Stroke and Coma

• Coma survival factors
  • Abnormal brain stem response
  • Absent verbal response
  • Absent withdrawl response to pain
  • Age > 70
  • Serum creatinine greater than 1.5 mg/dl
• Stroke  
• Non-traumatic hemorrhagic stroke
• Thrombotic/embolic stroke
• Other factors to consider
• Current history of pulmonary aspiration without effective response to speech language pathology intervention
• Dysphagia severe enough to prevent patine from contuining fluids/foods necessary to sustain life and patient does not receive artificial nutrition and hydration
• Sequential calorie counts documenting inadequate caloric/fluid intake
• Serum albumin equal or less than 2.5 gm/dl
• Weight loss
• Medical complications
  • Aspiration pneumonia
  • Fever recurrent after antibiotics
  • Phelonephritis
  • Refractory stage III/IV decubitus ulcers