The debate about the nature of
consciousness underway since ancient times. This concept refers to the various fields of human knowledge: science, philosophy, religion. From the point of view of medicine, consciousness is a product of higher nervous activity. Consciousness associated with the functioning of the cerebral cortex and certain subcortical structures. The various states of altered consciousness studied psychiatry and neurology. Coma - a state of impaired consciousness caused by the heavy defeat of the bilateral hemispheres of the brain pathology, or the ascending reticular formation of the pons, activating the cerebral cortex through the thalamus.
Coma combines unconsciousness, lack of active movements, reactions to external stimuli, loss of reflexes and sensitivity, disturbance of vital body functions (heart and respiratory activity). Coma is a threat to life and health of the patient. This state is not an independent disease. Such a heavy defeat may have different causes.
It can cause coma traumatic brain or other trauma, stroke, lack of oxygen in the blood (strangling, drowning), poisoning by drugs, alcohol, vitamin deficiencies, encephalopathy, cerebellar volume formation, vitamin deficiencies, ischemia of the brain stem, psychogenic factors, metabolic substances (renal insufficiency, diabetes).
The degree of coma can be different. There are predkomatoznye state - and stupor stupor. The initial stage is usually marked drowsiness - stupor. The patient responds to voice, but it seems all the time sleeping. Questions answered in monosyllables, can perform simple orders. Followed by stupor, when a patient responds to pain stimuli, but does not respond to the voice. With the deterioration of the coma. This characterizes the lack of response to painful stimuli and facing it. The patient does not talk, does not carry out even the simplest orders, he opens his eyes in response to a painful stimulus. GCS is worth an estimated 8 points or less.
By severity who are divided into three levels: mild, moderate and severe
. When coma mild in response to strong pain stimulation motor reactions occur, tendon and pupillary reflexes
. Disturbances of cardiac activity and respiration are mild
. The average degree of coma manifests worsening disorders: motor response to strong pain stimulation disappears, tendon and pupillary reflexes are hardly caused
. Violated swallowing function of the pelvic organs
. A more pronounced respiratory and cardiac pathology
. In severe coma patient's condition is extremely serious: complete muscle atonia, drop in body temperature, absence of reflexes
. Pronounced disorders of the respiratory and cardiac activity
. At the bilateral prefrontal lesions (frontal) sections of the brain (eg, ischemia, hemorrhage, tumor) in a patient retained the appearance of wakefulness, but he did not respond to the surroundings and even painful stimuli
. Neurologist should eliminate some like who states: hysterical reactions, normal sleep, overdose of sedatives, non-convulsive epilepsy, swelling of the frontal lobe syndrome "locked man"
Diagnosis of coma
Symptoms of a coma include the lack of response to external stimuli. Falling into a heavy coma, the patient loses the ability to consistently respond first to the orders, questions, and then pain. In coma symptoms can sometimes determine its cause. When herniation of the temporal bone, and compression of the brain stem is observed dilated pupil reaction to light is missing. This corresponds to a one-sided defeat of the injury. When oxygen starvation pupils will be expanded from two sides, reaction to light will not. If the coma was the result of
overdose of opiates (morphine, heroin) or stroke, the pupils will be greatly narrowed. Respiratory (fast or uryazhenie) is an injury or a brain stem stroke.
Diagnosis is based on characteristic symptoms of coma, laboratory and instrumental studies. The program of the initial examination of the patient in a coma include urinalysis, blood on toxic substances, biochemical blood tests, glucose, creatinine, bilirubin, liver enzymes, thyroid function (thyroid stimulating hormone), electrocardiogram, CT scan of the brain. Sometimes examine the spinal fluid. To eliminate injury of the cervical spine radiography of the spine. To exclude epilepsy electroencephalography recommended.
Treatment of coma
Help the patient is in the hospital immediately
. Treatment of coma depends on its cause
. As a means of urgent measures apply, circulation and respiration, relieves vomiting
. If the basis of the coma are metabolic disorders, requires their correction
. Since diabetic coma with a high level of blood sugar need insulin administered intravenously
. If your blood sugar is low, glucose is injected
. In the case of uremic coma (kidney failure) patients underwent hemodialysis (blood cleansing artificial kidney)
. Treatment often involves trauma surgery, stop the bleeding and correction of blood volume
. When hematomas in the meninges requires surgery in the neurosurgical department
. If the patient has convulsions, coma, used for the treatment of anticonvulsant phenytoin intravenously
. If a coma caused by intoxication, recommended diurez, dezintoksitsiruyuschie drugs, the introduction of fluids intravenously
. If you suspect an overdose of drugs used Narcan or naloxone
. When alcoholic coma or gipovitaminoze intravenous thiamine
. If breathing disorders may require intubation and mechanical ventilation
. Resuscitator selects a suitable mixture of gases frequently preferred higher oxygen content (for example, in the treatment of coma caused by alcohol)
Forecast determined the cause of the coma state and the stage, the most serious prognosis of moderate to severe coma. In most cases, symptoms coma heavier if it is based on lesion stem structures, not the cortex. Metabolic corrected easier than trauma and tumors, however in this case, coma is somewhat better prognosis. The most serious prognosis of coma when apoplexy (hemorrhage in the brain structures), uremic (renal), traumatic and eclamptic (a consequence of toxicity birth abortion) komah.