Coma - Causes, Signs And Symptoms Of Coma, Diagnosis And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2023-12-16 21:43

Coma

Causes, signs and symptoms of coma, diagnosis and treatment

A coma is called an acutely developing condition, which is characterized by loss of consciousness in a person, depression of the central nervous system, a disorder of the respiratory and cardiovascular system. Sometimes the concept of coma characterizes such a degree of decrease in the functions of the central nervous system, as a result of which brain death can begin. The death of the brain is characterized not only by a complete lack of consciousness, but also by the absence of reflexes, a violation of the activity of all vital organs.

The causes of coma

The main causes of coma development can be:

• Brain damage in stroke, trauma, epilepsy, infectious diseases;
• Metabolic disorders in endocrine diseases, with an excess or lack of hormones in the body, the use of certain hormonal drugs;
• Various intoxications with liver, kidney diseases, infectious diseases, poisoning;
• Lack of oxygen intake and the development of hypoxia.

All of these reasons are among the most common, they differ in the mechanism of development, changes in the body and the nervous system, in diagnosis and emergency care.

Signs of coma development

A coma can develop (depending on its type) within a few minutes (instantly), hours (quickly), or even a day (gradually). There are 4 degrees of severity in the disease. These include the precom and the four degrees.

• Precoma. Patients have confusion, lethargy, drowsiness. Some patients may develop the opposite, psychomotor agitation. Changes in the activity of internal organs correspond to the nature of the underlying disease that caused the coma. Reflexes persist.
• Coma of the 1st severity. Patients are already developing pronounced stunning, the reaction to stimuli is inhibited. A person can still swallow water, liquid food, perform simple movements, but contact is already difficult. Reflexes can be increased or decreased depending on the type of coma.

• Coma of the 2nd degree. The patient is inaccessible to contact, there is deep sleep, stupor, rare chaotic movements of the limbs. Respiration is noisy, arrhythmic, pathological, involuntary act of defecation and urination. On examination, pathological reflexes appear, there is no skin sensitivity, the pupils are narrowed.
• Coma of the 3rd degree. Consciousness, pain sensitivity, tendon reflexes are already absent, the pupils dilate, and there is no reaction to light. In patients, respiratory depression occurs, blood pressure is lowered, and a decrease in body temperature is noted.
• Coma 4th degree. There is a deep disturbance of consciousness, all reflexes are absent, muscle atony is observed, a decrease in body temperature, blood pressure, spontaneous breathing stops and the patient should be immediately transferred to an artificial respiration apparatus.

Coma symptoms

Each type of coma has not only its own reasons, but also its own distinctive features. There are also common manifestations of the disease. First of all, this is a violation of consciousness, changes in reflex activity, respiration and the work of the cardiovascular system. As mentioned, coma has different degrees of severity, which is determined using the Glasgow scale. It takes into account all the signs: pain sensitivity, reaction to the light of the pupils, opening the eyes, speech and motor reaction, reflex activity. All of them have their own number of points, according to their sum, the degree of coma is calculated.

Coma diagnostics

For a diagnostic search for the cause of the onset of a pathological condition, the following studies are carried out:

• A blood or urine test for drugs;
• Determination of blood alcohol level;
• Clinical analysis of blood and urine;
• Determination of blood glucose, serum electrolytes, creatinine, blood urea nitrogen;
• Analysis of the content of thyroid hormones in the blood;
• Carrying out liver tests;
• Arterial blood gas analysis;
• Electrocardiogram;
• In the presence of neurological symptoms - lumbar puncture, computed tomography of the head.

Coma treatment

In some cases, it is easy to establish the cause of the coma, sometimes it takes a certain number of tests to make a diagnosis. All patients in coma are treated in intensive care units. Particular attention is paid to the treatment of the underlying disease that caused the coma.

For all patients, they try to maintain the normal functioning of vital systems and organs, therapy directly depends on the severity of the condition. Intravenous access is established, if necessary connected to a ventilator, in addition to the underlying disease, they also treat those complications that have arisen in the pathological state of coma.

Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist

Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".