What is a coma: Are there any treatments and how long does it take?
A person who is experiencing a coma cannot be awakened, and they do not react to the surrounding environment. They do not respond to pain, light, or sound in the usual way, and they do not make voluntary actions.
Although they do not wake up, their body follows normal sleep patterns. Automatic functions, such as breathing and circulation, normally continue to function, but the person's thinking ability is suppressed.
A coma is a deep state of unconsciousness. It can happen as a result of a traumatic accident, such as a blow to the head, or a medical condition, for example, some types of infection.
Coma is different from sleep because the person is unable to wake up. It is not the same as brain death. The person is alive, but they cannot respond in the normal way to their environment.
What is a coma?
Coma may occur for various reasons, such as intoxication, a disease or infection that affects the central nervous system (CNS), a serious injury, and hypoxia, or oxygen deprivation.
Sometimes, a doctor will induce a coma using medications, for example, to protect the patient from intense pain during a healing process, or to preserve higher brain function following another form of brain trauma().
A coma does not usually last for more than a few weeks. If the patient's condition does not change after an extended period, it may be reclassified as a persistent vegetative state .
If a persistent vegetative state lasts for months, the person is unlikely to wake up.
symptoms of coma?
During a coma, a person cannot communicate, so diagnosis is through the outward signs.
These include:
- closed eyes
- limbs that do not respond or voluntarily move, except for reflex movements
- lack of response to painful stimuli, except for reflex movements
How long these will take to develop, and how long they will continue, depend on the underlying cause.
Before entering a coma, a person with worsening hypoglycemia (low blood sugar), or hypercapnia (higher blood CO2 levels), for example, will first experience mild agitation. Without treatment, their ability to think clearly will gradually decrease. Finally, they will lose consciousness.
If a coma results from a severe injury to the brain or a subarachnoid hemorrhage, symptoms may appear suddenly.
Anyone who is with the person should try to remember what occurred just before the coma started, because this information will help determine the underlying cause and give a better idea of what treatment to apply.
Can a person hear and think when they are in a coma?
A person in a coma may benefit from sensory stimulation, such as holding a hand. There is some evidence that people can hear and understand spoken instructions during a coma.
A person who is visiting a friend or family member who is in a coma can speak to them as they normally would, for example, explaining what has been happening during the day. It is unclear how much they can understand, but there is a chance the person may be able to hear and understand. They may like to listen to music.
causes of onset of coma
Causes or a coma vary, but they all involve some level of injury to the brain.
They include:
- Diabetes: If the blood sugar levels of a person with diabetesrise too much, this is known as hyperglycemia. If they become too low, this is hypoglycemia. If hyperglycemia or hypoglycemia continue for too long, a coma can result.
- Hypoxia, or lack of oxygen: If the supply of oxygen to the brain is reduced or cut off, for example, during a heart attack, stroke , or near drowning, a coma may result.
- Infections: Severe inflammationof the brain, spinal cord, or tissues surrounding the brain can result in coma. Examples include encephalitis or meningitis.
- Toxins and drug overdose: Exposure to carbon monoxide can result in brain damage and coma, as can some drug overdoses.
- Traumatic brain injuries: Road traffic accidents , sports injuries, and violent attacks that involve a blow to the head can cause coma.
Diagnosis
A medical and recent history, blood tests, physical tests, and imaging scans can help find out the cause of a coma, and this helps decide which treatment to apply.
Medical history
Friends, family, police, and witnesses, if appropriate, may be asked:
- whether the coma or symptoms beforehand started slowly or suddenly
- if the person had or appeared to have any vision problems, dizziness, stupor or numbness before the coma
- whether the patient has diabetes, any history of seizures(لینک به تشنج) or stroke(لینک به سکته مغزی), or any other condition or disease
- what medications or other substances the patient may have been taken
Physical tests
The aim is to check the person's reflexes, how they respond to pain, and their pupil size. Tests may involve squirting very cold or warm water into the ear canals.
These tests will trigger varying reflexive eye movements. The type of response varies according to the cause of the coma.
Blood tests
These will be taken to determine:
- blood count
- signs of carbon monoxide poisoning
- presence and levels of legal or illegal drugs or other substances
- levels of electrolytes
- glucose levels
- liver function
Lumbar puncture (spinal tap)
This can check for any infection or disorder of the central nervous system (CNS). The doctor inserts a needle into the patient's spinal canal, measures pressure, and extracts fluid to send for tests.
Imaging scans of the brain
These will help determine whether there is any brain injury or damage, and where. A CT or CAT scan or an MRI will check for blockages or other abnormalities. An electroencephalography (EEG) will measure electrical activity within the brain.
Glasgow Coma Scale
The Glasgow Coma Scale (GCS) can be used to assess the severity of brain damage following a head injury.
It gives patients a score, according to verbal responses, physical responses, and how easily they can open their eyes.
- Eyes: Scores range from 1 to 4, where 1 is when a person does not open their eyes, 2 is when they open their eyes in response to pain, 3 is when they open them in response to voice, and 4 is when they open them spontaneously.
- Verbal: Scores range from 1 to 5, where 1 means the person makes no sound, 2 means they mumble but cannot be understood, 3 is when they utter inappropriate words, 4 is when they speak but are confused, and 5 is normal communication.
- Motor, or physical reflexes: Scores range from 1 to 6, and 1 to 5 describe a person's response to pain. A person who scores 1 makes no movement, 2 is when they straighten a limb in response to pain, 3 is when they react in an unusual way to pain, 4 is when they move away from pain, and 5 is when they can pinpoint where the pain is. A score of 6 means the person can obey commands.
A score of 8 or less overall indicates a coma. If the score is from 9 to 12, the condition is moderate. If the score is 13 or more, the impairment to consciousness is minor.
Do People "Come Out" of Comas?
A coma is a serious medical emergency.
Health professionals will start by ensuring the immediate survival of the patient and securing their breathing and circulation to maximize the amount of oxygen that reaches the brain.
A doctor may administer glucose or antibiotics even before the results of blood tests are ready, in case the patient is in diabetic shock or has a brain infection.
Treatment will depend on the underlying cause of the coma, for example, kidney failure, liver disease, diabetes, poisoning, and so on.
If there is brain swelling, surgery may be needed to relieve the pressure.
