Coma
The debate about the nature of consciousness has been going on since ancient times. This concept is related to different areas of human knowledge: science, philosophy, religion. From the point of view of medicine, consciousness is a product of human higher nervous activity. Consciousness is associated with the functioning of the cerebral cortex and some subcortical structures. Various states of altered consciousness are studied by psychiatry and neurology. Coma is a state of impaired consciousness caused by severe bilateral damage to the cerebral hemispheres or pathology of the ascending reticular formation of the pons, which activates the cerebral cortex through the thalamus.
A coma combines unconsciousness, lack of active movements, reactions to external stimuli, loss of reflexes and sensitivity, disruption of vital body functions (cardiac and respiratory activity). Coma is a threat to the patient's life and health. This condition is not an independent disease. Such a severe defeat can have various reasons.
Coma can be caused by craniocerebral or other trauma, impaired cerebral circulation, lack of oxygen in the blood (suffocation, drowning), drug poisoning, alcohol, hypovitaminosis, encephalopathy, cerebellar mass, hypovitaminosis, ischemia of the brain stem, psychogenic factors, metabolic disorders substances (renal failure, diabetes).
The degree of coma can vary. Precomatose states are distinguished - stupor and stupor. The initial stage is usually marked drowsiness - stupor. The patient reacts to the voice, but seems to be asleep all the time. He answers questions in monosyllables, he can follow the simplest orders. This is followed by stupor when the patient reacts to pain stimuli, but does not respond to the voice. When the condition worsens, a coma occurs. Who is characterized by the lack of reaction to painful stimuli and addressed speech. The patient does not speak, does not follow even the simplest orders, does not open his eyes in response to a painful stimulus. On the Glasgow scale, this condition is rated at 8 points or less.
By severity, who is divided into three degrees: mild, moderate and severe. In a mild coma, in response to severe pain irritation, motor reactions, tendon and pupillary reflexes occur. Violations of cardiac activity and breathing are poorly expressed. The average degree of coma is manifested by the aggravation of the disorders: the motor reaction to severe painful irritation disappears, tendon and pupillary reflexes are almost not evoked. Swallowing and pelvic organ function are impaired. Respiratory and cardiac pathology is more pronounced. With a severe degree of coma, the patient's condition is extremely difficult: complete muscle atony, drop in body temperature, absence of all reflexes. Disturbances in breathing and cardiac activity are sharply expressed. In case of bilateral lesions of the prefrontal (frontal) parts of the brain (for example, with ischemia,hemorrhages, tumors), the patient retains the appearance of wakefulness, but he does not respond to the environment and even painful stimuli. A neurologist should rule out some coma-like conditions: hysterical reactions, normal sleep, overdose of sedatives, non-convulsive epilepsy, swelling of the frontal lobe, “locked-in” syndrome.
Coma diagnostics
Coma symptoms include a lack of response to external stimuli. Falling into a severe coma, the patient consistently loses the ability to respond first to orders, questions, and then pain. Symptoms of a coma can sometimes determine the cause. When the temporal bone is wedged and the brain stem is compressed, a dilated pupil is observed, there is no reaction to light. This lesion is unilateral and corresponds to the side of the injury. With oxygen starvation, the pupils will be dilated on both sides, there will be no reaction to light. If a coma is the result of an overdose of opiates (morphine, heroin) or a stroke, then the pupils will be severely constricted. Respiratory disorders (rapidity or straining) occur with trauma or stroke in the brain stem.
Diagnostics is based on the characteristic symptoms of coma, laboratory and instrumental studies. The program of the initial examination of a patient in a coma includes an analysis of urine, blood for toxic substances, a biochemical blood test to determine the level of glucose, creatinine, bilirubin, liver enzymes, a study of thyroid function (thyroid stimulating hormone), an electrocardiogram, a computed tomography of the brain. Sometimes cerebrospinal fluid is examined. To exclude trauma to the cervical spine, an X-ray of the spine is performed. Electroencephalography is recommended to rule out epilepsy.
Coma treatment
Patient assistance is provided immediately in a hospital setting. Treatment for coma depends on its cause. As an urgent measure, drugs are used that support blood circulation and respiration, and stop vomiting. If metabolic disorders are the basis of a coma, their correction is required. So in diabetic coma with high blood sugar levels, insulin must be administered intravenously. If the sugar level is low, a glucose solution is injected. In the case of uremic coma (renal failure), the patient undergoes hemodialysis (blood purification with an artificial kidney apparatus). Trauma treatment most often involves surgery, stopping bleeding, and correcting the volume of circulating blood. With hematomas in the membranes of the brain, surgical treatment is required in the conditions of the neurosurgical department. If the patient has seizures,the anticonvulsant drug phenytoin is used intravenously to treat coma. If the coma is caused by intoxication, forced diuresis, detoxifying drugs, and intravenous fluid administration are recommended. If a drug overdose is suspected, narcan or naloxone is used. With an alcoholic coma or hypovitaminosis, thiamine is administered intravenously. If breathing is impaired, tracheal intubation and mechanical ventilation may be required. The resuscitator selects a suitable gas mixture, often preference is given to increased oxygen levels (for example, in the treatment of alcohol-induced coma). If a drug overdose is suspected, narcan or naloxone is used. With an alcoholic coma or hypovitaminosis, thiamine is administered intravenously. If breathing is impaired, tracheal intubation and mechanical ventilation may be required. The resuscitator selects a suitable gas mixture, often preference is given to increased oxygen levels (for example, in the treatment of alcohol-induced coma). If a drug overdose is suspected, narcan or naloxone is used. With an alcoholic coma or hypovitaminosis, thiamine is administered intravenously. If breathing is impaired, tracheal intubation and mechanical ventilation may be required. The resuscitator selects a suitable gas mixture, often preference is given to increased oxygen levels (for example, in the treatment of alcohol-induced coma).
Coma prognosis
The prognosis of coma is determined by the cause and stage of the condition; the prognosis is most serious in moderate and severe coma. Most often, coma symptoms are more severe if the underlying structure is damage to the brainstem rather than the cerebral cortex. Metabolic disorders are easier to correct than injuries and tumors, so in this case, the prognosis of coma is somewhat better. The most serious prognosis of coma is with apoplexy (hemorrhage in the brain structure), uremic (renal), traumatic and eclampsic (a consequence of late pregnancy toxicosis) coma.
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The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
