Coma: Everything You Need to Know

A coma is a state of deep unconsciousness through which an individual is unresponsive for a protracted time. Although comas have many possible causes, all of them involve temporary or everlasting harm to the brain, impairing an individual’s awareness of their surroundings and their ability to answer them.

In some situations, a medically induced coma may help prevent brain damage, improving the possibilities of survival and reducing the likelihood of long-term disability. This article describes the causes of coma, rating scales, and what to anticipate if the one you love has been diagnosed with a coma.

What Is a Coma Exactly?

A coma is a state of unconsciousness brought on by altered brain function and can be medically induced in certain situations as a way of protecting the brain. People who’re diagnosed as being in a coma are unable to maneuver and typically require respiratory support—comparable to intubation and mechanical ventilation.

A coma may last for days or longer before an individual regains consciousness, but in some situations, an individual may never get better from a coma.

The final result of a coma is dependent upon the severity and cause. Often, the medical cause is treated while an individual is receiving respiratory and other support.

Types of Coma

Health conditions can result in a coma in alternative ways.

Some of the categories include:

• Metabolic changes: Alterations within the body’s chemicals, comparable to potassium, calcium, magnesium, and glucose, can affect brain cell function, resulting in changes in consciousness that would turn into everlasting if the metabolic changes usually are not quickly corrected.
• Hypoxia: Diminished oxygen supply to the brain as a result of heart failure, lung failure, or severe blood loss can result in impaired function or everlasting damage to nerve cells throughout the brain.
• Toxin exposure: Medications, drugs, and chemical exposures known to change brain function could cause a coma as a result of overdose or drug withdrawal—sometimes even with normal doses.
• Trauma: Physical injuries can result in blood loss, bleeding within the brain, or brain swelling—rapidly affecting brain cell function and resulting in lack of consciousness.

A coma can involve a number of of those physical changes.

What Is the Cause of a Coma?

Several medical conditions can affect an individual’s level of consciousness, potentially causing a coma.

The commonest causes of coma include:

• Traumatic brain injury: Any brain injury could cause swelling or bleeding within the brain. Additionally, the trauma may induce rapid chemical and fluid shifts, affecting brain function. Sometimes, people can have significant improvement after a traumatic brain injury, but when there may be substantial bleeding or swelling, the damage could also be everlasting.
• Stroke: Impaired blood supply to an area of the brain causes a stroke, which might result in brain swelling. A big stroke or brainstem stroke may impair consciousness, causing a coma.
• Brain tumor: Cancer within the brain could cause pressure on areas of the brain that affect consciousness, potentially causing a coma. In some instances, tumor removal could be curative.
• Lack of oxygen (hypoxia): A heart attack or severe lung disease may prevent sufficient oxygen from reaching the brain—resulting in substantial damage.
• Increased pressure within the brain: Many medical conditions could cause pressure within the brain, comparable to a brain tumor, bleeding within the brain, or swelling from a stroke, cancer, or traumatic brain injury.
• Diabetes: Uncontrolled diabetes could cause extreme changes in blood glucose levels and chemical and mineral concentration—stopping healthy brain cell function.
• Infections: A brain infection or a severe infection within the body can impair an individual’s level of consciousness.
• Toxins and drug overdose: Many several types of medications and medicines of abuse can have a rapid impact on the brain, potentially causing a coma.
• Medical complications: Liver failure, kidney failure, thyroid disease, and blood loss are a number of the medical conditions which have the potential to cause a coma.

What Are the Signs of a Coma?

A coma could also be diagnosed during a hospital stay or suspected during an emergency response. Often, a coma is diagnosed after an individual has been in an unresponsive condition for several hours or longer.

First responders will often describe an individual’s state of consciousness using the AVPU scale.

The AVPU scale is:

• Alert: This designation indicates that an individual is alert and responsive.
• Verbal: This designation indicates that an individual has a diminished level of alertness but can have some sort of response to sound.
• Pain: This designation indicates that an individual has a diminished level of alertness but has some sort of response to pain.
• Unresponsive: This designation indicates that an individual will not be alert and never conscious of sound, touch, or pain.

Healthcare providers diagnose a coma based on a physical examination, diagnostic tests, and assessment of the medical history and up to date situation.

How Doctors Determine Severity: The Glasgow Coma Scale

The Glasgow Coma Scale (GCS) assigns a severity number to a coma through assessment of physical movements, speaking, and movement. The scale may help healthcare professionals track improvement, decline, or stability.

The scale provides a maximum possible rating of 15, which correlates to a gentle coma. The lowest rating of three indicates a deep coma.

Scoring is predicated on:

• Eye opening: Rated from 1 (no eye opening) to 4 (eyes open spontaneously)
• Verbal response: Rated from 1 (no verbal response) to five (verbal response is smart)
• Physical responses: Rated from 1 (no movement) to six (follows commands)

How Comas Are Diagnosed

When an individual is diagnosed with a coma, healthcare providers work to discover the cause. Often, treatment involves medical stabilization to attenuate the chance of everlasting brain damage.

Diagnosis is predicated on:

• Medical history: This is the important thing feature for determining the explanation for a coma and directing treatment. For example, the treatment would differ for a coma brought on by a traumatic injury than for a coma brought on by an infection.
• Physical tests: A physical examination can assess the extent of consciousness and responsiveness and help evaluate the cause with clues comparable to neurological changes or bruises.
• Urine test: A urine test may detect evidence of medicine or medication that would impair consciousness.
• Blood tests: Metabolic problems and changes in organ function—comparable to liver, kidney, or lung disease—could be detected with blood tests.
• Electroencephalogram (EEG): This test examines brain activity through external wires placed on the scalp. It can discover certain patterns, comparable to seizures, sleep, brain death, and more.
• Lumbar puncture or spinal tap: In rare instances of coma, this procedure collects fluid from across the spinal cord with a needle. Examining the fluid can assist diagnose some forms of cancer and infections.
• Imaging scans of the brain: Usually, a brain scan, comparable to a brain computerized tomography (CT) or magnetic resonance imaging (MRI), can assist in identifying structural brain changes, comparable to stroke, cancer, or traumatic injury.
• Electrocardiogram (EKG): This study examines the function of the guts and may detect evidence of heart failure or a heart attack.
• Other imaging tests: Depending on a medical history, other imaging tests could also be ordered to visualise the structure of the kidney, liver, or lungs.

How a Coma Is Treated

Treatment is dependent upon how long an individual has been in a coma, the cause, and the likelihood of recovery. Often, particularly when there may be a high probability of recovery, the person is cared for within the intensive care unit, where close medical monitoring and quick medication adjustments are possible.

Corticosteroids or diuretics (water pills) can reduce brain swelling. Additionally, support for respiratory, blood pressure, and heart function is generally mandatory to keep up survival and forestall further brain injury. Medication to assist manage any ongoing infections or inflammatory conditions is usually mandatory.

Coma has many potential complications, which include pneumonia (lung infection or inflammation), skin infections, urinary tract infections, dysregulated body temperature, bowel obstruction, seizures, and more.

After recovery from a coma, rehabilitation can assist to strengthen respiratory muscles and construct muscle strength and control. Many coma survivors may also need speech and swallow therapy.

What’s the Outlook for Someone in a Coma?

Many people can get better from a coma. If the one you love is in a medically induced coma, they usually tend to have a full recovery since the coma-inducing medication could be reversed after they turn into medically stable.

If the one you love is in a comatose state as a result of a medical condition or a head injury, then the outlook and potential for recovery are highly variable based on their individual situation.

Coma Recovery

Recovery from a coma is dependent upon many aspects individual to the person and the explanation for the coma.

Waking Up From a Coma

Waking up from a coma is generally a gradual process. There could also be a delay of hours or days after medical causes are treated before an individual starts to turn into more alert.

If the one you love is waking up from a coma, remain patient and anticipate a slow recovery.

Signs of Coming Out of a Coma

When an individual is recovering from a coma, they could periodically open their eyes, begin to maneuver, respond to the touch or pain, or toss and switch in bed. They may additionally cough or try to tug out medical devices, comparable to intravenous (IV) catheters or respiratory tubes.

The Ranchos Scale

The Rancho Los Amigos Cognitive Scale-Revised (RLAS-R) is more detailed than the AVPU scale or the GCS. This scale rates people on 10 levels, based on many aspects, including responsiveness, eye movements, need for assistance, memory, cooperation, learning, and more.

Will You Remember Anything That Happened During the Coma?

People don’t typically remember anything from after they were in a coma after recovering from one. This is because they usually are not alert or aware of their surroundings during a coma. Some people can have a slight recollection of the event that caused the coma—comparable to a automobile accident—but often can’t remember most of the small print.

What Are the Risk Factors for Comas?

A head injury is probably the most clear-cut risk factor for a coma. Additionally, health conditions that may result in rapid alterations in metabolism may cause a coma. Drug or alcohol use or withdrawal can result in altered levels of consciousness that could be temporary, everlasting, or life-threatening.

Health conditions which might be related to a risk of coma include heart disease, lung disease, cerebrovascular disease (a disease of the blood vessels within the brain), thyroid disorders, diabetes, liver, disease, and kidney failure.

Can You Prevent a Coma?

Prevention of traumatic brain injury is an important step for stopping a coma. This includes wearing a seat belt while in a moving vehicle or wearing a helmet for certain contact sports.

Additionally, managing underlying health conditions, comparable to diabetes or kidney disease, can assist prevent metabolic changes that could lead on to a coma. Taking care of stroke risk aspects—like hypertension, high cholesterol, diabetes, and smoking—can all reduce the chance of a stroke-induced coma.

That said, there is no such thing as a specific coma prevention strategy. Taking care of your health is the very best technique to prevent serious brain damage that could lead on to unconsciousness.

Summary

A coma is a state of unresponsiveness. People could be diagnosed as being in a coma based on a physical examination, medical history, and diagnostic tests. Several health conditions are known to have the chance of resulting in a coma. Many people can get better from a coma, depending on its severity and underlying cause.

If the one you love has been diagnosed with a coma, that you must know that this diagnosis has variable outcomes—and their prognosis relies on many aspects. When the one you love is stabilized, their healthcare providers will discuss expectations and treatment plans with you.