Coma

Disputes on the nature of consciousness are conducted with ancient times. This concept is related to different areas of human knowledge: to science, philosophy, religion. From the point of view of medicine, consciousness is a product of higher nervous activity of the person. Consciousness is connected with functioning of a cerebral cortex and some subcrustal structures. Various conditions of the changed consciousness are studied by psychiatry and neurology. The coma is the condition of the broken consciousness caused by crushing bilateral defeat of cerebral hemispheres or pathology of the ascending reticular formation of the varoliyevy bridge activating a cerebral cortex through a thalamus.

Coma combines unconsciousness, lack of active movements, reactions to external irritants, loss of reflexes and sensitivity, disturbance of the vital functions of an organism (cordial and respiratory activity). The coma represents threat for life and health of the patient. This state is not an independent disease. Such severe defeat can have the different reasons.

To a coma craniocereberal or other injury, disturbance of cerebral circulation, lack of oxygen can bring into blood (a suffocation, drowning), poisonings with drugs, alcohol, hypovitaminosis, encephalopathy, volume formation of a cerebellum, hypovitaminosis, brain trunk ischemia, psychogenic factors, disbolism (a renal failure, diabetes).

Degree of a coma can be different. Mark out precomas – a sopor and a stupor. The expressed drowsiness - a sopor happens an initial stage usually. The patient reacts to a voice, but it seems sleeping all the time. Answers questions in monosyllables, can execute the elementary orders. Further the stupor when the patient reacts to painful irritants follows, but does not react to a voice. At an aggravation of symptoms there comes the coma. To whom characterizes lack of reaction to painful irritants and the turned speech. The patient does not talk, does not execute even the elementary orders, does not open an eye in response to a painful irritant. On a scale of Glasgow it is a condition it is estimated in 8 points and less.

On weight to whom divide into three degrees: easy, average degree and heavy. At coma of easy degree in response to strong pain stimulation there are motor reactions, tendon and pupillary jerks. Disturbances of cordial activity and breath are expressed poorly. Average degree of a coma is shown by aggravation of frustration: motor reaction on strong pain stimulation disappears, tendon and pupillary jerks are almost not caused. Swallowing and function of pelvic bodies are broken. Are more expressed respiratory and cardiac pathology. At heavy degree of a coma a condition of the patient extremely heavy: full atony of muscles, temperature drop of a body, lack of all reflexes. Disturbances from breath are sharply expressed and cordial activity. At bilateral defeats of prefrontal (frontal) departments of a brain (for example, at ischemia, hemorrhage, a tumor) at the patient visibility of wakefulness remains, but it does not react on surrounding and even painful irritants. The neurologist has to exclude some states, similar to a coma: hysterical reactions, a normal dream, overdose of sedative drugs, convulsiveless epilepsy, a tumor of a frontal lobe, a syndrome of "the locked person".

Diagnosis of a coma

Symptoms of a coma include lack of reaction to external irritants. Felling into a heavy coma, the patient consistently loses ability to react at first to orders, questions, then and pain. Sometimes it is possible to determine its reason by coma symptoms. At a vklineniya of a temporal bone and a prelum of a brainstem the mydriatic pupil is observed, the photoharmose is absent. This hemilesion also corresponds to the party of an injury. At air hunger pupils will be expanded from two parties, the photoharmose will not be. If the coma turned out to be consequence of overdose by opiates (morphine, heroin) or a stroke, then pupils will be strongly narrowed. Breath disturbances (increase or an uryazheniye) happens at an injury or a stroke of a brainstem.

Diagnosis is based on characteristic symptoms of a coma, laboratory and tool researches. The program of initial inspection of the patient in coma includes the analysis of urine, blood on toxic substances, biochemical analysis of blood with determination of level of glucose, creatinine, bilirubin, liver enzymes, a research of function of a thyroid gland (thyritropic hormone), the electrocardiogram, a computer tomography of a brain. Sometimes investigate cerebrospinal fluid. For an exception of an injury of cervical department of a backbone carry out a backbone X-ray analysis. For an exception of epilepsy the electroencephalography is recommended.

Treatment of a coma

Help to the patient is given immediately in hospital conditions. Treatment of a coma depends on its reason. As urgent measures apply the means supporting the blood circulation and breathes stopping vomiting. If exchange disturbances are the cornerstone of a coma, their correction is required. So at a diabetic coma with the high level of sugar of blood it is necessary to enter intravenously insulin. If sugar level low, then is entered glucose solution. In case of an uremic coma (renal failure) to the patient carry out a hemodialysis (blood clarification by the artificial kidney). Treatment of an injury most often means an operative measure, a stop of bleeding and correction of volume of the circulating blood. At hematomas in covers of a brain operational treatment in the conditions of neurosurgical department is required. If the patient had spasms, for treatment of a coma use anticonvulsant drug Phenytoinum intravenously. If coma is caused by intoxication, the artificial diuresis, dezintoksitsiruyushchy drugs, administration of liquid intravenously is recommended. At suspicion on overdose of narcotic substances Narcanum or Naloxonum is used. At an alcoholic coma or a hypovitaminosis intravenously enter thiamin. At disturbances of breath the intubation of a trachea and artificial ventilation of the lungs can be required. The resuscitator selects suitable mix of gases, often preference is given to the increased content of oxygen (for example, at treatment of the coma caused by alcohol).

Forecast of a coma

The forecast of a coma is defined by the reason and a stage of a state, the forecast at average and heavy degree of a coma is most serious. Most often symptoms of a coma it is heavier if defeat of trunk structures, but not a cerebral cortex is the cornerstone. Disbolism are adjusted easier, than injuries and tumors therefore in this case the forecast of a coma is slightly better. The forecast of a coma at an apoplexy is most serious (hemorrhage in structures of a brain), uraemic (renal), traumatic and eklampsichesky (a consequence of toxicosis of pregnancy on late term) koma.