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Eelco F.M. Wijdicks, Oxford University Press, Oxford, 2008, 608 pages, $125.00, ISBN: 978-0-19-532626-0/0-1953262-6-1


An important and valuable book for neuroscience nurses, The Comatose Patient offers a new and very practical clinical view for those involved in the management of patients in a comatose state. Eelco F.M. Wijdicks, the author and well-known professor of neurology, chairs the Division of Critical Care Neurology at the Mayo Clinic College of Medicine in Rochester, MN. He practices as a critical care neurologist and, on a daily basis, works in a collaborative relationship with neuroscience nurses. Readers will immediately associate the author with the new FOUR (Full Outline of Unresponsiveness) Score coma scale and comprehensive neurological assessment tool that are reviewed in the book; each copy of the book has a separate pullout pocket copy. Nurses are beginning to integrate the new coma scale into their critical-care, bedside patient assessments. The FOUR Score assessment includes four testable components: eye response, motor response, brainstem reflexes, and respiration at the bedside. A fully narrated DVD is included with the new multimedia book, along with easy-to-follow instructions explaining the FOUR Score assessment.


Among the highlights of the text is the complete coverage of all aspects of care of comatose patients. Included are 75 individualized examples of the comatose patient in a new comprehensive format, detailed explanations of the mechanisms of coma, special attention to leading the family conference, and a discussion of legal and social issues facing the patient and family. These issues are rarely discussed in a medical textbook but are often a major consideration nurses encounter when caring for comatose patients and their families.


"Part I: Understanding, Diagnosing, and Care of the Comatose Patients" reviews these concepts in the first nine chapters. Important concepts, such as brain herniation, increased intracranial pressure, localization of key clinical signs, mechanisms of metabolic encephalopathies, unresponsiveness, and the prolonged comatose state are described in great detail. Explanations of the awake state are provided in contrast to the comatose patient, and components of the neurologic examination for the patient in a prolonged, locked-in, persistent vegetative or minimally conscious state are included.


Of special interest are chapters on brain death, neuroimaging, neuropathology, clinical decisions, complete medical management, and supportive care. Nurses will discover a rare chapter on law and bioethics that discusses familiar landmark court cases, beginning with the Quinlan case and concluding with the more recent Schiavo case. The final chapter in part I covers media and popular-culture portrayal of the perception of coma. Concerns are expressed that the public may not get correct medical information about the causes, consequences, and outcomes of coma with the existing coverage.


"Part II: The Clinical Approach to the Comatose Patient" covers the entire spectrum of causes leading to coma and will serve as an excellent reference for neuroscience nurses. This section includes 75 vignettes that are introduced in a dialogue format using the familiar daily patient rounds, featuring common and uncommon cases with a standard template. The reader almost feels included in the multidisciplinary rounds as the detailed management of each case is reviewed.


Finally, the reader will receive a unique DVD with five narrated chapters that take the reader to the hospital's neuroscience intensive care unit (NICU). Nurses can view in-depth clinical observations of key components of the neurologic examinations from the taped examples of patients in different states of impaired consciousness. Of particular interest is the presentation on clinical determination of brain death using animation with detailed instructions.


This impressive new book includes many color illustrations, is well researched, and shares historical overviews as well as the author's personal experiences caring for the comatose patient. The tutorial format is an excellent learning method that will serve as a necessary and valuable resource and become a classic addition to the literature for the diagnosis and comprehensive management of the comatose patient-one of the most challenging patients that nurses care for in the NICU.


Reviewed by Ellen Barker, MSN APN CNRN, president, Neuroscience Nursing Consultants, Greenville, DE.