Explore information and support for understanding and coping with a coma. Meri Sehat offers expert insights and guidance for families and individuals.

Coma

A. JABBAR DENTAL CLINIC KARACHI

Sadia Khan

Overview

A coma is a deep state of unconsciousness for a prolonged period in which a person is unaware of and unresponsive to external stimuli. It is a medical emergency. 
&nbsp;

Coma is a common condition in the emergency department. However, it is difficult to determine its actual frequency due to differences in assessments by different providers.

According to a recent study, 0.4% of all emergency department patients had a coma of unknown etiology.<a href="#accordion">[1]</a> In 2021, the number of patients in a coma amounted to around 26,500 people in Spain, affecting mostly those 65 and over.<a href="#accordion">[2]</a> Another survey found the annual incidence of coma was almost twice as high in the US compared to the UK.<a href="#accordion">[3]</a> 
&nbsp;

Sign and Symptoms

An individual in a coma would usually present with:

<ul>
	<li>Irregular breathing</li>
	<li>No response or voluntary movement of the limbs, except reflex actions</li>
	<li>Lack of response to painful stimuli</li>
	<li>Closed eyes 
	&nbsp;</li>
</ul>

Causes

Coma can occur due to multiple reasons, including:

<ul>
	<li>Head injury, such as concussions or traumatic brain injuries</li>
	<li>Extreme blood sugar levels, electrolyte levels, body temperatures, or <a href="https://merisehat.pk/disease/hypertension-57">hypertension</a></li>
	<li>Toxins and poisons, such as alcohol, heavy metals, carbon monoxide, or certain pesticides</li>
	<li>Lack of oxygen or blood flow, especially from ischemic stroke</li>
	<li>Underlying conditions, such as life-threatening infections like sepsis or inflammation like multiple sclerosis 
	&nbsp;</li>
</ul>

Coma is not the same thing as brain death, which has its own criteria. Individuals in a coma are still alive, but their brain is functioning at its lowest stage of alertness. They may experience different levels of awareness:<a href="#accordion">[4]</a>

<ul>
	<li>Minimal Conscious State &ndash; Limited signs of awareness and occasional responses to stimuli, like grabbing hands, but don&rsquo;t retain consciousness for long periods</li>
	<li>Persistent Vegetative State &ndash; Unaware of surroundings and unable to move voluntarily for an indefinite period 
	&nbsp;</li>
</ul>

Doctors typically refer to the Glasgow coma scale when describing symptoms during a physical exam of the patient. It is simple and easy to administer. Scores from the 3 different categories are added, and the total score (ranging from 3 to 15) reflects the severity of the coma:<a href="#accordion">[5]</a>

<ul>
	<li>Best Motor Response &ndash; A score of 1 means no response, whereas 6 means obey commands</li>
	<li>Verbal Response &ndash; A score of 1 means no response, whereas 5 means alert and replies appropriately</li>
	<li>Eye Opening &ndash; A score of 1 means no eye opening, whereas 4 means opening eyes spontaneously 
	&nbsp;</li>
</ul>

Diagnosis

Since the patient cannot express themselves, the healthcare professional will ask family or friends about any possible events that could have caused a coma:

<ul>
	<li>Whether the person lost consciousness quickly or over time</li>
	<li>Recent changes in the person&rsquo;s behavior or health</li>
	<li>Noticeable symptoms before losing consciousness, like headaches or vomiting</li>
	<li>Medical history, including a previous stroke&nbsp;</li>
	<li>Drug use, including nonprescription and prescription medicines and illicit drugs 
	&nbsp;</li>
</ul>

They will then perform a physical exam to check for signs of bruises, observe breathing patterns, and test reflexive movements.

Further, they may also order lab tests, like CBC, thyroid, kidney, and liver functions, electrolyte and sugar levels, and toxin levels. Sometimes, a lumbar puncture is advised for infections in the nervous system, while imaging tests like a CT scan, MRI, and EEG help identify areas of brain injury. 
&nbsp;

Treatment

The treatment depends on the cause of the coma.<a href="#accordion">[6]</a>

<ul>
	<li>The first line of action is to maintain the breathing and circulation of the affected individuals through intravenous medicines or other types of supportive care in the intensive care unit at a hospital.</li>
	<li>Antibiotics or glucose may be necessary to alleviate brain swelling and relieve pressure on the brain. It may be provided before the blood tests in case the doctor suspects an infection or very low blood sugar.</li>
	<li>Other medicines, like anti-seizure drugs or overdose-reversing medications, may be given to treat underlying diseases causing the condition. 
	&nbsp;</li>
</ul>

A coma usually does not last more than 2-4 weeks. Recovery usually takes time, and the condition is reversed.

However, depending on the cause, site of damage, and severity, some people remain in a coma for years or decades.

In the case of severe brain damage, the individual either never regains consciousness or has permanent physical, psychological, or intellectual problems. They may need therapy to relearn basic things like learning to walk or speak all over again. 
&nbsp;

People in comas need 24/7 medical care. They cannot move, bathe, feed, or take care of themselves in any manner. These include:

<ul>
	<li>Pressure ulcers, blood clots, or bed sores due to inability to move</li>
	<li>Bladder or bowel incontinence due to lack of response to body stimuli</li>
	<li>Pneumonia due to inability to handle respiratory secretions</li>
	<li>Healthcare-associated infections like catheter-associated urinary tract infections</li>
	<li>Delirium</li>
</ul>

Lack or delay of proper cardiovascular or respiratory support may lead to secondary brain injury or death. 
&nbsp;

Coma can affect anyone, regardless of their age, gender, ethnicity, or other factors. Certain conditions increase the risk of having a coma:

<ul>
	<li>Metabolic conditions, such as diabetes-related ketoacidosis and type 1 diabetes.</li>
	<li>Chronic conditions, such as hyperlipidemia, hypertension, or seizure-related conditions like epilepsy. 
	&nbsp;</li>
</ul>

Some ways to prevent or reduce the risk of coma include:

<ul>
	<li>Wearing safety equipment like seat belts and helmets, when applicable</li>
	<li>Managing chronic conditions as per doctor&rsquo;s recommendations, such as eating a balanced diet and staying physically active</li>
	<li>Maintaining a healthy weight</li>
	<li>Avoiding substance and nonmedical drug abuse 
	&nbsp;</li>
</ul>

Key Points

<ul>
	<li>Coma is a state of unconsciousness where an individual is unresponsive to external stimuli and cannot be awakened. It is a medical emergency that requires prompt attention.</li>
	<li>Key signs include unresponsiveness, absent or diminished reflexes, limited motor responses, and altered vital signs.</li>
	<li>Various factors can lead to coma, including traumatic head injuries, strokes, brain infections, certain toxins, metabolic imbalances, and severe illnesses.</li>
	<li>Coma exists on a spectrum of severity, ranging from mild impairment of consciousness to a deep and prolonged state of unresponsiveness.</li>
	<li>It is diagnosed using the Glasgow Coma Scale. Moreover, neurological assessments, imaging studies (CT scans or MRIs), and laboratory tests are needed to identify any underlying conditions or injuries.</li>
	<li>Treatment plans are individualized based on the specific circumstances. Life-sustaining measures, such as mechanical ventilation, may be necessary in some cases.</li>
	<li>Some individuals may recover fully, while others may experience long-term cognitive or physical impairments. Rehabilitation is often a crucial aspect of recovery for individuals who emerge from a coma to regain or improve overall functioning.</li>
	<li>Some causes of coma, such as traumatic injuries, can be prevented through safety measures, including wearing helmets and seatbelts, practicing workplace safety, and taking precautions to avoid accidents.</li>
</ul>