Why a person falls into a coma possible reasons. Are there coma qualifications? Consequences of coma

By definition, coma is a state characterized by a complete loss of consciousness. A person in a coma has no active movements, the process of breathing and cardiac activity is disturbed. Often, doctors and relatives of the patient are faced with the question of whether a miracle should be expected, or whether the patient should be disconnected from the life support apparatus and allowed to do so. However, a person in a coma can be much more alive than it seems.

The patient is more alive than dead

A person lying in a coma, as a rule, is visited by relatives and relatives. They read to him, tell him the latest news and events from their lives. Outwardly, the patient does not react in any way to their presence, but if you connect special equipment, a different picture emerges. For example, scientists have discovered an interesting phenomenon in a young man who fell into a coma after a serious accident and resulting head injuries. Whenever an unfortunate motorcyclist came to visit a loved one, the patient began to beat more often, which was recorded by the equipment. Subsequently, when the young man began to recover, it was the presence that had a beneficial effect on him and contributed to recovery.

Paying attention to the brain of those lying in a coma, you can also find that it is not. Based on ripple changes, patients respond to the presence of loved ones, as well as what they say to them, according to research conducted at the University of Tübingen in Germany. Every fourth person has this ability. Hugs or touch also affect heart activity and brain activity. The more pronounced such reactions are, the more chances the patient has to get out of the coma.

Responding to the words of others and external stimuli, as well as experiencing emotions depending on their content, is capable of not only people lying in a coma, but also patients under anesthesia. A curious incident occurred in a German clinic during an operation on a particularly obese patient. While he was unconscious on the operating table, the doctors took the liberty of making a couple of jokes about his extra weight. Waking up

Coma is a very serious phase of the disease, which is completely unpredictable. After all, it has not yet been clearly studied what a person feels during a coma, what determines its duration. Also, no one can predict what the consequences of such a difficult development of events will be.

The word "coma" in Greek means "deep sleep, drowsiness." It is characterized as a loss of consciousness, a sharp weakening or loss of reaction to external stimuli, the extinction of reflexes, etc.

A coma develops as a result of inhibition in the cerebral cortex with spread to the subcortex and other parts of the nervous system. Typically, the main reason for the development of coma is a violation of blood circulation in the brain due to head trauma, inflammation affecting the brain, etc.

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Causes of coma

The causes of coma can be very diverse. So, for example, a person can fall into an immobilized and insensible state due to serious damage to both the head and brain, as a result of infection with a serious viral infection such as meningitis, lack of oxygen in the brain for a long time, poisoning with any drugs or chemicals. , as a result of alcohol intoxication, etc.

Of course, you should not think that if some event from the specified list has occurred, this will immediately lead to the development of a coma. Each person has an individual risk of developing such a pathology as a coma.

In general, the mechanism for the appearance of coma as a result of one of these reasons is quite simple: part of the brain cells wipes and ceases to function, as a result of which a person loses consciousness and falls into a coma.

Types of coma

Coma is divided into several different degrees depending on the severity of the patient's condition. As a rule, it is divided into 3 main types:

deep;

Just a coma;

Surface.

In general, who in medicine is divided into 15 degrees. However, about 5 of the most basic ones can be distinguished from them, which, as a result, are reduced to 3 main states.

In the first case, we are talking about a situation where the patient does not come to his senses at all and does not react in any way to any stimuli. At the same time, he does not make sounds, does not respond to the voice and touch of even the closest.

With a normal coma, the patient may make any sounds and even spontaneously open his eyes. However, he is not conscious.

Superficial coma is characterized by the fact that the patient, being unconscious, can open his eyes in response to a voice. In some cases, he can even pronounce certain words and answer questions. In fact, speech is mostly incoherent.

The exit from a coma is characterized by a gradual restoration of the nervous system and brain functions. As a rule, they return in the order of their oppression. First, the pupils begin to react, then consciousness returns.

Effects

On average, the coma lasts 1-3 weeks. However, there are cases when it lasted for a longer time - people can lie unconscious for years.

The return of the patient to consciousness occurs gradually. First, he comes to his senses for a couple of hours, then this time increases more and more. As a rule, the body goes through several different stages during this time. And on how he copes with the burden placed on him, depends on what the consequences will be.

Since the brain is affected in a coma, one should be prepared for the fact that the patient may not recover many vital functions. So, for example, quite often people cannot walk, talk, move their arms, etc. Naturally, the severity of the damage directly depends on the degree of coma in which the patient has been. So, for example, after a superficial coma, you can recover an order of magnitude faster than after a normal one. The third degree, as a rule, is characterized by almost complete destruction of the brain. So, there is no need to wait for good recovery results.

Among the most common problems faced by a person who has been in a coma are memory impairment, decreased attention, and various changes in behavior (lethargy, aggressiveness, etc.). Sometimes relatives do not even recognize a person close to them.

Also, after a coma, many patients restore household skills for a long time. For example, they cannot eat on their own, wash themselves, etc.

One of the signs of recovery and recovery of a person after a coma is the desire for some kind of activity. However, in this case, you should not be too happy and immediately give the patient the maximum load - too abrupt return to normal life can negatively affect his condition and lead to a noticeable deterioration in well-being.

Naturally, you should be prepared for the fact that you will have to spend a lot of effort on recovery. The list of important rehabilitation activities includes gymnastics (to restore motor skills), maintaining hygiene, proper nutrition, walking, good sleep, taking medications and regular consultations with a doctor.

What are the consequences of coma

How to understand the degree of unconsciousness of a person, can he hear, experience any feelings in response to what is happening, or has he become like a plant organism, to which any help is useless?

Today, the world receives support for euthanasia, or the voluntary departure from the life of incurable patients, in whose condition it is impossible to diagnose prospects for improving health or hopelessness.

To continue thinking about this topic, for a start, apparently, one should give a more precise definition of what a coma is, name its causes, and understand in which situations there is hope for an improvement in the patient's condition, and in which it is not. Today, the criteria for recovery are changing, so we are not indifferent to the topic of recovery.

Coma (from the Greek koma - a state of drowsiness, deep sleep) is an unconscious state and a threat to life, under the influence of which a person almost does not show any reactions to the world around him. Reflexes weaken and disappear, breathing is disturbed - both frequency and depth, vascular tone becomes different, the pulse changes to more frequent or slower, the temperature regulation mode suffers.

The causes of this condition are very different, but their consequence is a strong inhibition in the area of \u200b\u200bthe cerebral cortex, which extends to the subcortex and other parts of the central nervous system. Inhibition of this type occurs due to acute circulatory failure of the brain, trauma, inflammation (malaria, encephalitis, meningitis), carbon monoxide poisoning, and can also occur when hepatitis, uremia, diabetes mellitus.

Usually, a precoma can occur before a coma, in which the symptoms of inhibition in the cerebral cortex increase, an acid-base balance of the nervous tissue is disturbed, oxygen starvation occurs, energy starvation of nerve cells, and ion exchange deviates from the normal level.

The unpredictability of a coma is that it can come on for several hours and end without a trace, or it can “not let go” for several years. The duration of this state distinguishes coma from fainting, which lasts for a few minutes.

Doctors often find it difficult to determine the cause of a coma. Who can be characterized by the rate of development of the disease. Coma can occur spontaneously as a result of an acute vascular disorder in the brain, and if a gradual decline in a person’s strength is observed, these are manifestations of infectious diseases. Manifestations of coma look even slower in case of endogenous poisoning, diabetes, diseases of the liver and kidneys.

Coma-like condition

Specialists who manage patients who have fallen into a coma consider many nuances before making a final diagnosis of "coma". After all, there are a number of other similar conditions. This includes the “locked-in syndrome”, when the patient suffers from paralysis of the facial, masticatory and bulbar muscles and is unable to respond to the outside world. This syndrome occurs as a result of damage to such a part of the brain as the base of the pons. The patient is able to move his eyeballs, and nothing more, but at the same time he is fully conscious.

In the described state, there is much in common with the symptoms of those suffering from akinetic mutism, who are also conscious and track the movements of surrounding objects with their eyes. Only the bodily movement of these patients is limited due to tumors, injuries, vascular lesions of some areas of the brain. In this regard, until now, the distinguishing feature between the states of coma and akinetic mutism is precisely consciousness. Currently, these criteria may vary, and we will consider a little later. why.

Exit from a coma and consequences

Not everyone has to come out of a coma, unfortunately. It happens that this condition lasts for years, and at the same time, brain damage is so complex that hope for recovery is lost. Relatives, together with doctors, decide the issue of disconnecting the patient from life-supporting drugs and systems.

In some cases, the patient successfully comes out of a coma, but lingers in another unfavorable state, which can be characterized as vegetative: the person is awake, but all his perceptual functions have been lost. Such a patient can sleep and wake up, breathe normally, his heart and internal organs do not fail, but he does not move, does not speak, does not respond to sound stimuli. In this state, the patient can stay for months, but the prospects are disappointing: often death occurs from infection or pressure sores. A vegetative state can come from a global lesion of the anterior region of the brain, sometimes the brain is completely turned off. This state is a sufficient reason to disable support systems.

Despite all this, comatose patients have a chance of recovery. This is accompanied by the correct method of treatment and favorable data. With the exit from the coma, the central nervous system begins to recover with its autonomic functions and reflexes. An interesting fact is that recovery occurs in ascending order. Often the recovery process proceeds through clouded consciousness or delusional manifestations occur, in which there is discoordination of movements, convulsions. When the ability to live a full life returns to a person, it becomes important how thorough the care behind him all this time. After all, if the muscles have atrophied, bedsores have formed, then additional treatment will be required.

Happy occasions: life after a coma

One cannot keep silent about the fact that the experience of medicine is full of successful cases of getting out of a long coma. It is worth saying that most of the cases were recorded abroad.

In 2003, Terry Wallis (American) was revived from a 19-year coma after a car accident.

In 2005, Don Herbert, a firefighter, came out of a coma after 10 years of being in it after 12 minutes of asphyxiation.

2007 - the exit from the coma of Jan Grzebski, a citizen of Poland, who had been in it for 18 years. Grzebski ended up in a coma after he was injured in a train accident. His wife did not leave him for a single day, and he happily got out of this state without bedsores and muscle atrophy. He had to learn a lot of news at once - that his children got married, that he had 11 grandchildren, and not only that ...

Chinese woman Zhao Guihua fell into a coma for 30 years and woke up in November 2008. The husband of this woman was constantly nearby and kept in touch with her - uttered affectionate words, talked about current events. It seems that his support had a positive effect on the patient's condition: as recent studies show, many comatose patients retain hearing and the function of understanding what they heard. This fact changes the whole idea that a person in a coma is a person without consciousness.

New Research

The problem of coma requires thorough research and work, because to make a mistake means to pay with the life of a person. In countries where euthanasia is allowed (disconnecting an unconscious patient from support systems), in accordance with the wishes of the patient or his close relatives, a person could come to his senses. Disconnection from life support systems occurs after the person himself makes a request for voluntary departure from life in advance. Most people and medical professionals around the world have a negative attitude towards euthanasia.

The German-Belgian Group, whose activities are devoted to the study of coma, headed by Professor Stephen Loris, conducted a study based on computer diagnostics. A special program was developed that reads the data of encephalograms of different groups of people - patients in a state of coma and ordinary healthy people participating in the experiment. Encephalograms were built on the basis of the patients' responses to simple questions, where each patient chose the correct answer by answering "yes" or "no", "stop", "forward". The results of studies of patients in a coma were amazing - three out of ten patients gave the correct answers to the main part of the questions! It follows from this that the knowledge of medicine in the field of a coma of a person is not complete, and there are many nuances regarding coma. In the future, there is hope for an accurate diagnosis through contact with patients, to determine the chances of recovery from a coma and to find out the needs of patients - what they are concerned about and whether they are satisfied with the care.

The results of the study were announced at the conference of the European Neurological Society and received the highest marks from scientists from other countries.

What do Russian doctors think about this study? This question was asked in the end to Dr. Efremenko. The doctor believes that in the field of coma research, science is only on the shores of an endless ocean of knowledge, and specialists conducting research in this area have not yet plunged into it in order to have the right to make important decisions about the fate of patients. It is necessary to have comprehensive information about the coma and the vegetative state in order to assert something.

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nebolei.ru »About health

Coma is an extremely difficult condition for the patient, which is characterized by the absence of almost all reflexes and the extinction of the vital processes of the body. However, if earlier a coma could only mean the imminent death of a person, today's advances in medicine make it possible to maintain life, including in the later stages of a vegetative state, and even return the patient to consciousness.

In a coma, a person can spend quite a long period of time, so after leaving the coma, the patient begins a long way to restore lost skills and reflexes.

Types and stages of coma

Coma can be caused by various reasons. It does not occur as an independent disease, but is a complication of a number of diseases.

The following types of this condition are divided:

cerebral coma, which occurs when the functions of the central nervous system associated with brain damage are suppressed (this includes coma after traumatic brain injury - traumatic, and strokes - apoplectic).
endocrine coma, which develops as a result of both a lack and an excess of hormones or an overdose of hormonal drugs (diabetic, hypothyroid, etc.).
toxic coma in case of poisoning with various poisons or intoxication of the body as a result of kidney, liver failure, etc. (this class includes alcoholic, uremic, barbituric coma, etc.).
hypoxic due to respiratory depression.
Coma as a reaction of the body loss of water, electrolytes and energy (starvation coma).
Thermal coma caused by overheating of the body.

A person can fall into a depressed state both instantly and over time (sometimes up to several hours and even days). Specialists classify the precoma state (precoma) and four stages of coma. Each stage has its own characteristics.

Precoma. Confusion of consciousness, lethargy, or, on the contrary, extreme excitement, poor coordination, but with the preservation of all reflexes;
I degree. Stupor, decreased reactions to external stimuli (such as pain, sound), increased muscle tone. In this case, the patient can make separate movements - swallowing food, turning. When checking the reaction of pupils to light, defocusing of vision, movements of the eyeballs from side to side can be observed.
II degree. Stopper, lack of contact with the patient, an even more significant decrease in reactions to external stimuli, pupils almost do not react to light, hyperventilation, spastic muscle contractions, fibrillation.
III degree. The so-called atonic coma. The patient is unconscious, there are no reflexes. Characterized by respiratory arrhythmia, lowering blood pressure, lowering the temperature, involuntary defects.
IV degree. Outrageous coma. It is characterized by mydriasis (dilated pupil), hypothermia, cessation of breathing and a sharp drop in blood pressure. The most common consequence is death.

Important!
Sometimes doctors intentionally put the patient into a coma (called an artificial or drug-induced coma). This is done to protect the body and brain from irreversible damage. Also, this method is used when urgent neurosurgical operations are required. For introduction into a coma, either a certain anesthetic is used, or the patient's body is cooled to 33 degrees.

First aid

The first aid to the patient in case of suspicion of whom should be an immediate call to the medical service, as well as measures to place the patient in comfortable conditions. It is necessary to ensure that the patient's tongue does not block the passage to the respiratory tract. For this person, if possible, turn to the side.

The conclusion from a coma should be handled by specialists. If the measures to save the patient are successful, the patient will have a long rehabilitation period (and the longer the person spent in a coma, the longer the recovery period).

Treatment and recovery after coma

The rehabilitation period after a coma is extremely important to take place under the supervision of doctors, otherwise it can drag on for years, and at the same time, the prognosis, initially positive, may worsen. That is why it is recommended to undergo a rehabilitation course in a specialized rehabilitation center. For example, in the "Three Sisters" the patient will be provided with round-the-clock care by highly qualified medical staff and doctors of various specializations. The patient will have at his disposal not only a comfortable room equipped with the necessary medical equipment, but also all the possibilities of rehabilitation therapy: physiotherapy, erotherapy, massage, exercise therapy. Relatives can always come to the patient, and if desired, even live or visit the patient in the room. "Three Sisters" will help you return to an active full life even after the most severe traumatic brain injuries, strokes and other serious diseases and conditions.

Modern advances in medicine give a chance to survive to many of those who fifteen years ago were doomed to die immediately. But for some, this salvation turns into a real disaster, from which neither relatives nor doctors can save them. The head of the department of neurosurgical resuscitation of the Sklifosovsky Research Institute for Emergency Medicine, Doctor of Medical Sciences Sergey Tsarenko reflects on the moral and ethical problems in neuro-resuscitation.

Coma

- Sergei Vasilyevich, people often come to you in a coma. But there are other states that are similar to a coma only externally. For example, a lethargic dream. Although its nature is probably quite different.

Indeed, lethargic sleep is not a coma, but a protracted psychogenic reaction. At first glance, she looks like a coma. However, there are two or three relatively simple neurological tests by which any neuroresuscitator will distinguish him from a coma.

- Distinguish, but not be able to help?

It's not his part. We need a psychiatrist here. It is necessary to introduce a neuroleptic - and the patient will come to his senses for a while. Then he needs to be treated with psychotropic drugs.

- Or can a person sleep in this way for a long time outside the field of view of doctors?

Can not. It must at least be watered and fed through a gastric tube or intravenous catheter. Otherwise, the person will die within a week.

-What other reasons can cause a coma?

Coma can occur in the course of an infectious disease, in particular, meningitis. Sometimes, you know, diabetic coma. Coma often accompanies cerebral stroke and traumatic brain injury.

Work for the brain

- With the recent number of strokes and injuries, the cause you serve is extremely important. How would you define its essence?

The ideology of salvation is simple: start helping immediately. And this immediacy does not consist in introducing some kind of saving fast-acting medicine, but in ensuring an adequate supply of oxygen to the patient's brain. Only in this way can his defeat be stopped.

Patients come to us, as a rule, in a coma. In a coma, the patient most often breathes normally. But the function of the brain is so affected that the normal amount of oxygen in the blood is not enough for it. A larger amount is provided only by artificial ventilation of the lungs. One of the features of neuroresuscitation is that artificial ventilation treats not only the affected lungs, but also the brain!

Another task of resuscitators is to increase blood flow to the brain. To do this, the patient is injected with liquid as aggressively as oxygen. In addition, intensively increase blood pressure with drugs. All this is done with one goal: to ensure the flow of oxygen-rich blood to the brain. But we all know what high blood pressure can do to the brain. So there is a risk. The resuscitator has to "play on the verge of a foul." But there is no other way, otherwise the patient cannot be saved.

Artificial ventilation of the lungs is carried out with the help of special devices. The first in our country was created back in the 60s specifically for Academician Landau, who was in a car accident. His students and friends copied and improved the Swedish Engstrem apparatus. This RO apparatus of ours was recognized as the best in the world in 1960. Unfortunately, little has changed since then. And many clinics are still equipped with such devices.

- What devices do you use?

Our clinic is now well equipped. Artificial ventilation devices are so "smart" that they independently adjust to the rhythm of the patient's breathing and supply him with oxygen at the very moment when he takes a breath.

- It turns out that effective neuroresuscitation is carried out only in your department?

15-20 years ago, 60-70% of patients died from severe traumatic brain injury. Today - 30-35%.

Not only. There are specialized neuroresuscitation units in Moscow at the Burdenko Institute of Neurosurgery, in St. Petersburg at the Military Medical Academy and at the Polenov Institute of Neurosurgery. In addition, there are clinics in large cities where effective neuroresuscitation care is provided by general intensive care units. But a common misfortune throughout Russia is the low saturation of control and diagnostic equipment: there are few devices for performing computed tomography of the brain, magnetic resonance imaging. Without them, the state of the brain is difficult to assess. But it is so important to know where the blood has accumulated, on which parts of the brain it presses, where the brain is shifting, how effective the therapeutic actions are. It is on this information that the neurosurgeon's tactics are based. And the sooner he receives this information, the greater the likelihood of a positive outcome of the operation. Both in trauma and stroke, brain cells die quickly, and as a result, even if the patient survives, his quality of life is greatly reduced. At best, an arm or leg is immobilized, at worst, intelligence or memory is reduced.

- You say: procrastination is like death. It turns out that the ambulance should intervene aggressively. Are the machines equipped for this task?

Unfortunately, in practice this can only be done by a special team - an intensive care team. There are many of them in Moscow, but still not enough. Therefore, now we are striving to ensure that each ambulance team is prepared for a complex of resuscitation measures and is appropriately equipped. Its task is to deliver the patient to the hospital as soon as possible, providing an enhanced supply of blood and oxygen to his brain along the way. Need to reorganize and emergency hospitals. Our institute is an example of a modern emergency center: we have all round-the-clock diagnostic services, operating rooms, intensive care units. Although there are also enough problems, and not the last - the lack of personnel. Too hard work, too low wages...

After the operation, it is also important to use the entire arsenal of means for monitoring the patient's condition that is available today. Based on the modern requirements of science, a neurosurgeon inserts a special sensor into the skull during the operation to constantly monitor the dynamics of the patient's brain edema in the postoperative period. But due to the lack of equipment, only a few specialized centers regularly practice this technique. Also important is information about the sufficiency of oxygen saturation of the brain, the state and work of the heart. This data is also monitored continuously. On the monitor at the head of the patient - all the information that allows you to provide adequate assistance to the operated patient.

- And it helps to avoid complications?

If the patient was treated in this way at all stages, there is hope that many of the problems usually associated with a stroke or brain injury will bypass him. Otherwise, it will take longer to recover. And this means that he is longer in intensive care.

Hole in the skull

- What other treatments are used to treat brain injury?

During some neurosurgical interventions, for example, for craniocerebral injuries, in the postoperative period, the brain swells very much, and the volume of the skull seems to be not enough for it. This edema can persist for a long time, and the consequences can be serious. To reduce the resulting pressure on the brain from the side of the skull, the surgeon sometimes removes part of the bone and sews it between the muscles of the patient's thigh.

- What for?

Then take it out and put it back in place.

- The thigh is used as a storage room? And nothing happens with this piece?

This piece in the muscles of the thigh is perfectly preserved, except that it slightly decreases in size. But this is immaterial. Later, sewn into place in the skull, it works as a base for tissue growth. The bone begins to grow later - from the periphery to the center.

- And how long does this piece of bone lie in the thigh?

From a month to six months.

- And all this time the patient walks with a hole in his head?

It is acceptable. It is important to avoid direct injury to an unprotected area. By the way, native bone is not always used to heal a skull defect. Sometimes they put a titanium or plastic plate, it then grows with its own bone tissue.

- Everything you said seems to be top notch. That is not typical for the whole country. Or is the death rate from craniocerebral injuries decreasing across the country? Are there any statistics on such deaths?

It is the statistics that show that in the country the results of medical intervention for traumatic brain injuries are changing for the better. 15-20 years ago, 60-70% of patients died from severe traumatic brain injury. Today - 30-35%, in the best clinics - 20, and among children - 10-12 at all. If you remember that only in Moscow there are about 5,000 victims of severe traumatic brain injury per year, you can imagine how many lives can be saved. And how much more can be saved with sufficient equipment of diagnostic and monitoring equipment and medicines.

- Do the survivors fully recover?

If out of 10 victims 8 survive, then 5-6 of these 8 return to work. But something in them is still changing. As a rule, memory decreases, the ability to learn, emotional disorders may begin. True, we had a patient from alcoholics. Before the injury, he was aggressive, and after discharge, according to his wife, he became calm and kind. But most patients, even those who are quite kind in life, usually come out of a coma through a state of aggression.

- And how long does it last?

Differently. More often a few days. But if, for example, the frontal lobes of the brain are injured, the state of aggression can last for several weeks. Moreover, aggression is so strong that it is necessary to fix arms and legs with special devices so that a person does not injure himself. However, patients do not remember this later. They generally do not remember their stay in the intensive care unit, even if they were conscious and were able to communicate with doctors and relatives. This is a defensive reaction of the brain - it prefers to spend the minimum energy that it has on recovery, and nothing else.

Vegetative state

How long can a person be in a coma?

It is believed that if within a month the brain has not recovered to such an extent that it is able to perceive this world, it means that some serious changes have occurred in it.

- And there is no way to bring him out of a coma?

Strictly speaking, no "anti-comic" drugs have yet been invented. This does not mean that there are no promising drugs. But, unfortunately, the effects of most of the drugs proposed to date have not yet received sufficient clinical confirmation. All the efforts of doctors are reduced to preserving the largest possible number of brain cells in a coma, and creating conditions for it to still begin to function. The art of neuro-resuscitation is to most successfully replace temporarily lost brain functions at all stages of resuscitation.

- And if this does not happen in a month?

Then we qualify his condition as vegetative. Journalists dubbed such people "vegetables." Doctors consider the use of this term unethical. In such patients, most of the functions of the body are preserved, they can open their eyes, make some slight movements, but are not able to contact the outside world.

- And it's irreversible?

Some of those in a vegetative state are slowly but surely coming out of it. Sometimes specially designed measures to increase the external flow of information help - they talk to the patient, turn on music, take them out to the balcony or street. If at the same time nothing changes within three months, the prognosis is very poor. Theoretically, if such a patient is fed, watered, provided with sanitation of the lungs, protected from bedsores, he can live indefinitely, but only in the conditions of intensive care units.

It would be better for these people to have special institutions, as in many other countries. In our country, they lie “over the state”, that is, there are no additional staff units for their treatment. Therefore, the staff does not have time to pay enough attention to them, trying first of all to save newly admitted emergency patients, because they are in greater danger. This does not improve the life prognosis of those in a vegetative state at all.

And some people live like this for a year, two, ten. But what next? In my opinion, the fate of such patients should be decided by relatives. And document your decision. As it is done in America, England, and half of Europe too. If their will is to save a loved one from further suffering, he is disconnected from all devices. To avoid pain, narcotic analgesics are administered. And the patient dies quietly.

We have such a scenario - an unaffordable luxury. The doctor, seeing that the patient is hopeless, could decide to stop supporting his life, but in this case he will inevitably break the law.

- Yes, you will not envy this patient.

- And who can act as donors?

These may be patients who have recorded brain death (legally, it is equated to the death of the body). As well as patients with irreversible cardiac arrest. Unfortunately, the legal framework in this area is very contradictory in our country. In particular, according to the law on transplantation, in our country there is a so-called presumption of consent. The meaning of this concept is that any citizen who has not expressed a direct refusal to be a transplant donor is a potential donor. At the same time, according to the law on the funeral business, any person who has taken the trouble to bury the deceased may refuse to open the body.

Recently, the media has been fanning passions about doctors selling liver and heart abroad from people who are still alive. Some stupidity. The procedure for ascertaining brain death is so transparent that even a non-specialist can check it. After ascertaining brain death, another 6 hours pass until it is legally possible to take the organs. During this time, any verification is possible. Unfortunately, when taking organs from patients with irreversible cardiac arrest, such a check cannot be carried out: to lose time before transplantation - the recipient's organs will not take root! However, here, too, the mechanism for ascertaining death is unequivocal.

But, trying to help a patient in need of a donor organ, the doctor risks being behind bars. Although in the whole civilized world the problem has long ceased to be a problem. Everyone decides for himself in advance whether it will be possible after death to use his organs for transplanting them to those in need or not. He sets out his decision on paper and wears it on his driver's license. The public does not feed on information about the horrors of transplantation, but has access to objective data about the importance of this problem. There are many patients in Russia for whom only a kidney, liver, lung or heart transplant will give a chance to live. So the problem is acute.

The word "coma" in Greek means "deep sleep, drowsiness." It is characterized as a loss of consciousness, a sharp weakening or loss of reaction to external stimuli, the extinction of reflexes, etc.

A coma develops as a result of inhibition in the cerebral cortex with spread to the subcortex and other parts of the nervous system. As a rule, the main reason for the development of coma is a violation of blood circulation in the brain due to trauma, inflammation affecting the brain, etc.

Causes of coma

Of course, you should not think that if some event from the specified list has occurred, this will immediately lead to the development of a coma. Each person has an individual risk of developing such a pathology as a coma.

Types of coma

Coma is divided into several different degrees depending on the severity of the patient's condition. As a rule, it is divided into 3 main types:
- deep;
- just a coma;
- superficial.

In general, who in medicine is divided into 15 degrees. However, about 5 of the most basic ones can be distinguished from them, which, as a result, are reduced to 3 main states.

In the first case, we are talking about a situation where he does not come to his senses at all and does not react in any way to any stimuli. At the same time, he does not make sounds, does not respond to the voice and touch of even the closest.

With a normal coma, the patient may make any sounds and even spontaneously open his eyes. However, he is not conscious.

Effects

On average, the coma lasts 1-3 weeks. However, there are cases when it lasted for a longer time - people can lie unconscious for years.

The return of the patient to consciousness occurs gradually. First, he comes to his senses for a couple of hours, then this time increases more and more. As a rule, the body goes through several different stages during this time. And on how he copes with the load entrusted to him, it also depends on what they will be.

Since the brain is affected in a coma, one should be prepared for the fact that the patient may not recover many vital functions. So, for example, quite often people cannot speak, move, etc. Naturally, the severity of the damage directly depends on the degree of coma in which the patient has been. So, for example, after a superficial coma, you can recover an order of magnitude faster than after a normal one. The third degree, as a rule, is characterized by almost complete destruction of the brain. And, you don’t have to wait for good recovery results.

Also, after a coma, many patients restore household skills for a long time. For example, they cannot eat on their own, etc.

- a state between life and death, associated with a complete defeat and disruption of the brain and all physiological systems. This is a kind of protective reaction of the body, which has an unsatisfactory prognosis. The likelihood of recovery from coma is recorded infrequently and requires long-term rehabilitation.

Why does the patient go into a coma?

A coma in a stroke is a consequence of an apoplexy, accompanied by cerebral hemorrhage and leading to an unconscious state with a partial loss of reflexes.

There are also ischemic strokes, characterized by damage to the vessels of the brain.

A person can come to this state due to a number of factors:

internal cerebral bleeding that occurs when pressure increases in one of the segments;
ischemia - insufficient blood supply to any organ;
cerebral edema as a result of hormonal dysfunction and hypoxia of brain cells;
atheroma (degeneration) of the vascular walls;
intoxication of the body;
collagenosis, characterized by changes in connective tissues (capillaries);
deposition (angiopathy) in the cerebral vessels of beta-amyloid protein;
acute lack of vitamins;
blood diseases.

Coma is diagnosed less often, mainly accompanied by an independent exit from it. With hemorrhagic hemorrhage, a coma is dangerous, as it leads to necrosis of large areas of the brain.

How to determine who

The literal meaning of the word "coma" is deep sleep. Indeed, a patient in a coma after a stroke is like someone who is sleeping. A person lives, but it is impossible to wake him up, since there is no reaction at all.

There are a number of signs that can distinguish coma from clinical death, fainting or deep sleep. These include:

prolonged unconsciousness;
weak brain activity;
hardly expressed breath;
barely perceptible pulse;
lack of pupillary response to light;
barely perceptible heartbeat;
violation of heat transfer;
spontaneous bowel movements and urination;
non-responsiveness to stimuli.

The above symptoms are different for each person. In some cases, the manifestation of basic reflexes continues. Partial preservation of spontaneous breathing sometimes does not require connection to the apparatus, and the presence of swallowing functions allows you to refuse food through the probe. Often coma is accompanied by a reaction to light stimuli with spontaneous movements.

The coma develops rapidly. However, with ischemic stroke, early recognition of coma is possible.

The consequences of a stroke can be predicted if a person has the following symptoms:

dizzy;
reduced vision;
drowsiness appears;
confused consciousness;
yawning does not stop;
severe headache;
numb limbs;
movement is disrupted.

Timely response to warning signs provides people with an additional chance for life and subsequently a favorable prognosis for the course of the disease.

Degrees of coma in stroke

Post-stroke coma is a rather rare phenomenon (fixed in 8% of cases). This is a very difficult condition. You can correctly predict the consequences by determining the degree of coma.

In medicine, there are 4 degrees of development of coma in strokes:

The first degree is characterized by lethargy, manifested by a lack of response to pain and stimuli. The patient is able to contact, swallow, roll over slightly, perform simple actions. Has a positive outlook.
The second degree is manifested by suppression of consciousness, deep sleep, lack of reactions, constriction of the pupils, uneven breathing. Spontaneous muscle contractions, atrial fibrillation are possible. The chances of survival are doubtful.
The third, atonic degree is accompanied by an unconscious state, a complete absence of reflexes. The pupils are constricted and do not react to light. The lack of muscle tone and tendon reflexes provokes convulsions. Fixed arrhythmia, lowering the pressure and temperature, involuntary bowel movements. The prognosis for survival is reduced to zero.
The fourth degree is characterized by areflexia, muscle atony. Fixed pupil dilation, a critical decrease in body temperature. All brain functions are disturbed, breathing is irregular, spontaneous, with long delays. Recovery is not possible.

In a state of coma after a stroke, a person does not hear, does not respond to stimuli.

It is almost impossible to determine how long the coma will last. It depends on the severity and extent of brain damage, on the location of the pathology and the cause of the stroke, its variety, as well as on the promptness of treatment. Most often, the prognosis is unfavorable.

The average duration of a person being in a coma is 10-14 days, however, in medical practice, cases of long-term stay in a vegetative state have been recorded.

It has been proven that in the absence of oxygen supply to the brain cells for more than a month, human viability is not restored.

Most often, death occurs 1-3 days after entering the coma. Lethal outcome is determined by the following factors:

repeated stroke led to immersion in "deep sleep";
lack of reactions to sounds, light, pain;
the patient's age is more than 70 years;
decrease in serum creatinine to a critical level - 1.5 mg / dl;
extensive brain disorders;
necrosis of brain cells.

A more accurate clinical picture can be given by laboratory blood tests, computer diagnostics or magnetic resonance imaging.

Introduction to induced coma after stroke

Sometimes a medical shutdown of a person’s consciousness is required to exclude life-threatening changes in the brain.

In case of compressive pressure on the brain tissues, their edema or hemorrhages and bleeding resulting from craniocerebral trauma, the patient is immersed in an artificial coma that can replace anesthesia in times of crisis.

Prolonged analgesia allows to narrow the vessels, reduce the tension of the cerebral flow, and avoid necrosis of brain tissues.

Sedation is caused by the introduction of a controlled high dose of special drugs that depress the central nervous system in intensive care.

This condition can last a long time and requires constant monitoring of the patient's condition. Any reactions to external stimuli, movements indicate the possibility of the return of consciousness.

The task of the medical staff is to provide assistance in getting out of a coma.

Introduction to sedation has side effects, expressed as complications of the respiratory system (tracheobronchitis, pneumonia, pneumothorax), hemodynamic disorders, renal failure, and neurological pathologies.

Care and treatment of patients in a coma

With impaired consciousness, post-stroke coma is accompanied by independent breathing and palpitations. It is impossible to predict the duration of a coma during a stroke, so special patient care is required.

Food. Since comatose patients are fed through a special tube inserted into the stomach, the food must have a liquid consistency. Baby food is ideal for this: milk mixture or fruit and vegetable puree in jars.
Hygiene. To prevent the development of ulcers and bedsores, to maintain cleanliness of the body, it is necessary to treat the patient's skin daily with soapy water or special products, and also clean the patient's oral cavity with wet gauze wipes. Comb daily (especially long hair) and wash the hairy parts of the body at least once a week.
Change of position. To prevent bedsores, the patient should be systematically turned in different directions.

In the case of an extensive hemorrhagic stroke, surgical removal of a hematoma inside the brain is indicated, which increases the chances of recovery.

Coma resulting from ischemic stroke is treated in a specialized intensive care unit of the neurological department. If life-supporting functions are impaired, the patient is connected to an artificial lung ventilation apparatus (ALV) and a monitor that records body parameters. Euthanasia is prohibited in Russia, so a person's life will be maintained for as long as it takes days.

For ischemic stroke:

anticoagulants (aspirin, heparin, warfarin, trental);
nootropics (cavinton, mexidol, actovegin, cerebrolysin).

Exit from a coma

Functions lost as a result of a coma after a stroke return slowly. Coming out of a coma after a stroke includes the following steps:

Patient care

The function of swallowing returns (weakly expressed), the reaction of the skin and muscles to external manifestations appears. A person reflexively moves his limbs, his head. The doctor predicts a positive development.
The patient begins to rave, hallucinations are possible, consciousness returns, memory, vision and partially are restored.
Motor activity resumes: the patient first sits, then slowly gets up and subsequently walks with support.

When consciousness returns, the patient is shown a tomographic examination to determine the degree of brain damage and choose the method of subsequent recovery.

The rehabilitation process takes a long time and requires moral and physical strength from both the patient and relatives.

Stroke and coma are accompanied by the destruction of brain cells and the loss of vital body functions. The task of rehabilitation is to ensure that these processes do not spread to other parts of the brain. To do this, every day for a long time, people must perform gradually more difficult special gymnastic exercises.

Recovery exercises

The task of the relatives of the victim as a result of a coma is to help get out of this state, creating the most favorable moral and psychological conditions for the rehabilitation period.

A person who has come out of a coma requires increased attention.

In order to avoid the recurrence of an apoplexy, the following recommendations must be observed:

give hope for recovery;
create a favorable psychological climate and comfortable environment;
motivate for daily activities and praise for success;
master the skills.

Only love, care and attention can work wonders. Love and take care of yourself and your loved ones, and a favorable forecast will not keep you waiting.

Video

Coma is a state of complete absence of consciousness, when a person does not react to anything. In a coma, no stimulus (neither external nor internal) is able to bring a person to life. This is a life-threatening resuscitation condition, because, in addition to loss of consciousness, in coma, violations of the functions of vital organs (respiration and cardiac activity) are observed.

Being in a state of coma, a person is not aware of either the world around him or himself.

Coma is always a complication of any disease or pathological condition (poisoning, injury). All comas have a number of common signs, regardless of the cause of their occurrence. But there are also differences in clinical symptoms in different types of coma. Treatment of coma should be carried out in the intensive care unit. It is aimed at maintaining the vital functions of the body and preventing the death of brain tissue. From this article, you will learn about what coma are, how they are characterized, and what are the basic principles for the treatment of coma.

What is the basis of coma?

Coma is based on two mechanisms:

bilateral diffuse lesions of the cerebral cortex;
primary or secondary lesion of the brain stem with the reticular formation located in it. The reticular formation maintains the tone and active state of the cerebral cortex. When the reticular formation is "turned off", deep inhibition develops in the cerebral cortex.

Primary damage to the brain stem is possible in conditions such as a tumor process. Secondary disorders occur with metabolic changes (with poisoning, endocrine diseases, etc.).

A combination of both mechanisms of coma development is possible, which is most often observed.

As a result of these disorders, normal transmission of nerve impulses between brain cells becomes impossible. At the same time, coordination and coordinated activities of all structures are lost, they switch to an autonomous mode. The brain loses its managerial functions over the whole organism.

com classification

Coma states are usually divided according to various criteria. The most optimal are two classifications: according to the causal factor and according to the degree of oppression of consciousness (the depth of the coma).

When divided according to the causal factor, all coma is conditionally classified into coma with primary neurological disorders (when the process in the nervous system itself served as the basis for the development of coma) and secondary neurological disorders (when brain damage occurred indirectly during any pathological process outside the nervous system). Knowing the cause of coma allows you to correctly determine the tactics of treating the patient.

So, depending on the cause that led to the development of coma, there are such types of coma: neurological (primary) and secondary genesis.

Neurological (primary) genesis:

traumatic (with traumatic brain injury);
cerebrovascular (with acute vascular circulatory disorders in the brain);
epileptic (result);
meningoencephalitic (the result of inflammatory diseases of the brain and its membranes);
hypertension (due to a tumor in the brain and skull).

secondary genesis:

endocrine (diabetic in diabetes mellitus (there are several types), hypothyroid and thyrotoxic in diseases of the thyroid gland, hypocorticoid in acute adrenal insufficiency, hypopituitaric in total deficiency of pituitary hormones);
toxic (with renal or hepatic insufficiency, with poisoning by any substances (alcohol, drugs, carbon monoxide, and so on), with cholera, with an overdose of drugs);
hypoxic (with severe heart failure, obstructive pulmonary disease, anemia);
coma when exposed to physical factors (thermal when overheating or hypothermia, with electric shock);
coma with a significant deficiency of water, electrolytes and food (hungry, with indomitable vomiting and diarrhea).

According to statistics, the most common cause of coma is a stroke, drug overdose is in second place, and complications of diabetes mellitus are in third place.

The need for the existence of the second classification is due to the fact that the causative factor itself does not reflect the severity of the patient's condition in a coma.

Depending on the severity of the condition (the depth of oppression of consciousness), it is customary to distinguish the following types of coma:

I degree (light, subcortical);
II degree (moderate, anterior-stem, "hyperactive");
III degree (deep, rear-stem, "sluggish");
IV degree (exorbitant, terminal).

A sharp division of the degrees of coma is rather difficult, since the transition from one stage to another can be very fast. This classification is based on different clinical symptoms corresponding to a certain stage.

Signs of a coma

Coma I degree

It is called subcortical, because at this stage the activity of the cerebral cortex is inhibited and the deeper parts of the brain, called subcortical formations, are disinhibited. It is characterized by such manifestations:

feeling that the patient is in a dream;
complete disorientation of the patient in place, time, personality (it is impossible to stir up the patient);
lack of answers to the questions asked. Perhaps inarticulate lowing, the publication of various sounds out of touch with what is happening from the outside;
the absence of a normal reaction to a painful stimulus (that is, the reaction is weak and very slow, for example, when a patient pricks the arm with a needle, it does not immediately pull it away, but only weakly bends or unbends some time after applying painful irritation);
spontaneous active movements are practically absent. Sometimes sucking, chewing, swallowing movements may occur as a manifestation of brain reflexes, which are normally suppressed by the cerebral cortex;
muscle tone is increased;
deep reflexes (knee, Achilles and others) increase, and superficial (corneal, plantar and others) are inhibited;
possible pathological hand and foot symptoms (Babinsky, Zhukovsky and others);
the reaction of the pupils to light is preserved (narrowing), strabismus, spontaneous movements of the eyeballs can be observed;
lack of control over the activity of the pelvic organs;
usually spontaneous breathing is preserved;
on the part of cardiac activity, an increase in heart rate (tachycardia) is observed.

Coma II degree

At this stage, the activity of subcortical formations is inhibited. Violations descend to the anterior sections of the brain stem. This stage is characterized by:

the appearance of tonic convulsions or periodic shudders;
lack of speech activity, verbal contact is impossible;
a sharp weakening of the reaction to pain (slight movement of the limb during injection);
oppression of all reflexes (both superficial and deep);
narrowing of the pupils and their weak reaction to light;
an increase in body temperature;
increased sweating;
sharp fluctuations in blood pressure;
severe tachycardia;
respiratory failure (with pauses, with stops, noisy, with different depth of breaths).

Coma III degree

Pathological processes reach the medulla oblongata. The risk to life increases and the prognosis for recovery worsens. The stage is characterized by the following clinical signs:

protective reactions in response to a painful stimulus are completely lost (the patient does not even move his limb in response to an injection);
surface reflexes are absent (in particular, corneal);
there is a sharp decrease in muscle tone and tendon reflexes;
pupils are dilated and do not react to light;
breathing becomes superficial and arrhythmic, unproductive. Additional muscles (muscles of the shoulder girdle) are involved in the act of breathing, which is not normally observed;
blood pressure decreases;
occasional seizures are possible.

Coma IV degree

At this stage, there are no signs of brain activity. This manifests itself:

the absence of all reflexes;
the maximum possible expansion of the pupils;
muscle atony;
lack of spontaneous breathing (only artificial ventilation of the lungs supports the provision of the body with oxygen);
blood pressure drops to zero without medication;
drop in body temperature.

Achieving a grade IV coma has a high risk of death approaching 100%.

It should be noted that some of the symptoms of the various stages of coma may differ depending on the cause of the coma. In addition, certain varieties of comatose states have additional signs, in some cases being diagnostic.

Clinical features of some types of com

Cerebrovascular coma

It always becomes the result of a global vascular catastrophe (ischemic or aneurysm rupture), therefore it develops suddenly, without precursors. Usually consciousness is lost almost instantly. At the same time, the patient has a red face, hoarse breathing, high blood pressure, and a tense pulse. In addition to the neurological symptoms characteristic of a coma, there are focal neurological symptoms (for example, facial distortion, puffing out of one cheek when breathing). The first stage of coma may be accompanied by psychomotor agitation. If a subarachnoid hemorrhage occurs, then positive meningeal symptoms are determined (stiff neck muscles, symptoms of Kernig, Brudzinsky).

Traumatic coma

Since it usually develops as a result of a severe craniocerebral injury, damage to the skin can be detected on the patient's head. There may be bleeding from the nose, ear (sometimes leakage of cerebrospinal fluid), bruising around the eyes (symptom of "glasses"). Quite often, the pupils have a different size on the right and left (anisocoria). Also, as in cerebrovascular coma, there are focal neurological signs.

epileptic coma

It is usually the result of recurring one after one epileptic seizures. With this coma, the patient's face acquires a bluish tint (if the attack was quite recent), the pupils become wide and do not respond to light, there may be traces of a bite of the tongue, foam on the lips. When the seizures stop, the pupils still remain wide, muscle tone decreases, and reflexes are not evoked. Tachycardia and rapid breathing occur.

Meningoencephalitic coma

Occurs against the background of an existing inflammatory disease of the brain or its membranes, so it is rarely sudden. There is always an increase in body temperature, of varying severity. Possible rash on the body. In the blood, there is a significant increase in the content of leukocytes and ESR, and in the cerebrospinal fluid - an increase in the amount of protein and leukocytes.

Hypertensive coma

It occurs as a result of a significant increase in intracranial pressure in the presence of an additional formation in the cranial cavity. Coma develops due to compression of some parts of the brain and its infringement in the notch of the cerebellar tenon or foramen magnum. This coma is accompanied by bradycardia (slow heart rate), decreased respiratory rate, and vomiting.

hepatic coma

It develops gradually against the background of hepatitis or cirrhosis of the liver. A specific hepatic odor emanates from the patient (the smell of "raw meat"). The skin is yellow, with petechial hemorrhages, scratching places. Tendon reflexes are increased, convulsions may occur. Blood pressure and heart rate are low. The pupils are dilated. The patient's liver is enlarged. There may be signs of portal hypertension (for example, the "head of a jellyfish" - the expansion and tortuosity of the saphenous veins of the abdomen).

renal coma

It also develops gradually. The patient smells of urine (ammonia). The skin is dry, pale gray (as if dirty), with traces of scratching. There are swelling in the area of the waist and lower extremities, puffiness of the face. Blood pressure is low, tendon reflexes are high, pupils are narrow. Involuntary muscle twitches in individual muscle groups are possible.

Alcoholic coma

It develops gradually with alcohol abuse and taking too large a dose. Naturally, the smell of alcohol is felt (however, it should be borne in mind that if this sign is present, there may be another coma, for example, traumatic. It’s just that a person could drink alcohol before the injury). The heart rate rises and blood pressure falls. The skin is red, wet with sweat. Muscle tone and reflexes are low. The pupils are narrow.

Coma due to carbon monoxide poisoning

This coma is accompanied by tachycardia with low blood pressure, shallow breathing (respiratory paralysis is possible). Characterized by wide pupils with no reaction to light. A very specific symptom is the color of the face and mucous membranes: cherry red (carboxyhemoglobin gives this color), while the limbs may be cyanotic.

Coma due to poisoning with sleeping pills (barbiturates)

Coma develops gradually, being a continuation of sleep. Characterized by bradycardia (low heart rate) and low blood pressure. Breathing becomes shallow and rare. The skin is pale. The reflex activity of the nervous system is so inhibited that there is no reaction to pain, tendon reflexes are not evoked (or they are sharply weakened). Increased salivation.

Coma with drug overdose

It is characterized by a drop in blood pressure, a decrease in heart rate, a weak pulse, and shallow breathing. The lips and fingertips are bluish in color, the skin is dry. Muscle tone is sharply weakened. The so-called "point" pupils are characteristic, they are so narrowed. There may be marks from injections (although this is not necessary, since the route of drug use may be, for example, intranasal).

diabetic coma

It would be more correct to say not a coma, but a coma. Because there can be several of them in diabetes mellitus. These are ketoacidotic (with the accumulation of fat metabolism products in the blood and an increase in glucose levels), hypoglycemic (with a drop in glucose levels and an excess of insulin), hyperosmolar (with severe dehydration) and lactacidemic (with an excess of lactic acid in the blood). Each of these varieties has its own clinical features. So, for example, with ketoacidotic coma, there is a smell of acetone from the patient, the skin is pale and dry, the pupils are constricted. With a hypoglycemic coma, foreign odors from the patient are not felt, the skin is pale and moist, and the pupils are dilated. Of course, when determining the type of diabetic coma, additional research methods play a major role (the amount of glucose in the blood, in the urine, the presence of acetone in the urine, and so on).

Principles of treatment for com

Coma is a condition, first of all, requiring urgent measures to maintain the vital activity of the body. These measures are taken regardless of what reason caused the coma. The main thing is not to let the patient die and to preserve the brain cells from damage as much as possible.

Measures that ensure the vital functions of the body include:

breathing support. If necessary, sanitation of the respiratory tract is carried out to restore their patency (foreign bodies are removed, a sunken tongue is straightened), an air duct, an oxygen mask are installed, artificial ventilation of the lungs is carried out;
support of the circulatory system (the use of agents that increase blood pressure in hypotension, and reduce it in hypertension; agents that normalize heart rhythm; normalization of circulating blood volume).

Symptomatic measures are also used to remove existing violations:

large doses of vitamin B 1 for suspected alcohol poisoning;
in the presence of seizures;
antiemetic drugs;
sedatives for arousal;
intravenous glucose is given (even if the cause of the coma is not known, because the risk of brain damage from low blood glucose is higher than from high blood glucose. Giving some glucose at high blood levels will not do much harm);
gastric lavage in case of suspected poisoning with drugs or low-quality food (including mushrooms);
drugs to reduce body temperature;
in the presence of signs of an infectious process, the use of antibiotics is indicated.

At the slightest suspicion of an injury to the cervical spine (or in the absence of the possibility of excluding it), stabilization of this area is necessary. Usually, a collar-shaped splint is used for this purpose.

After establishing the cause that caused the coma, the underlying disease is treated. Then a specific therapy is already prescribed, directed against a specific ailment. This can be hemodialysis for kidney failure, the administration of Naloxone for drug overdose, and even surgery (for example, for a brain hematoma). The type and extent of therapeutic measures depends on the diagnosis.

Coma is a life-threatening complication of a number of pathological conditions. It requires immediate medical attention, as it can be fatal. There are a great many varieties of coma due to the large number of pathological conditions that can be complicated by them. Treatment of coma is carried out in the intensive care unit and is aimed at saving the life of the patient. At the same time, all measures should ensure the preservation of brain cells.