Definition

Coma is a state of prolonged unconsciousness in which a person is unresponsive to their environment. Unlike sleep, a person in a coma cannot be awakened, even with painful stimuli. During a coma, brain activity is minimal, and the person's awareness is significantly impaired.

A coma is a medical emergency requiring immediate action to save the patient's life and brain function. It is one of the common emergencies that bring individuals to the emergency unit.

One of the most common causes of coma is brain hemorrhage and tumors, followed by brain disorders, particularly those causing epilepsy, extensive infections, poisoning, and dysfunctions of other organs besides the brain. To prevent and manage a coma appropriately, recognize its signs through this article.

Causes

Under normal conditions, information from the external environment is transmitted as nerve signals to the brain, allowing a person to be conscious and responsive to their surroundings. A coma indicates a disruption in the brain, which can result from structural nerve disturbances or processes affecting the central nervous system. Below are various conditions and diseases that can lead to a coma:

1. Head injury: Injuries, usually from traffic accidents or violent actions, can cause bleeding, lack of oxygen, or increased pressure in the head.
2. Stroke: Disrupted blood flow in the brain from blocked or ruptured blood vessels.
3. Brain tumor: Tumors or masses in the cranial cavity or brainstem can be benign or malignant.
4. Alcohol or drug poisoning.
5. Chronic diseases:
• Diabetes: Extremely high or low blood sugar levels in diabetic patients can lead to a coma.
• Metabolic encephalopathy: Brain function is impaired due to toxins in the body from metabolic disturbances.
6. Hypoxia or lack of oxygen: Can occur in someone recently drowned or resuscitated from cardiac arrest.
7. Infection: Severe infections attacking brain tissues can cause inflammation in the brain's lining, brain tissue, brainstem, and surrounding tissues.
8. Toxins: Substances like carbon monoxide or lead can damage brain tissues.

Risk Factor

Since coma results from brain disturbances, the risk factors are typically diseases related to the central nervous system or metabolic disorders affecting oxygen delivery to brain tissues, such as:

1. Severe chronic diseases, especially with a history of heart, liver, and kidney disorders
2. Type 1 and Type 2 diabetes mellitus
3. History of blood clots
4. History of cancer and chemotherapy
5. Unsafe driving habits
6. Heavy smoking or alcohol consumption

Symptoms

A person in a coma typically has their eyes closed and does not respond to external stimuli like calls, hand claps, pinching, and other painful stimuli. There might be preceding personality changes or thinking impairments. Sometimes, severe headaches or explosive vomiting due to increased intracranial pressure precede the loss of consciousness.

Diagnosis

Initially, the doctor will interview close contacts to obtain the patient's medical history and the circumstances leading to unconsciousness.

During a physical examination, the doctor will look for signs of trauma, especially around the head. Neurological examinations will include responses to pain, a brief assessment of body movements and reflexes, eye-opening responses, and voice responses. Lack of response in these tests indicates a coma.

The doctor may conduct laboratory tests like blood analysis, electrolyte levels, thyroid function, and kidney and liver function tests. They may also check for carbon monoxide and drug or alcohol overdose. Cerebrospinal fluid analysis via a spinal tap can reveal signs of brain tissue infection.

Head scans use radiology and other tests to identify the cause of a coma. CT scans (Computed Tomography scans) and MRIs (Magnetic Resonance Imaging) can reveal the cause or disturbance in the brain, such as blocked or ruptured blood vessels. An EEG (Electroencephalography) can show which areas of the brain are affected and is performed on someone who has had a seizure before falling into a coma.

Management

Coma is a medical emergency, so doctors will secure and maintain the airway and blood circulation using medications and other therapies. If low or high blood sugar levels cause the coma, the treatment will focus on correcting that. Blood sugar levels should be checked in all comatose or unconscious patients. If drug overdose is suspected, specific antidotes might be administered. For patients with low blood pressure in a coma, it is crucial to maintain and raise blood pressure to ensure adequate blood flow, especially to brain tissues.

Coma treatment occurs in intensive care units for close monitoring to ensure stable breathing and blood pressure while treating the coma's cause. Nutritional support and physical therapy during recovery are also essential to prevent joint stiffness.

Complications

In some cases, people who have fallen into a coma gradually recover consciousness. If someone recovers from a coma, they may have mild to severe disabilities.

However, in other cases, a coma results in a vegetative state or death. A vegetative state is when a person is awake but unresponsive to their surroundings or only shows minimal responses, like tracking objects with their eyes or reacting to sounds.

Other complications from a coma include pressure sores from prolonged immobility, urinary tract infections, blood clots in the legs, and other issues. Permanent brain damage may occur post-coma, necessitating ongoing therapy, such as physical and occupational therapy, to help restore bodily functions to near-normal levels. The likelihood of regaining consciousness from a coma depends on the severity and cause of the brain trauma.

Prevention

Measures to prevent a coma include:

1. Preventing head trauma by using proper head protection, especially when driving or engaging in sports
2. Monitoring blood sugar levels in diabetics, as Type 1 diabetics are more prone to coma than Type 2 diabetics. Regular blood sugar checks are crucial for preventing complications and monitoring treatment. Preventive measures include regular checkups, dietary management, and avoiding dehydration
3. Regular check-ups and management for those with a history of stroke and other chronic diseases
4. Avoiding smoking and heavy alcohol consumption

When to See a Doctor?

If you know someone who falls into a coma with the mentioned symptoms, seek immediate medical attention for first aid and further examination. Conditions that may precede a coma include:

1. Progressive decrease in consciousness, which may begin with confusion.
2. Decreased responsiveness to the environment
3. Seizures with repeated vomiting
4. Sudden numbness in the face, arms, or legs, especially on one side of the body
5. Difficulty seeing in one or both eyes
6. Difficulty coordinating, walking, and losing balance

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