A coma is a state of deep unconsciousness that a person cannot be woken from. A person in a coma cannot react to events in the environment.
Information about your environment is normally passed from the brainstem into the rest of the brain. This feedback allows a person to be aware of and react to the environment. A coma is caused by a breakdown in this system.
Brainstem and Cerebrum
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The system may be interrupted by:
Risk factors for coma include:
Risk factors for brain injury include:
Symptoms of a coma include the following:
Since the patient cannot speak, the doctor will need to gather information from other sources. The doctor may need to speak to friends, family members, and people who witnessed the accident. This is important to help with diagnosis. The doctor will also need to know about the person’s medical history and any drug or alcohol use. It is important to provide honest information in order to help with treatment.
The doctor will test reflexes, listen to breathing, and examine the eyes. A physical exam will also be done including tests of the nervous system. In addition, the following tests may be done:
Clinical findings of comatose patients can be rated according to the Glasgow Coma Scale (GCS). This scale assesses three different functions: eye opening, motor response, and verbal response. Scores can range from 15 to 3. A lower score indicates less responsiveness. Scores are interpreted as follows:
A coma is a medical emergency. Any unconscious person should be taken to the emergency room immediately.
Doctors will work quickly to determine the cause of the coma. Further treatment will depend on the cause of the coma. Supportive care may include:
If a specific cause of the coma is suspected, supportive care may also include:
In some cases, surgery may correct the cause of a coma.
If the coma persists after emergency care, ongoing care may be needed. Once the person is stabilized, treatment will focus on providing nutrition and preventing infections. The care staff will also work to prevent bedsores .
The following can help decrease your risk of coma:
Brain Injury Association of America
Coma Recovery Association, Inc.
Brain Injury Association of Canada
Ontario Brain Injury Association
Berger, JR. Stupor and coma. In: Bradley WG, et al, eds. Neurology in Clinical Practice . 5th ed. Philadelphia, PA: Butterworth Heinemann Elsevier; 2008.
Braunwald E. Harrison's Principles of Internal Medicine . 15th ed. New York, NY: McGraw-Hill; 2001.
Coma. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated February 20, 2012. Accessed August 31, 2012.
Hall JB, Schmidt GA, Wood L. Principles of Critical Care . 3rd ed. New York, NY: McGraw-Hill; 2005: chap 67.
Last reviewed December 2013 by Rimas Lukas, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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