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Patient education: Coma (The Basics)

Patient education: Coma (The Basics)

What is a coma? — A coma is a deep state of unconsciousness. A person in a coma:

Looks like they are asleep

Cannot be woken up

Cannot move on their own

Does not respond to pain or react when spoken to, touched, or shaken

People in a coma sometimes twitch, move a hand or finger, or make faces or sounds, but that does not mean that they are aware, awake, or in control.

What causes a coma? — A coma can be caused by anything that disrupts normal brain function. Some of the most common causes include:

Head injury

Stroke or bleeding in the brain

Brain tumors

Very low blood sugar or other chemical imbalances in the body

Poisoning, or drug or alcohol overdose

Lack of oxygen or blood to brain, which could happen if a person's heart stopped or if the person almost drowned

Infections such as meningitis or encephalitis

Seizures

How do doctors find the cause of a coma? — If a person is unconscious, their doctors and nurses will review the medical history. This includes learning about their health conditions and any past problems or symptoms. They will also do an exam to see how the person responds to touch and pain. This helps show if their reflexes are normal, including how their eyes respond to light.

Then, the doctor or nurse might order tests, such as:

Blood tests

Imaging tests of the brain – These tests create pictures of the brain and can show if any parts of the brain are damaged. Examples of these tests include CT scans and MRIs.

Electroencephalogram ("EEG") – This test measures the electrical activity in the brain. It can measure brain waves, and shows whether a person is asleep or unconscious and whether they are having seizures.

Lumbar puncture (also called a "spinal tap") – For this test, a doctor puts a thin needle into the person's lower back and removes a small amount of spinal fluid. Spinal fluid is the fluid that surrounds the brain and spinal cord. The spinal fluid goes to the lab for tests.

How is a coma treated? — The only way to get a person out of a coma is to reverse the condition that caused it. That is not always possible. For some conditions, treatment needs to be given right away to prevent death and permanent brain damage.

When a person is in a coma, doctors use machines to monitor their "vital signs." These include breathing, blood pressure, and heart rate. That way, the medical team can respond right away if anything goes wrong. Some people who are in a coma need to be put on a machine that breathes for them, called a "ventilator."

People in a coma also:

Get medicines to help control basic body functions, such as blood pressure, heart rate, and body temperature

Get fed through a thin tube that goes into a vein (called an "IV") or through a stomach tube

Get moved every so often so that they do not develop sores on their body

Have routine blood tests, so the doctors and nurses can look for signs of infection or other problems

Have their reflexes and responses to pain checked every so often

Have their temperature checked

How long can a coma last? — Most people who are in a coma come out of it in 2 to 4 weeks. Coma is not a permanent condition and does not usually last more than several weeks. Patients either recover completely or partially, or die.

Some people with severe brain injury transition from a coma to something called a "persistent vegetative state." Doctors also use the term "unresponsive wakefulness syndrome." In this state, people have brain activity suggesting that they go to sleep and wake up, but otherwise seem like they are in a coma.

More on this topic

Patient education: Head injury in adults (The Basics)
Patient education: Pressure sores (The Basics)
Patient education: Advance directives (The Basics)
Patient education: Medical care during advanced illness (The Basics)

This topic retrieved from UpToDate on: Feb 02, 2024.
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