Coma: Symptoms & Causes



An individual in a coma is conscious but has no control over their movements, and they cannot often find the reason, communicate, or react to their surroundings. In most situations, vital processes like breathing and heart rate are hampered. Medication and other therapies, such as airway pressure and ventilators, may help sustain a patient's breathing. Medical staff moves rapidly to ensure the best result whenever a patient experiences a loss of consciousness, whether it occurs suddenly or over time. With a coma diagnosis, it is crucial to keep a patient's systems functioning as well as possible until they come out of it. After spending a few days in a coma, sometimes patients begin to reawaken slowly. However, some may live in such a coma for generations with artificial nourishment, respiration, and cardiovascular support.

What is Coma?

Several factors might lead to a person falling into a coma. Occasionally, a physician may create a coma to prevent a patient from suffering needless or life-threatening effects. This could be required in severe illness, illness, or trauma from an incident. Individuals in a coma cannot normally react to their surroundings, much like when asleep. Coma is distinct from sleep in that patients cannot rouse themselves from it. The extent to which the brain is active determines the corresponding degrees of awareness and attentiveness. The duration of a coma might range from several days to many weeks.

Symptoms of Coma

To make the diagnosis of coma, a patient must fulfil certain criteria, including but not limited to −

  • Sluggishness

  • Abnormal breathing pattern

  • Body parts not reacting outside of reactions

  • Almost no emotional reaction to pain other than instinct

  • The ability to swallow as well as cough may persist even in a comatose state.

  • Individuals in comas can breathe on their own or with the aid of a respirator the majority of the time.

Causes of Coma

Brain damage is the root cause of all comas. Tension, hemorrhage, respiratory failure, and toxic accumulation are all potential causes of brain damage. The harm may only be short-term and easy to recover from. More than half of all comas are caused by some head injury or a problem with the mind's blood supply.

Brain Injury − Most comas may be traced back to head trauma. Brain injury may be brought on by stress, bleeding, poor breathing, or a buildup of toxins. There is a chance the damage will not be too severe. About fifty percent of all comas may be traced back to trauma to the head or brain's blood flow issues.

Trauma − Head trauma can lead to swelling and bleeding. A traumatic brain injury leads the brain to enlarge, and the fluid inside the head presses on the head. The RAS, which is important for alertness and consciousness, may be damaged if the enlargement causes the brain to press down on the medulla oblongata.

Bleeding − Coma may result from swelling and pressure on the affected part of the head caused by a subdural hemorrhage. Shifting of the brain due to compression is what harms the medulla as well as the RAS. Non-traumatic explanations of brain hemorrhage include elevated blood pressure, brain aneurysm collapse, or tumors.

Pathophysiology

The ascending reticular activating system (ARAS), which is responsible for arousal, is formed of a neuronal network in the dorsal pons and midbrain. Neurons from these areas connect to the thalamus and subsequently to the bilateral cerebral cortex, which governs sensory processing and cognition, resulting in consciousness. Coma is caused by a mechanism that affects the brain's arousal center, consciousness center, the tracts that link them, or any combination of these. As a result, patients are not conscious or alert. Prolonged coma may result in the unconscious, waking cycles (eyes open coma). Because the comatose state is difficult to measure, some comatose individuals may be minimally aware (minimally conscious condition), while others may be more aware than can be assumed or tested.

Treatment of Coma

The intensity and the main cause of a coma will determine the most appropriate treatment plan for the patient. When a patient is admitted to urgent care in a coma, the first order of business is to get them to the Critical Care Unit (ICU), where their breathing and heart rate will be closely monitored. Intubation, mechanical breathing, intravenous (IV) liquids, blood transfusions, and other life-sustaining interventions are used to keep the patient alive.

Care − Once a person's life is no more in danger, the goal shifts from stabilizing to the maintenance of health. Patients at risk for developing pressure sores due to bed rest should be rotated every three to four hours. Physical mobility therapy benefits coma patients by reducing the likelihood of orthopedic deformities like atelectasis and contractures.

Caregivers − Friends, relatives, and caretakers experience a wide range of emotions when a loved one is in a coma. According to studies, the length of time because the coma-inducing injury happened is more important than the magnitude of the damage itself. The human mind has a wide range of responses, including despair, wrath, irritation, and denial. Care for a comatose patient should concentrate on developing a connection with the medical personnel, the patient, and the family or other caregivers.

Prognosis − In dire cases, a coma might endure for years. Individuals' outcomes vary widely; some emerge from comas, others enter vegetative states, and others pass away. Individuals who might have gone into a state of neglect may recover some level of consciousness later, while others may stay in this state indefinitely.

Recovery − After waking from a coma, a person's physical, mental, and emotional health may all be compromised, requiring specialized care. Coma patients frequently exhibit acute perplexity upon regaining consciousness, dysarthria, or the incapacitation to speak. The path to healing is often long and winding.

Conclusion

Regaining consciousness after a coma is a very tall order for doctors, and consultation with your physician is recommended due to individual variation. Consistent with common sense, a patient's prognosis deteriorates as time spent in a coma increases. A coma may last for weeks, yet many people do regain consciousness afterward. Nonetheless, they might be severely impaired.


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