxygen to the brain for an estimated 20 minutes after choking? She has a history of CHF and is a full code patient per her living will.
Posted Sun, 6 May 2012 in X-ray, Lab tests and Scans
Answered by Dr. Robert Galamaga 40 minutes later
Hello and thanks for your query.

It sounds like you're dealing with a very complex situation with challenges on both a medical as well as ethical level. You presented to me the case of an elderly patient with a past medical history significant for a significant degree of heart failure. In addition you're not dealing with a complex situation due to the recent injury to the brain. 20 min. of lack of adequate blood flow to the brain can cause a severe degree of damage. This is quite often very life-threatening. At this point the physicians involved in the case should probably sit down with you and give you their clinical judgment as to what is going on with her at this time.

I think it is necessary to have a detailed conversation with her physicians regarding a few things. First what is the likelihood that she will somehow come out of this coma. Next in the event that she does come out of the coma what is the likelihood that she will have any level of functional existence. Next are there any other considerations such as respiratory status and prevention of infection that will be a complication should street again somehow come out of the coma. I fear it may be unlikely that she will actually come out of the coma at this time. It is important that a medical power of attorney is appointed and participate in these discussions. I realize that her wishes were to be a full code but at this point we have to consider what the real benefit to her would be if that level of medical care is continued.

Regarding the electroencephalogram test which you mentioned in your question I really do not see a clinical benefit in ordering this test. The only way that this would make any meaningful difference is if she had some degree of neurologic function and they wanted to assess how strong that function was. Until then if she continues to exist any comatose state the electroencephalogram will not be helpful.

Again I realize that you're dealing with an extremely stressful and difficult situation and there really are no easy answers at this time. I hope some of the information I have provided is helpful and informative for you. If you have additional questions related to these concerns I would be happy to address them.


Dr. Robert.
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