Eat (medicine)

In medicine, the coma (from the Greek κῶμα [kôma], which means "deep sleep") is a severe state of loss of consciousness, which can result from a wide variety of conditions including poisoning (drugs, alcohol or toxins), cardiorespiratory arrest, metabolic abnormalities (hypoglycemia, hyperglycemia), heart disease, central nervous system, stroke, head trauma, seizures and hypoxia. Metabolic causes are the most frequent.

Coma is therefore a syndrome. In the International Classification of Health Disorders (ICD-10) it is assigned the letter R (symptoms and diagnoses). The coma is an expression of a strong disorder of the brain functions and therefore with danger of death. The development (prognosis) of the comatose patient is dependent on the underlying diseases and medical care.

Causes

Metabolic disorder – metabolic coma

• Disorder of sugar metabolism.
  • Hipoglucemia
  • Hiperglycemia, Diabetic Coma (see diabetes mellitus)

• O2 deficiency or excess CO2 in the blood.
  • In oxygen reception disorder (airways, lungs)
  • In circulatory collapse (after a few seconds)
• Kidney insufficiency (Uremic coma)
• Hepatic Insufficiency (Hepatic Coma)
• Other metabolic causes (congenital metabolism disorders, mixedema, etc.)
• Hormonal causes (hypophysis insufficiency: Sheehan syndrome, Addison disease, adrenal gland insufficiency, etc.)

Poisoning

• Generally it occurs by accident, although and to a lesser extent, it may be intentional, the excessive use of drugs such as narcotics or alcohol itself are the protagonists, producing the most common, ethylic coma.

• Occasionally it can be produced by poisons, whether natural or artificial.

• When it is medically recommended, to prevent unnecessary movements or efforts by the patient from impeding a healing process, generally from a cerebrovascular accident, the patient is induced into an artificial coma.

• The most common are those caused by allergies.

Pathophysiology

Coma is the product of structural lesions of the central nervous system, such as hemorrhages, tumors, inflammations, edema, etc. It can also be the consequence of a diffuse metabolic or toxic failure that affects the basal nuclei, a complex nervous system located along the brain stem, on which alertness and relationship life depend.

A division has been established according to clinical criteria and corresponds to the reaction to certain stimuli. According to the Classification used, three to four degrees of coma can be distinguished:

• First degree: selective reaction to pain, movement of unaltered pupils, movement of the eyes by stimulus of the organ of the intact balance (vestybulum- ocular reflection).
• Second grade: disorderly reaction to pain, mass movement, bizcar (divergent eye movement).
• Third grade: without defense, only leaky reflexes, missing the hall-ocular reflex, weakened pupil reaction.
• Fourth grade: without reaction to pain, without reaction of pupils, absence of other protective reflections.

In emergency medicine, the Glasgow scale has been established as an aid in decision-making, if it is necessary to apply oxygenation. This scale includes evaluations at the level of ocular response, motor response and verbal response, each with their respective scores. The minimum score that a person in a coma can have is 3 and the maximum score that a healthy person can have is 15, according to this scale.

Forecast

Coma can last from several hours to several weeks. In the most severe cases a coma can last for more than five weeks, while some have lasted for several years. After this time, many patients gradually come out of a coma, others progress to a vegetative state, and still others die. Some patients who have entered a vegetative state are able to regain some degree of consciousness. Others remain in a vegetative state for years or even decades (the longest period on record is 37 years).

The outcome for coma and vegetative states depends on the cause, location, severity, and extent of neurologic damage. A deep coma by itself does not necessarily mean less chance of recovery, as some people in a deep coma have recovered normally, while other people who appear to recover well from a milder coma sometimes stop breathing. improve.

People may emerge from a coma with a combination of physical, intellectual, and psychological difficulties that require special attention. Recovery usually occurs gradually, with patients becoming increasingly able to respond. Some patients never progress beyond very basic responses, but many do regain full consciousness.

Return to consciousness is not instantaneous. During the first few days, patients are awake for only a few minutes, and the duration of awake time gradually increases, unlike the situation in many movies where people who wake up from a coma are immediately able to continue their normal lives. In reality, the coma patient sometimes wakes up in a profound state of confusion, not knowing how he got there, and sometimes suffers from dysarthria, inability to articulate words, and many other disabilities.

Predictions of recovery are variable due to different techniques used to measure the extent of neurological damage. All forecasts are based on stat rates with some level of current recovery chance: a person with a low recovery chance can still awaken. Time is the best general indicator of a chance of recovery. After four months in a coma caused by brain damage, the chance of partial recovery is less than 15%, and the chance of full recovery is very low.

The most common cause of death for a person in a vegetative state is a secondary infection such as pneumonia, which can occur in patients who are in a coma for long periods of time.

People who have come out of a long-term coma

Occasionally people come out of a coma after long periods of time. Here are some known cases:

1. Terry Wallis, 19, in 1984, had a car accident that left him tetraparaplegic in a coma and although the doctors assured that he would never wake up, in 2003, Terry spontaneously began to speak and regained consciousness of his surroundings.
2. Munira Abdulla from the United Arab Emirates woke up from the coma, after 27 years in April 2019. His case gained relevance at the national level thanks to the efforts of his son Omar who got the Crown Prince of Abu Dhabi, Mohammed bin Zayed, to grant the family a grant for a medical program in Germany. He woke up uttering his son Omar's name to whom he protected during the car accident that left her in a coma.

Comas that last a few seconds or minutes result in post-traumatic amnesia that lasts hours to days; a full recovery takes days or weeks. Comas lasting hours to days result in post-traumatic amnesia lasting days to weeks; a full recovery takes months. Those that last for weeks result in post-traumatic amnesia that lasts for months; a full recovery takes years.

Derived terms

Induced or artificial coma

This term is used for sedation or narcosis, which is nothing more than the induction of loss of consciousness by medication. Where it does not necessarily imply total loss of consciousness, it can be applied even with light sedation in order to reassure the patient. This clarifies why some artificially comatose patients have memories and perceptions during this state. In deep sedation, for example with barbiturates (possibly controlled by electroencephalography).

Society and culture

Dr. Eelco Wijdicks investigated the portrayal of the coma in film and was published in Neurology in May 2006. Wijdicks studied 30 films (between 1970 and 2004) portraying actors in a prolonged coma, and came to the conclusion that only two films thoroughly reproduced the state of the victim in a coma and the agony of waiting for a patient to wake up: Reversal of Fortune (1990) and La vie rêvée des anges (1998). The remaining 28 were criticized for portraying miraculous awakenings, no lasting side effects, unrealistic depictions of necessary treatments and materials, and the patients recovered from the coma muscular and tanned.

For decades, medical specialists and others have struggled—and continue to struggle—to define the circumstances in which a patient is 'dead'. Society attaches great importance to the idea of "brain death" because "most industrialized countries have equated this with the death of the person." However, according to Dr. Rady and his coworkers, "human death is a unique phenomenon, characterized by the irreversible cessation of all vital functions (circulation, respiration, and consciousness)." This means that death consists of much more than the inability of the brain to function. For example, even if a patient is "brain dead," he can still be considered alive because he can still grow and reproduce.