Coma Health Article

Treatment

Coma is a medical emergency, and attention must first be directed to maintaining an individual's respiration and circulation, using intubation and ventilation, administration of intravenous fluids or blood as needed, and other supportive care. If head trauma has not been excluded, the neck should be stabilized in the event of fracture. It is extremely important for a physician to quickly determine the cause of a coma, so that potentially reversible conditions are immediately treated. These conditions may include an infection that can be treated with antibiotics, a brain tumor that can be removed, or brain swelling that can be reduced with certain medications.

Various metabolic disorders can be addressed by supplying an individual with the correct amount of oxygen, glucose, or sodium, by treating the underlying problem in liver disease, asthma, or diabetes, and by halting seizures with medication. Because of their low incidence of side effects and potential for prompt reversal of coma in certain conditions, glucose, the B-vitamin thiamine, and Narcan (to counteract any narcotic-type drugs) are routinely given.

Prognosis

Some conditions that cause coma can be completely reversed, restoring an individual to an original level of functioning. However, if areas of the brain have been sufficiently damaged due to the severity or duration of the condition that led to the coma, an individual may recover with permanent disabilities, either physical or mental, or may never regain consciousness. Short of death, the most severe types of brain injury result in states in which an individual loses all ability to function and remains deeply unresponsive. An individual who has suffered such a severe brain injury may remain in a coma indefinitely. This condition is termed a persistent vegetative state.

Outcome from a coma is therefore quite variable and depends a great deal on the cause and duration of the coma. In the case of drug poisonings, extremely high rates of recovery can be expected following prompt medical attention. Persons who have suffered head injuries tend to do better than do those whose coma was caused by medical illness. Besides those people whose coma results from drug poisoning, only about 15% of individuals who remain in a coma for more than just a few hours make a good recovery. Adult patients who remain in a coma for more than four weeks have almost no chance of eventually regaining their previous level of functioning. On the other hand, children and young adults have regained functioning after two months in a coma.

Health care team roles

Emergency medical team members are often first on the scene to provide a preliminary assessment of unconsciousness. In the hospital, a physician makes the diagnosis of coma, often with assistance from radiologists and laboratory technicians. Nurses provide supportive care throughout the duration of a coma. Physical therapists provide range of motion and other therapeutic movements designed to preserve normal muscular functioning.

Prevention

Medical conditions known to cause comas should be monitored and promptly treated. Applicable safety precautions and rules should be followed when engaging in any activity that has the potential for serious head injury.

KEY TERMS

Anatomic—Related to the physical structure of an organ or organism.

Metabolic—Refers to the chemical processes of an organ or organism.

Narcan—A drug that reverses the effects of narcotics.

Neuron—The cells within the body which comprise the nervous system.

Reticular activating system (RAS)—A network of structures, including the brainstem, medulla, and thalamus, and nerve pathways, which function together to produce and maintain arousal.

Stimulus—Action performed on an individual that predictably provokes a reaction.

BOOKS

Adams, Raymond D., Maurice Victor, and Allan H. Ropper. Adam's & Victor's Principles of Neurology, 6th ed. New York: McGraw Hill, 1997.

Mindell, Amy, and Robert King. Coma, A Healing Journey: A Guide for Family Friends and Helpers. Portand, OR: Lao Tse Press, 1999.

O'Farrell, Maggie. After You'd Gone. New York: Viking Press, 2001.

Ropper, Allan H., and Joseph B. Martin. "Acute Confusional States and Coma." In Harrison's Principles of Internal Medicine, 14th ed., edited by Anthony S. Fauci, et al. New York: McGraw-Hill, 1998, pp. 125-34.

Simon, Roger P. "Brain Death." In Cecil Textbook of Medicine, 21st ed., edited by Lee Goldman and J. Claude Bennett. Philadelphia: W.B. Saunders, 2000, pp. 2027-8.

Simon, Roger P. "Coma and Disorders of Arousal." In CecilTextbook of Medicine, 21st ed., edited by Lee Goldman and J. Claude Bennett. Philadelphia: W.B. Saunders, 2000, pp. 2023-6.

Simon, Roger P. "Persistent Vegetative State." In CecilTextbook of Medicine, 21st ed., edited by Lee Goldman and J. Claude Bennett. Philadelphia: W.B. Saunders, 2000, pp. 2026-7.