12 May

Coma - causes the degree of coma , symptoms, treatment

Contents:

1. Pathogenesis

2. Degrees coma

3. Diagnostics

4. Treatment coma

5. forecast coma

Coma is the most significant degree of pathological CNS inhibition, which is characterized by a profound loss of consciousness, disorders of regulation of vital body functions, as well as a lack of reflexes to external stimuli.

In addition, it is a severe complication of various diseases, so distinguish between many types of comatose states:

  • neurological, caused by a primary lesion of the central nervous system;
  • toxic, are characterized by endogenous or exogenous intoxication;
  • conditions caused by loss of water, energy substances or electrolytes;
  • coma in endocrine diseases that are triggered by a metabolic disorder;
  • condition resulting from a violation of gas exchange.

Pathogenesis

Different in ethology coma, often have a different pathogenesis.In turn, the total for the emergence of all kinds of the coma - a dysfunction of the cerebral cortex and the brain structures that c

ause disorders of consciousness.

in the pathogenesis of these changes play a key role such pathogenetic factors:

  • violation of energy metabolism and cellular respiration in the brain as a result of microcirculation disorders in it (when hypoxemia, anemia, stroke, etc.)
  • electrolyte imbalance;
  • hormonal disorders in the endocrine pathologies;
  • violation of the structure and physical properties of the brain and intracranial structures in traumatic brain injury, increased intracranial pressure, with tumor processes.

thus can cause coma:

  • traumatic brain injury or other;
  • lack of oxygen in the blood (drowning, strangulation);
  • cerebrovascular accident;
  • vitamin deficiencies;
  • alcohol poisoning and Drug Administration;
  • encephalopathy, and cerebellar mass lesion;
  • psychogenic factors;
  • ischemia of the brain stem;
  • metabolic disorders (diabetes, renal failure).

Degrees coma

There are several levels of coma, which differ in the scale of the defeat of the organism and the patient's consciousness.Therefore, coma symptoms will vary depending on its severity:

  • mild (stage I) - the patient is stunned, answers the questions with difficulty, his speech was slurred, possible mental anxiety, loss of coordination of movements with safety conscious reflexes.Breathing hardly changed, there is a slight tachycardia.
  • moderate (stage II) - stunning (somnolence) with a sharp braking response of the patient to strong stimuli, including pain.Also, there is a stupor (deep depression of consciousness), tachycardia, decreased blood pressure.Symptomatic coma at this level is to improve, then the weakening of the tendon reflexes.
  • deep (Stage III) - a state of deep sleep in which patients do not come in contact with others, and their consciousness is lost.At the same time, some patients retained sensitivity to pain, and spasmodic contraction of certain muscle groups.By this stage of coma symptoms include: dilated pupils, shallow, rapid and arrhythmic breathing, blood pressure reduction.
  • extremely deep (stage IV) - an absolute weakness, areflexia, drop in body temperature, deep disorders of autonomic functions.With this degree of coma occur pathological types of breathing, a sharp decrease in blood pressure, disturbance frequency and heart rate.Coma of stage IV prognosis extremely poor.

If the decision to exclude the diagnosis of a neurologist should state that can remind someone (hysterical reactions, overdose of sedatives, normal sleep, the frontal lobe tumor, non-convulsive epilepsy syndrome "locked man").

Diagnostics

coma symptoms suggest a lack of response to external stimuli.The patient falling into a severe coma, loses the ability to respond to both speech addressed to him, and in pain.

Sometimes symptoms of a coma is possible to determine its cause.For example, when oxygen starvation will occur mydriasis and the absence of reaction to light, as in stroke or opiate overdose, the pupils will be greatly narrowed.

Diagnosis is based on the analysis of the characteristic features of a coma, as well as instrumental and laboratory studies.The program of the examination of the patient involves:

  • blood test for toxic substances;
  • urinalysis;
  • detailed biochemical analysis of blood;
  • cerebral computer tomography;
  • electrocardiogram;
  • study of cerebrospinal fluid (in rare cases).

In order to avoid injuries of the cervical spine X-ray of the spine is carried out.To exclude epilepsy, it is desirable to conduct electroencephalography.

Treatment

coma patient is assisted immediately in the hospital and the treatment is carried out of the coma, regardless of its cause.The use tools that support breathing and circulation, as well as cropped vomiting as urgent measures.

In the case of diabetic coma with a high level of blood sugar, insulin is administered to the patient intravenously, and if the sugar level is low, then - glucose solution.

When uremic coma as a result of renal failure, patients underwent a blood purification apparatus of artificial kidneys (hemodialysis).Therapy

injury often requires surgical intervention, blood volume correction and stop bleeding.

In the formation of hematoma in the brain membranes is necessary surgery in the neurosurgical department.

If a patient having seizures, coma, to treat used anticonvulsants.With such a state of coma, which is caused by intoxication, dezintoksitsiruyuschie prescribed drugs, forced diuresis and intravenous fluids.

In the case of drug overdose coma treatment involves the use of an antidote (naloxone, or Narcan).

If hypovitaminosis or alcoholic coma patient intravenous thiamine.

Very often in cases of violations of breathing is performed endotracheal intubation and mechanical ventilation.In the treatment of all types and degrees of coma carry antibiotic therapy, enteral and parenteral nutrition.In addition, as important a thorough patient care due to the high danger of pressure sores.

forecast coma

forecast coma is usually determined by the stage and the cause of the condition.The most formidable is the prognosis of moderate to severe coma.As pointed out by experts, metabolic therapy more easily than the tumor and trauma, so in this case the coma prognosis little better.It is a serious forecast coma when doctors give:

  • brain haemorrhage;
  • renal failure;
  • traumatic coma;
  • eclampsia (a complication of pregnancy).

very important to prevent the occurrence of this condition and soften the severity of his timely appeal for medical help.In these cases, coma treatment may not be necessary, as will be necessary to carry out treatment of the underlying disease, which may be the cause.

Attention!

This article is available exclusively in the educational purposes and is not research material or professional medical advice.

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