Coma Health Article

Treatment

Coma is a medical emergency, and attention must first be directed to maintaining the patient's respiration and circulation, using intubation aand ventilation, administration of intravenous fluids or blood as needed, and other supportive care. If head trama has not been excluded, the neck should be stablized in the event of fracture. It is obviously extremely important for a physician to determine quickly the cause of a coma, so that potentially reversible conditions are treated immediately. For example, an infection may be treated with antibiotics; a brain tumor may be removed; and brain swelling from an injury can be reduced with certain medications. Various metabolic disorders can be addressed by supplying the individual with the correct amount of oxygen, glucose, or sodium; by treating the underlying disease 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 the individual to his or her original level of functioning. However, if areas of the brain have been sufficiently damaged due to the severity or duration of the condition which led to the coma, the individual may recover from the coma with permanent disabilities, or may even never regain consciousness. Take, for example, the situation of someone whose coma was caused by brain injury in a car accident. Such an injury can result in one of three outcomes. In the event of a less severe brain injury, with minimal swelling, an individual may indeed recover consciousness and regain all of his or her original abilities. In the event of a more severe brain injury, with swelling that resulted in further pressure on areas of the brain, an individual may regain consciousness, but may have some degree of impairment. The impairment may be physical (such as paralysis of a leg) or may even result in a change in the individual's intellectual functioning and/or personality. The most severe types of brain injury, short of death, result in states in which the 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 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. Patients who have suffered head injuries tend to do better than do patients whose coma was caused by other types of medical illnesses. Leaving out those people whose coma followed drug poisoning, only about 15% of patients who remain in a coma for more than just a few hours make a good recovery. Those adult patients who remain in a coma for greater 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 even after two months in a coma.

BOOKS

Guberman, Alan. An Introduction to Clinical Neurology. Boston: Little, Brown and Co., 1994.

Liebman, Michael. Neuroanatomy Made Easy and Understandable. Baltimore: University Park Press, 1991.

Ropper, Allan H., and Joseph B. Martin. "Acute Confusional States and Coma." In Harrison's Principles of Internal Medicine, ed. Anthony S. Fauci, et al. New York: McGraw-Hill, 1997.

PERIODICALS

Engeler, Amy. "A Life on Hold: What a Coma Really Looks Like." Redbook, July 1996, 72+.

ORGANIZATIONS

American Academy of Neurology. 1080 Montreal Ave., St. Paul, MN 55116. (612) 695-1940. <http://www.aan.com>.

Coma Recovery Association, Inc. 570 Elmont Rd., Suite 104, Elmont, NY 11003. (516) 355-0951.

Rosalyn Carson-DeWitt, MD

KEY TERMS

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

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

Neuron—The cells within the body which make up the nervous system, specifically those along which information travels.

Physiological—Pertaining to the functioning of an organ, as governed by the interactions between its physical and chemical conditions.

Psychological—Pertaining to the mind, its mental processes, and its emotional makeup.

Stimulus/stimuli—Action or actions performed on an individual which predictably provoke(s) a reaction.