Also described as being comatose, a person in a state of coma is unconscious for more than 6 hours, does not initiate any voluntary actions, cannot be awakened, fails to respond to normal stimuli like light or sound and lacks the normal sleep-wake cycle.
A comatose person lacks any wakefulness and cannot hear, feel, move or speak consciously. Any injury to the cerebral cortex or the reticular activating system could cause someone to experience a coma.
There are many possible causes for a coma that might include metabolic abnormalities, intoxication, central nervous system diseases, traumatic injuries or acute neurological injuries such as strokes, hypoxia, hypoglycemia, herniation and hypothermia.
Most often the coma occurs due to drug poisoning, about 40% of the cases. Drugs weaken or damage the synaptic functioning in the ascending reticular activating system (ARAS). This is why the hospitals test comatose patients observing pupil size and eye movement.
Secondary effects of the drugs like abnormal blood pressure, abnormal sweating and breathing as well as abnormal heart rate might affect the ARAS and lead to coma. A major role in the ARAS malfunctioning is played by seizures and hallucinations.
The second on the list of the most common causes is the lack of oxygen. 25% of the cases of coma are due to lack of oxygen. Oxygen deprivation harms the neuron communication.
The side effects of strokes are the cause of 20% cases of coma. Blood flow in the brain can be blocked or restricted during strokes. Blood carries nutrients and oxygen to the neurons and if blood cells are blocked and cannot reach neurons, they die and the brain tissue is deteriorated.
15% percent of comatose cases are due to other causes like malnutrition, excessive blood loss, hyperthermia, trauma, hypothermia or other causes.
There is no problem diagnosing the coma, the real challenge is diagnosing the cause that led to a coma. The first thing that is done when someone is comatose is stabilization of the patient then Dr Bruce Rubinowicz start investigations to detect the cause.
Diagnosis process follows a series of steps to determine the cause of the coma.
First step is the initial assessment of the coma that is meant to gauge the level of consciousness. Then doctors try to find the part of the brain that is affected and might cause the coma. Then blood is drawn to see if drugs were involved and to check the level of important substances in the blood. Also brain scans might be performed to observe any abnormality in the brain functioning.
The treatment for a comatose patient depends on the cause of the coma and the severity. There is no such thing as the best treatment for comatose patients yet. Usually the comatose patients are put in ICU (Intensive Care Unit) where the patients’ brain activity and breathing is monitored. The medical team is focused on stabilizing the patient and once it is stable they focus on maintaining the stability and avoiding infections. Also the patient has to be moved to avoid bed sores. Sometimes persons in a coma might become restless and need special care to be prevented from hurting themselves.
Most often the medical personnel are trying to reverse the cause of the coma.
The coma may last days or weeks, sometimes even years. People may emerge from a coma and recovery is gradual. Some patients progress to full awareness while others never recover beyond basic responses.