Overview
A coma is a deep state of unconsciousness, during which an individual is not able to react to his or her environment. Someone in a coma cannot consciously respond to stimulation. Coma can be caused by an underlying illness, or it can result from head trauma. A comatose person is still very much alive, but he or she is not simply asleep. The brain wave activity in a comatose person is very different from that of a sleeping person; you can wake up a sleeping person, you can't wake a person in a coma.
A coma usually does not last for more than a few weeks. Many people recover their full physical and mental functioning when they emerge from a coma. Others require various forms of therapy to recover as much functioning as possible. Some patients never recover anything but very basic body functions.
What Happens When Someone Is In A Coma?
Someone who is in a coma is unconscious and will not respond to voices, other sounds, or any sort of activity going on nearby. The person is still alive, but the brain is functioning at its lowest stage of alertness. You can't shake and wake up someone who is in a coma like you can someone who has just fallen asleep.
What Can Cause A Coma?
Comas can be caused by different things, including: -
- a severe injury to the head that hurts the brain
- seizures
- infections involving the brain
- brain damage caused by a lack of oxygen for too long
- an overdose (taking too much) of medicine or other drugs
- a stroke
When one of these things happens, it can mess up how the brain's cells work. This can hurt the parts of the brain that make someone conscious, and if those parts stop working, the person will stay unconscious.
Diagnosis
As with most neurological problems, the first step in diagnosing what is causing a coma or other state of unconsciousness is to obtain a complete medical history. Obviously, there is no way to get this information from the comatose patient, so physicians must rely on friends and family for these details. It is important to know how the coma developed, whether it was sudden or slow. It is also helpful to know about any medical problems that the comatose person has, including diabetes mellitus, high blood pressure, kidney disease, liver disorders, or a history of seizures.
Physical Exam & Neurological Evaluation
The physical exam will evaluate a comatose person's breathing pattern and cardiovascular function, as well as look at the skin and limbs for any noticeable abnormalities. Sometimes, particular breathing patterns are related to specific abnormalities in the brain, and they can be used to identify the underlying problem.
Eye Examination
The eyes will be examined carefully. Like a person's breathing pattern, the way the eye moves is sometimes related to specific abnormalities in the brain and can be used to identify the underlying problem.
A fundoscope is used to examine the optic nerve in the back of the eye for any signs of swelling, which indicates that there may be increased intracranial pressure.
Laboratory Tests
Usually, a full set of laboratory tests are done on the comatose patient. These include blood tests that check the liver, kidney and thyroid function, glucose levels, and the presence of any toxins. The results of the various lab tests may provide clues as to what has caused the coma.
A CT (computerized axial tomography) and MRI (magnetic resonance imaging) can both be used to visualize most abnormalities in the brain. In some cases, a lumbar puncture, known as a spinal tap, may be done to remove some of the cerebrospinal fluid for evaluation.
Treatment
The "Coma Cocktail"
Although the treatment of coma depends on the cause, there are some general treatment rules. If the cause is unknown, what is often called a "coma cocktail" is given to the patient. It's a mixture of thiamin (a vitamin that can help in alcoholic or nutritionally starved patients), glucose (a sugar that can help diabetics who have developed a coma due to low sugar level), and naloxene (a substance that reverses the action of many narcotics and is used to treat overdoses).
Correcting for Electrolyte Imbalance or Toxic Substances
Electrolytes are chemicals like salts, such as sodium and chlorine salts, that are found in the blood and tissues throughout the body and play an essential role in most physiological processes. Depending on what has caused the coma, it may be necessary to correct any electrolyte abnormalities. A renal dialysis, for example, is a process that removes toxins and maintains normal electrolyte balance in the kidneys.
Decreasing Intracranial Pressure
If the coma is related to increased pressure in the brain, there are various things that can be done to reduce it, including hyperventilation, diuretics and surgery. Hyperventilation involves increasing the rate and depth of breathing so that the blood vessels in the brain constrict and the blood flow slows down, which can decrease the brain pressure. Diuretics, also known as fluid pills, can decrease brain pressure by removing excess fluid in the brain. If there is an accumulation of fluid in the ventricles, known as hydrocephalus, surgery can remove excess fluid, which can also decrease the intracranial pressure.
The Glasgow Coma Scale was developed to provide health-caregivers a simple way of measuring the depth of coma based upon observations of eye opening, speech, and movement. Patients in the deepest level of coma : -
- do not respond with any body movement to pain
- do not have any speech
- do not open their eyes.
Those in lighter comas may offer some response, to the point they may even seem wake, yet meet the criteria of coma because they do not respond to their environment.
What Happens After A Coma?
Usually, a coma does not last more than a few weeks. Sometimes, however, a person stays in a coma for a long time — even years — and will be able to do very little except breathe on his or her own.
Most people do come out of comas, however. Some of them are able to return to the normal lives they had before they got sick. On TV, someone in a coma usually wakes up right away, looks around, and is able to think and talk normally. But in real life, this rarely happens. When coming out of a coma, a person will often be confused and can only slowly respond to what's going on. It will take time for the person to start feeling better.
Whether someone fully returns to normal after being in a coma depends on what caused the coma and how badly the brain may have been hurt. Sometimes people who come out of comas are just as they were before — they can remember what happened to them before the coma and can do everything they used to do. Other people may need therapy to relearn basic things like tying their shoes, eating with a fork or spoon, or learning to walk all over again. They may also have problems with speaking or remembering things.
Over time and with the help of therapists, however, many people who have been in a coma can make a lot of progress. They may not be exactly like they were before the coma, but they can do a lot of things and enjoy life with their family and friends.
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