Coma - Knowledge

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understood as having a stake in something that can affect what makes our life good in that domain. An interest is what directly and immediately improves life from a certain point of view or within a particular domain, or greatly increases the likelihood of life improvement enabling the subject to realize some good. That said, sensitivity to reward signals is a fundamental element in the learning process, both consciously and unconsciously. Moreover, the unconscious brain is able to interact with its surroundings in a meaningful way and to produce meaningful information processing of stimuli coming from the external environment, including other people.

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fractures. Angiography is used on rare occasions for TBIs i.e. when there is suspicion of an aneurysm, carotid sinus fistula, traumatic vascular occlusion, and vascular dissection. A CT can detect changes in density between the brain tissue and hemorrhages like subdural and intracerebral hemorrhages. MRIs are not the first choice in emergencies because of the long scanning times and because fractures cannot be detected as well as CT. MRIs are used for the imaging of soft tissues and lesions in the posterior fossa which cannot be found with the use of CT.

1155: 1019: 1115: 1197:(below Tentorium cerebelli), (3) metabolic or (4) diffused. This classification is merely dependent on the position of the original damage that caused the coma, and does not correlate with severity or the prognosis. The severity of coma impairment however is categorized into several levels. Patients may or may not progress through these levels. In the first level, the brain responsiveness lessens, normal reflexes are lost, the patient no longer responds to pain and cannot hear. 1282:

since the injury occurred. Common reactions, such as desperation, anger, frustration, and denial are possible. The focus of the patient care should be on creating an amicable relationship with the family members or dependents of a comatose patient as well as creating a rapport with the medical staff. Although there is heavy importance of a primary care taker, secondary care takers can play a supporting role to temporarily relieve the primary care taker's burden of tasks.

319:(ARAS) and keep the system from properly functioning to arouse the brain. Secondary effects of drugs, which include abnormal heart rate and blood pressure, as well as abnormal breathing and sweating, may also indirectly harm the functioning of the ARAS and lead to a coma. Given that drug poisoning is the cause for a large portion of patients in a coma, hospitals first test all comatose patients by observing pupil size and eye movement, through the 1139: 1103: 707: 3904: 65: 3761: 1449: 568:

neural transmission. While a diffuse cause is limited to aberrations of cellular function, that fall under a metabolic or toxic subgroup. Toxin-induced comas are caused by extrinsic substances, whereas metabolic-induced comas are caused by intrinsic processes, such as body thermoregulation or ionic imbalances (e.g. sodium). For instance, severe

3815:"Henry Adams: The Middle Years. By <italic>Ernest Samuels</italic>. (Cambridge, Mass.: Belknap Press of Harvard University Press. 1958. Pp. xiv, 514. $ 7.50.) and Henry Adams: The Major Phase. By <italic>Ernest Samuels</italic>. (Cambridge, Mass.: Belknap Press of Harvard University Press. 1964. Pp. xv, 687. $ 10.00.)". 1423:. Well-being can broadly be understood as the positive effect related to what makes life good (according to specific standards) for the individual in question. The only condition for well-being broadly considered is the ability to experience its 'positiveness'. That said, because experiencing positiveness is a basic emotional process with 373:, or brain tumor may cause restriction of blood flow. Lack of blood to cells in the brain prevents oxygen from getting to the neurons, and consequently causes cells to become disrupted and die. As brain cells die, brain tissue continues to deteriorate, which may affect the functioning of the ARAS, causing unconsciousness and coma. 1338:, the inability to articulate any speech. Recovery is usually gradual. In the first days, the patient may only awaken for a few minutes, with increased duration of wakefulness as their recovery progresses, and they may eventually recover full awareness. That said, some patients may never progress beyond very basic responses. 1356:(DBS), successfully roused communication, complex movement and eating ability in the man with a traumatic brain injury. His injuries left him in a minimally conscious state, a condition akin to a coma but characterized by occasional, but brief, evidence of environmental and self-awareness that coma patients lack. 564:, and then finally to the cerebral cortex. Any impairment in ARAS functioning, a neuronal dysfunction, along the arousal pathway stated directly above, prevents the body from being aware of its surroundings. Without the arousal and consciousness centers, the body cannot awaken, remaining in a comatose state. 1364:

Research by Eelco Wijdicks on the depiction of comas in movies was published in Neurology in May 2006. Wijdicks studied 30 films (made between 1970 and 2004) that portrayed actors in prolonged comas, and he concluded that only two films accurately depicted the state of a coma patient and the agony of

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is a stereotypical posturing in which the legs are similarly extended (stretched), but the arms are also stretched (extended at the elbow). The posturing is critical since it indicates where the damage is in the central nervous system. A decorticate posturing indicates a lesion (a point of damage) at

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According to Hawkins, "1. A life is good if the subject is able to value, or more basically if the subject is able to care. Importantly, Hawkins stresses that caring has no need for cognitive commitment, i.e. for high-level cognitive activities: it requires being able to distinguish something, track

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The outcome for coma and vegetative state depends on the cause, location, severity and extent of neurological damage. A deeper coma alone does not necessarily mean a slimmer chance of recovery; similarly, a milder coma does not indicate a higher chance of recovery. The most common cause of death for

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Coma has a wide variety of emotional reactions from the family members of the affected patients, as well as the primary care givers taking care of the patients. Research has shown that the severity of injury causing coma was found to have no significant impact compared to how much time has passed

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Structural and diffuse causes of coma are not isolated from one another, as one can lead to the other in some situations. For instance, coma induced by a diffuse metabolic process, such as hypoglycemia, can result in a structural coma if it is not resolved. Another example is if cerebral edema, a

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are still intact and functioning and is an important part of the physical exam. Due to the unconscious status of the patient, only a limited number of the nerves can be assessed. These include the cranial nerves number 2 (CN II), number 3 (CN III), number 5 (CN V), number 7 (CN VII), and cranial

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The severity and mode of onset of coma depends on the underlying cause. There are two main subdivisions of a coma: structural and diffuse neuronal. A structural cause, for example, is brought upon by a mechanical force that brings about cellular damage, such as physical pressure or a blockage in

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In the treatment of traumatic brain injury (TBI), there are 4 examination methods that have proved useful: skull x-ray, angiography, computed tomography (CT), and magnetic resonance imaging (MRI). The skull x-ray can detect linear fractures, impression fractures (expression fractures) and burst

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something. 2. A life is good if the subject has the capacity for relationship with others, i.e. for meaningfully interacting with other people." This suggests that unawareness may (at least partly) fulfill both conditions identified by Hawkins for life to be good for a subject, thus making the

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is a qualitative assessment of the functions mediated by the cortex, including cognitive abilities such as attention, sensory perception, explicit memory, language, the execution of tasks, temporal and spatial orientation and reality judgment. Neurologically, consciousness is maintained by the

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roots, it is likely to occur at a completely unaware level and, therefore, introduces the idea of an unconscious well-being. As such, the ability of having interests is crucial for describing two abilities which those with comas are deficient in. Having an interest in a certain domain can be

560:(RF). The RAS has two tracts, the ascending and descending tract. The ascending tract, or ascending reticular activating system (ARAS), is made up of a system of acetylcholine-producing neurons, and works to arouse and wake up the brain. Arousal of the brain begins from the RF, through the 771:, quantify an individual's reactions such as eye opening, movement and verbal response in order to indicate their extent of brain injury. The patient's score can vary from a score of 3 (indicating severe brain injury and death) to 15 (indicating mild or no brain injury). 1237:

Once a patient is stable and no longer in immediate danger, there may be a shift of priority from stabilizing the patient to maintaining the state of their physical wellbeing. Moving patients every 2–3 hours by turning them side to side is crucial to avoiding

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Pupil assessment is often a critical portion of a comatose examination, as it can give information as to the cause of the coma; the following table is a technical, medical guideline for common pupil findings and their possible interpretations:

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The gag, or pharyngeal, reflex is centered in the medulla and consists of the reflexive motor response of pharyngeal elevation and constriction with tongue retraction in response to sensory stimulation of the pharyngeal wall, posterior tongue,

144:. The person may experience respiratory and circulatory problems due to the body's inability to maintain normal bodily functions. People in a coma often require extensive medical care to maintain their health and prevent complications such as 3973: 3958: 3943: 647:

demonstrate active resistance to passive opening of the eyelids, with the eyelids closing abruptly and completely when the lifted upper eyelid is released (rather than slowly, asymmetrically and incompletely as seen in comas due to organic

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Coma patients may also deal with restlessness or seizures. As such, soft cloth restraints may be used to prevent them from pulling on tubes or dressings and side rails on the bed should be kept up to prevent patients from falling.

1298:, and others die. Some patients who have entered a vegetative state go on to regain a degree of awareness; and in some cases may remain in vegetative state for years or even decades (the longest recorded period is 42 years, the 894:

However, failure of both eyes to move to one side can indicate damage or destruction of the affected side. In special cases, where only one eye deviates and the other does not, this often indicates a lesion (or damage) of the

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People may emerge from a coma with a combination of physical, intellectual, and psychological difficulties that need special attention. It is common for coma patients to awaken in a profound state of confusion and experience

1377:(1998). The remaining 28 were criticized for portraying miraculous awakenings with no lasting side effects, unrealistic depictions of treatments and equipment required, and comatose patients remaining muscular and tanned. 608:

Although diagnosis of coma is simple, investigating the underlying cause of onset can be rather challenging. As such, after gaining stabilization of the patient's airways, breathing and circulation (the basic

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is a complex scale that has eight separate levels, and is often used in the first few weeks or months of coma while the patient is under closer observation, and when shifts between levels are more frequent.

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If the patient's eyes slowly deviate toward the ear where the water was injected, then the brainstem is intact, however failure to deviate toward the injected ear indicates damage of the brainstem on that

767:(alert, vocal stimuli, painful stimuli, unresponsive) scale by spontaneously exhibiting actions and, assessing the patient's response to vocal and painful stimuli. More elaborate scales, such as the 826:, and are important available tools not only for the assessment of the cortical activity but also for predicting the likelihood of the patient's awakening. The autonomous responses such as the 1352:

A man with brain damage and trapped in a coma-like state for six years was brought back to consciousness in 2003 by doctors who planted electrodes deep inside his brain. The method, called

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Assessment of posture and physique is the next step. It involves general observation about the patient's positioning. There are often two stereotypical postures seen in comatose patients.

1217:(ICU) immediately, where maintenance of the patient's respiration and circulation become a first priority. Stability of their respiration and circulation is sustained through the use of 1108:

Normal eye with two pupils equal in size and reactive to light. This means that the patient is probably not in a coma and is probably lethargic, under influence of a drug, or sleeping.

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It has been argued that unawareness should be just as ethically relevant and important as a state of awareness and that there should be metaphysical support of unawareness as a state.

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rates, expressed as the level of chance the person has of recovering. Time is the best general predictor of a chance of recovery. For example, after four months of coma caused by

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Treatment for people in a coma will depend on the severity and cause of the comatose state. Upon admittance to an emergency department, coma patients will usually be placed in an

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Twenty percent of comatose states result from an ischemic stroke, brain hemorrhage, or brain tumor. During a stroke, blood flow to part of the brain is restricted or blocked. An

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Predicted chances of recovery will differ depending on which techniques were used to measure the patient's severity of neurological damage. Predictions of recovery are based on

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The patient's head is then moved to the patient's left, to observe whether the eyes stay or deviate toward the patient's right; same maneuver is attempted on the opposite side.

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One pupil is dilated and unreactive, while the other is normal (in this case, the right eye is dilated, while the left eye is normal in size). This could mean damage to the

400:, abnormal glucose levels, and many other biological disorders. Furthermore, studies show that 1 out of 8 patients with traumatic brain injury experience a comatose state. 580:

levels in the blood) are examples of a metabolic diffuse neuronal dysfunction. Hypoglycemia or hypercapnia initially cause mild agitation and confusion, but progress to

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is also derived from Greek, where it can be found in the roots of several words meaning soporific or sleepy. It can still be found in the root of the term 'carotid'.

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Formisano R; Carlesimo GA; Sabbadini M; et al. (May 2004). "Clinical predictors and neuropleropsychological outcome in severe traumatic brain injury patients".

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as the control over the muscles in the face and throat is diminished. As a result, those presenting to a hospital with coma are typically assessed for this risk ("

152:. Coma patients exhibit a complete absence of wakefulness and are unable to consciously feel, speak or move. Comas can be the result of natural causes, or can be 3400: 3621: 159:

Clinically, a coma can be defined as the consistent inability to follow a one-step command. It can also be defined as having a score of 8 or less on the

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Comas can last from several days to, in particularly extreme cases, years. Some patients eventually gradually come out of the coma, some progress to a

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If the patient's eyes move in a direction opposite to the direction of the rotation of the head, then the patient is said to have an intact brainstem.

1844: 4055: 3577: 1261:. A coma patient's lack of a gag reflex and use of a feeding tube can result in food, drink or other solid organic matter being lodged within their 1010:

Those in comatose states will often demonstrate poor gag reflexes if there has been damage to their glossopharyngeal (CN 9) or vagus nerve (CN 10).

1859: 229:(second century AD). Subsequently, it was hardly used in the known literature up to the middle of the 17th century. The term is found again in 2592: 1533: 2886: 983:

Those in a comatose state will have altered corneal reflex depending on the severity of their unconscious and the location of their lesion.

3014: 2950: 1265:(from the trachea to the lungs). This trapping of matter in their lower respiratory tract can ultimately lead to infection, resulting in 4048: 1795: 1070:, whereas a decerebrate posturing indicates a lesion at or below the red nucleus. In other words, a decorticate lesion is closer to the 3866: 3800: 3380: 3325: 3134:

Nakahara, Kuniaki; Shimizu, Satoru; Utsuki, Satoshi; Oka, Hidehiro; Kitahara, Takao; Kan, Shinichi; Fujii, Kiyotaka (January 2011).

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diffuse dysfunction, leads to ischemia of the brainstem, a structural issue, due to the blockage of the circulation in the brain.

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Daltrozzo J.; Wioland N.; Mutschler V.; Lutun P.; Jaeger A.; Calon B.; Meyer A.; Pottecher T.; Lang S.; Kotchoubey B. (2009c).

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to decrease and intracellular calcium to increase, which harms neuron communication. Lack of oxygen in the brain also causes

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When an unconscious person enters a hospital, the hospital utilizes a series of diagnostic steps to identify the cause of

549:, relay of the sensory input via the thalamic pathway, and many other neurological functions, including complex thinking. 847: 320: 4208: 4092: 3013:

Daltrozzo J.; Wioland N.; Mutschler V.; Lutun P.; Calon B.; Meyer A.; Jaeger A.; Pottecher T.; Kotchoubey B. (2010a).

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In the ethical discussions about disorders of consciousness (DOCs), two abilities are usually considered as central:

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The second most common cause of coma, which makes up about 25% of cases, is lack of oxygen, generally resulting from

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If pupils are reactive to light, then that also indicates that the cranial nerve number 3 (CN III) (or at least its

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or opiate overdose, which can be responsible for a patient's coma. The pinpoint pupils are still reactive to light

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Thim, Troels; Krarup, Niels Henrik Vinther; Grove, Erik Lerkevang; Rohde, Claus Valter; Løfgren, Bo (2012-01-31).

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Lombardi, Francesco FL; Taricco, Mariangela; De Tanti, Antonio; Telaro, Elena; Liberati, Alessandro (2002-04-22).

4087: 2951:"Predicting Coma and other Low Responsive Patients Outcome using Event-Related Brain Potentials: A Meta-analysis" 2826:

Haupt, Walter F; Hansen, Hans Christian; Janzen, Rudolf W C; Firsching, Raimund; Galldiks, Norbert (2015-04-16).

2615:"Initial assessment and treatment with the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach" 1394: 1342: 1295: 827: 43: 2813:"Classification and Complications of Traumatic Brain Injury: Practice Essentials, Epidemiology, Pathophysiology" 3988: 3783:

Hawkins, Jennifer (2016-03-01), "What Is Good for Them? Best Interests and Severe Disorders of Consciousness",

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Qadeer, Anam; Khalid, Usama; Amin, Mahwish; Murtaza, Sajeela; Khaliq, Muhammad F; Shoaib, Maria (2017-08-21).

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Haupt, Walter F; Hansen, Hans Christian; Janzen, Rudolf W C; Firsching, Raimund; Galldiks, Norbert (2015).

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Siwicka-Gieroba, Dorota; Robba, Chiara; Gołacki, Jakub; Badenes, Rafael; Dabrowski, Wojciech (2022-10-25).

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Pupil reaction to light is important because it shows an intact retina, and cranial nerve number 2 (CN II)

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Oculocephalic reflex, also known as the doll's eye, is performed to assess the integrity of the brainstem.

1665: 1489:(vegetative coma), deep coma without detectable awareness. Damage to the cortex, with an intact brainstem. 1353: 906: 760: 690: 628:. According to Young, the following steps should be taken when dealing with a patient possibly in a coma: 589: 522: 377: 355: 335: 36: 3581: 3181:

Korkmazer, Bora; Kocak, Burak; Tureci, Ercan; Islak, Civan; Kocer, Naci; Kizilkilic, Osman (2013-04-28).

1148:(cranial nerve number 3, CN III) on the right side, or indicate the possibility of vascular involvement. 671:

Check for levels of serum glucose, calcium, sodium, potassium, magnesium, phosphate, urea, and creatinine

3136:"Linear fractures occult on skull radiographs: a pitfall at radiological screening for mild head injury" 1480: 1062: 1050: 1042: 1022: 787: 724: 420: 32: 1876: 1737: 1160:

Both pupils are dilated and unreactive to light. This could be due to overdose of certain medications,

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away from this deviated position and is often seen in patients who are conscious or merely lethargic.

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can also show a lot about the activity level of the cortex such as semantic processing, presence of

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Pneumonia is also common in coma patients due to their inability to swallow which can then lead to

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There are reports of people coming out of a coma after long periods of time. After 19 years in a

977: 768: 656: 640: 636: 444: 296: 218: 160: 93: 2925: 1313:, the chance of partial recovery is less than 15%, and the chance of full recovery is very low. 3603: 4157: 3999: 3952: 3913: 3862: 3828: 3796: 3750: 3732: 3674: 3550: 3472: 3454: 3376: 3331: 3321: 3281: 3263: 3222: 3204: 3163: 3155: 3116: 3098: 3053: 3037: 2989: 2973: 2909: 2867: 2849: 2789: 2757: 2722: 2714: 2654: 2636: 2588: 2542: 2502: 2475: 2467: 2398: 2363: 2322: 2312: 2265: 2247: 2208: 2156: 2138: 2097: 2048: 1938: 1930: 1824: 1785: 1646: 1607: 1558: 1529: 1262: 1165: 1007:

with the soft tip of a cotton applicator and visually inspecting for elevation of the pharynx.

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can be instantaneous. The mode of onset may therefore be indicative of the underlying cause.

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Abnormal, difficulty, or irregular breathing or no breathing at all when coma was caused by

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Assessment of the brainstem and cortical function through special reflex tests such as the

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Traub, Stephen J.; Wijdicks, Eelco F. (2016). "Initial Diagnosis and Management of Coma".

1863: 1477:, paralysis of most muscles, except ocular muscles of the eyes, while patient is conscious 1454: 1386: 1114: 915: 662: 625: 585: 502: 491: 366: 262: 185: 133: 2812: 2697:

Baxter, Cynthia L.; White, William D. (September 2003). "Psychogenic Coma: Case Report".

2283: 1713: 1074:, as opposed to a decerebrate posturing which indicates that the lesion is closer to the 3909: 3578:"Coma Information Page: National Institute of Neurological Disorders and Stroke (NINDS)" 2036: 3982: 3745: 3710: 3670: 3521: 3467: 3432: 3276: 3241: 3217: 3182: 3111: 3078: 2862: 2827: 2649: 2614: 2557: 2538: 2526: 2260: 2227: 2151: 2116: 1961: 1239: 1222: 953: 859: 851: 610: 577: 459: 447:

is the only lung condition to cause coma, but many different lung conditions can cause

404: 397: 331: 308: 290: 163:(GCS) for at least 6 hours. For a patient to maintain consciousness, the components of 1254:

or other orthopedic deformities which would interfere with a coma patient's recovery.

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Many types of problems can cause a coma. Forty percent of comatose states result from

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Hermanowicz, Neal (2007), "Cranial Nerves IX (Glossopharyngeal) and X (Vagus)",

3183:"Endovascular treatment of carotid cavernous sinus fistula: A systematic review" 3151: 2710: 2200: 2000: 1642: 1462: 1432:

it for a while, recognize it over time, and have certain emotional dispositions

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Cold water is injected into one ear and the patient is observed for eye movement

706: 581: 573: 518: 436: 389: 343: 265:(1624–89) mentioned the term 'coma' in several cases of fever (Sydenham, 1685). 189: 172: 149: 137: 4004: 3765: 2781: 2749: 2494: 2390: 2355: 2228:"Sensory stimulation for brain injured individuals in coma or vegetative state" 2076:"Hypoxic-ischemic brain injury: Pathophysiology, neuropathology and mechanisms" 1909:"Historical study of coma: looking back through medical and neurological texts" 1550: 976:

Touching the sclera or eyelashes, presenting a light flash, or stimulating the

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for example, and is performed to identify specific causes of the coma, such as

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Bordini, A.L.; Luiz, T.F.; Fernandes, M.; Arruda, W. O.; Teive, H. A. (2010).

1495:, for an approach to working with residual consciousness in comatose patients. 1468: 1444: 1390: 1335: 1180: 1125: 1034: 990: 855: 815: 811: 546: 475: 428: 381: 86: 4040: 3832: 3736: 3458: 3335: 3299: 3267: 3208: 3159: 3102: 2853: 2718: 2640: 2471: 2326: 2251: 2142: 1934: 1650: 613:) various diagnostic tests, such as physical examinations and imaging tools ( 4134: 3135: 3094: 2422:"Ascending Reticular Activating System - an overview | ScienceDirect Topics" 1406: 1322: 1318: 1075: 943: 652: 553: 197: 180: 145: 82: 64: 3824: 3754: 3678: 3554: 3491: 3476: 3285: 3226: 3167: 3120: 3041: 2977: 2913: 2871: 2793: 2761: 2726: 2658: 2506: 2479: 2402: 2367: 2269: 2212: 2160: 2101: 2052: 1942: 1925: 1908: 1611: 1562: 1242:

as a result of being confined to a bed. Moving patients through the use of

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Perform brain scans to observe any abnormal brain functioning using either

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in which a person cannot be awakened, fails to respond normally to painful

3858: 3199: 2092: 2075: 1501:, the inducement of a temporary cessation or decay of main body functions. 3849:

Farisco, Michele (2016-04-28). Farisco, Michele; Evers, Kathinka (eds.).

3320:. Goetz, Christopher G. (3rd ed.). Philadelphia: WB Saunders. 2007. 1690:"The Glasgow structured approach to assessment of the Glasgow Coma Scale" 1349:

spontaneously began speaking and regained awareness of his surroundings.

823: 561: 530: 510: 455: 246: 238: 140:, light, or sound, lacks a normal wake-sleep cycle and does not initiate 3449: 2631: 2133: 1018: 932:

Caloric reflex test also evaluates both cortical and brainstem function

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may also provide further insight on the patient's emotional processing.

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with a tissue or cotton swab induces a rapid blink reflex of both eyes.

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Take blood work to see if drugs were involved or if it was a result of

614: 339: 3935: 2584: 4112: 3962: 3947: 2527:"Mechanisms and Morphology of Cellular Injury, Adaptation, and Death" 1121: 1026: 997: 970: 643:

present with voluntary movement of their eyes, whereas patients with

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Make sure the patient is in an actual comatose state and is not in a

542: 526: 351: 311:. Certain drug use under certain conditions can damage or weaken the 2117:"Cerebral Oxygen Delivery and Consumption in Brain-Injured Patients" 1821:

MedStudy Internal Medicine Review Core Curriculum: Neurology 11th Ed

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Depressed brainstem reflexes, such as pupils not responding to light

4028: 1128:(in both eyes, not just one). Another possibility is damage to the 885:

Patient's eyelids are gently elevated and the cornea is visualized.

4122: 3015:"Electrodermal Response in Coma and Other Low Responsive Patients" 1325:, which can occur in patients who lie still for extended periods. 1017: 514: 226: 112: 3764:

Material was copied from this source, which is available under a

2673:"First aid for unconsciousness: What to do and when to seek help" 1465:, lack of activity in both cortex, and lack of brainstem function 655:, back of brain...) and assess the severity of the coma with the 621:, etc.) are employed to access the underlying cause of the coma. 552:

The RAS, on the other hand, is a more primitive structure in the

3433:"Caregiver's Burden of the Patients With Traumatic Brain Injury" 1129: 1057:

at the elbow, and arms adducted toward the body, with both legs

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exhaustion and cellular breakdown from cytoskeleton damage and

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Daltrozzo J.; Wioland N.; Mutschler V.; Kotchoubey B. (2007).

819: 807: 700: 618: 1960:. University of North Carolina at Chapel Hill. Archived from 1483:, type of experience registered by people in a state of coma. 759:

In the initial assessment of coma, it is common to gauge the

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or experiencing psychogenic unresponsiveness. Patients with

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is a stereotypical posturing in which the patient has arms

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Find the site of the brain that may be causing coma (e.g.,

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Edwarda O'Bara, who spent 4 decades in a coma, dies at 59

1738:"Glasgow Coma Scale - an overview | ScienceDirect Topics" 2384: 2382: 283:

Lack of response to physical (painful) or verbal stimuli

3655:"The portrayal of coma in contemporary motion pictures" 1907:

Wijdicks, Eelco F. M.; Koehler, Peter J. (2008-03-01).

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The corneal reflex assesses the proper function of the

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In those with deep unconsciousness, there is a risk of

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Perform a general examination and medical history check

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Creative Commons Attribution 4.0 International License

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Eelco F.M. Wijdicks, MD; Coen A. Wijdicks, BS (2006).

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Liversedge, Timothy; Hirsch, Nicholas (2010). "Coma".

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or above. This positioning is stereotypical for upper

273:

General symptoms of a person in a comatose state are:

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fluids or blood and other supportive care as needed.

980:

will induce a less rapid but still reliable response.

498:(RAS) is sufficient to cause a person to enter coma. 3925: 4166: 4143: 4078: 4014: 3929: 3709:Farisco, Michele; Evers, Kathinka (December 2017). 3622:"Electrodes stir man from six-year coma-like state" 2699:

The International Journal of Psychiatry in Medicine

2018: 2016: 2014: 2012: 2010: 217:, meaning deep sleep, had already been used in the 118: 102: 92: 76: 57: 3604:"Mother stunned by coma victim's unexpected words" 1845:"Persistent vegetative state: A medical minefield" 1003:This reflex is examined by touching the posterior 818:of the brain structures. Special tests such as an 192:that forms the brain's outermost layer—and by the 3638:: CS1 maint: bot: original URL status unknown ( 350:, causes sodium and calcium from outside of the 2788:, Treasure Island (FL): StatPearls Publishing, 2756:, Treasure Island (FL): StatPearls Publishing, 2748:Romanelli, David; Farrell, Mitchell W. (2022), 2525:Miller, Margaret A.; Zachary, James F. (2017). 2501:, Treasure Island (FL): StatPearls Publishing, 2397:, Treasure Island (FL): StatPearls Publishing, 2389:Arguinchona, Joseph H.; Tadi, Prasanna (2022), 2362:, Treasure Island (FL): StatPearls Publishing, 2354:Mercadante, Anthony A.; Tadi, Prasanna (2022), 1557:, Treasure Island (FL): StatPearls Publishing, 241:(pathological sleep), 'coma' (heavy sleeping), 72:Image of a comatose man unresponsive to stimuli 42:"Comatose" redirects here. For other uses, see 3851:Neurotechnology and Direct Brain Communication 3715:Philosophy, Ethics, and Humanities in Medicine 2573:"Obtundation, stupor and coma Peter Dickinson" 1524:Weyhenmyeye, James A.; Eve A. Gallman (2007). 175:is a quantitative assessment of the degree of 4056: 3787:, Oxford University Press, pp. 180–206, 685:Continue to monitor brain waves and identify 8: 2339:: CS1 maint: multiple names: authors list ( 2176:"Coma: Types, Causes, Treatments, Prognosis" 1317:a person in a vegetative state is secondary 588:. In contrast, coma resulting from a severe 2780:Jain, Shobhit; Iverson, Lindsay M. (2022), 2579:, CRC Press, pp. 140–155, 2012-03-15, 2452:Emergency Medicine Clinics of North America 2391:"Neuroanatomy, Reticular Activating System" 2284:"Coma - an overview | ScienceDirect Topics" 1714:"Coma - an overview | ScienceDirect Topics" 1625:Cooksley, Tim; Holland, Mark (2017-02-01). 474:, and infections involving the brain, like 4063: 4049: 4041: 3926: 3711:"The ethical relevance of the unconscious" 3077:Lee, Bruce; Newberg, Andrew (April 2005). 63: 54: 3793:10.1093/acprof:oso/9780190280307.003.0011 3744: 3726: 3522:Aruna Shanba, who spent 42 years in coma. 3466: 3448: 3275: 3257: 3216: 3198: 3110: 3079:"Neuroimaging in Traumatic Brain Imaging" 2887:"Cortical Information Processing in Coma" 2861: 2843: 2648: 2630: 2619:International Journal of General Medicine 2556: 2493:Huff, J. Stephen; Tadi, Prasanna (2022), 2259: 2150: 2132: 2091: 1989:Anaesthesia & Intensive Care Medicine 1924: 1601: 1549:Huff, J. Stephen; Tadi, Prasanna (2022), 1471:, a system to assess the severity of coma 747:Learn how and when to remove this message 253:could turn and which he localized in the 122:Can vary from a few days to several years 1385:A person in a coma is said to be in an 1089: 899:(MLF), which is a brainstem nerve tract. 865: 858:. Reflexes are a good indicator of what 338:requires a great deal of oxygen for its 2311:(3rd ed.). New York: McGraw-Hill. 2232:Cochrane Database of Systematic Reviews 2199:Ali, Rimsha; Nagalli, Shivaraj (2022). 1823:. MedStudy. pp. (11–1) to (11–2). 1511: 4214:Symptoms and signs of mental disorders 3631: 3341: 2531:Pathologic Basis of Veterinary Disease 2332: 1814: 1812: 1810: 1808: 1761:Laureys; Boly; Moonen; Maquet (2009). 942:The cortex is responsible for a rapid 277:Inability to voluntarily open the eyes 3844: 3842: 3778: 3776: 3774: 3704: 3702: 3395: 3393: 3391: 2577:Small Animal Neurological Emergencies 517:. The cerebral cortex is composed of 403:Heart-related causes of coma include 317:ascending reticular activating system 7: 2894:Cognitive & Behavioral Neurology 1579: 1577: 1519: 1517: 1515: 1093:Pupil sizes (left eye vs. right eye) 729:adding citations to reliable sources 376:Comatose cases can also result from 1666:"What Is a Medically Induced Coma?" 1401:come into play when discussing the 966:(CN 7), and is present at infancy. 529:, whereas the inner portion of the 3671:10.1212/01.wnl.0000210497.62202.e9 3492:"Caring for Care Giver and Family" 2539:10.1016/B978-0-323-35775-3.00001-1 2074:Busl, K. M.; Greer, D. M. (2010). 1586:"Coma scales: a historical review" 1528:. Mosby Elsevier. pp. 177–9. 806:(CAT or CT) scan of the brain, or 545:. White matter is responsible for 25: 1365:waiting for a patient to awaken: 3902: 3759: 3373:10.1016/b978-141603618-0.10013-x 2121:Journal of Personalized Medicine 2045:10.1111/j.1749-6632.2009.04471.x 1801:from the original on 2014-10-20. 1782:10.1016/B978-008045046-9.01770-8 1526:Rapid Review Neuroscience 1st Ed 1447: 1437:unconscious ethically relevant. 1185:A coma can be classified as (1) 1153: 1137: 1113: 1101: 705: 584:, stupor, and finally, complete 490:Injury to either or both of the 449:decreased level of consciousness 245:(deprivation of the senses) and 208:The term 'coma', from the Greek 1603:10.1590/S0004-282X2010000600019 863:nerves 9 and 10 (CN IX, CN X). 716:needs additional citations for 3892:Merriam-Webster.com Dictionary 3817:The American Historical Review 3367:, Elsevier, pp. 217–229, 3365:Textbook of Clinical Neurology 3318:Textbook of clinical neurology 3300:"Neurological Assessment Tips" 2174:Durning, Marijke Vroomen; RN. 1664:Marc Lallanilla (2013-09-06). 897:medial longitudinal fasciculus 802:Imaging basically encompasses 295:Scores between 3 and 8 on the 280:A nonexistent sleep-wake cycle 1: 3304:London Health Sciences Centre 2307:S., Saladin, Kenneth (2011). 1590:Arquivos de Neuro-Psiquiatria 1041:damage. The other variant is 456:severe or persistent seizures 454:Other causes of coma include 132:is a deep state of prolonged 3034:10.1016/j.neulet.2010.03.043 2970:10.1016/j.clinph.2006.11.019 2906:10.1097/wnn.0b013e318192ccc8 2023:Young, G.B. (2009). "Coma". 1819:Hannaman, Robert A. (2005). 1770:Encyclopedia of Neuroscience 342:. Oxygen deprivation in the 336:Central Nervous System (CNS) 4093:Persistent vegetative state 3242:"Coma and cerebral imaging" 3152:10.1097/TA.0b013e3181d76737 2828:"Coma and cerebral imaging" 2711:10.2190/yvp4-3gtc-0ewk-42e8 2356:"Neuroanatomy, Gray Matter" 2001:10.1016/j.mpaic.2010.05.008 1886:Online Etymology Dictionary 1643:10.1016/j.mpmed.2016.12.001 1487:Persistent vegetative state 1120:"Pinpoint" pupils indicate 1045:, not seen in this picture. 794:) to safeguard the airway. 496:reticular activating system 194:reticular activating system 109:Persistent vegetative state 4230: 4072:Disorders of consciousness 3576:NINDS (October 29, 2010). 3187:World Journal of Radiology 1493:Process Oriented Coma Work 1178: 850:test (cold caloric test), 257:) are mentioned. The term 233:' (1621–1675) influential 210: 196:(RAS), a structure in the 29: 4088:Minimally conscious state 3728:10.1186/s13010-017-0053-9 3608:The Sydney Morning Herald 3547:10.1007/s00701-004-0225-4 3259:10.1186/s40064-015-0869-y 2845:10.1186/s40064-015-0869-y 2464:10.1016/j.emc.2016.06.017 2244:10.1002/14651858.cd001427 2207:. StatPearls Publishing. 1343:minimally conscious state 1296:minimally conscious state 846:test (doll's eyes test), 828:skin conductance response 451:, but do not reach coma. 71: 62: 44:Comatose (disambiguation) 3490:Coma Care (2010-03-30). 2958:Clinical Neurophysiology 2677:www.medicalnewstoday.com 1694:www.glasgowcomascale.org 1627:"The management of coma" 1246:also aids in preventing 1096:Possible interpretation 409:ventricular fibrillation 321:vestibular-ocular reflex 27:State of unconsciousness 4204:Intensive care medicine 3095:10.1602/neurorx.2.2.372 1417:experiencing well-being 1389:state. Perspectives on 1374:The Dreamlife of Angels 1263:lower respiratory tract 1202:Rancho Los Amigos Scale 594:subarachnoid hemorrhage 537:and is composed of the 413:ventricular tachycardia 3348:: CS1 maint: others ( 1354:deep brain stimulation 1046: 1000:, or faucial pillars. 926:Oculovestibular reflex 907:Pupillary light reflex 848:oculovestibular reflex 761:level of consciousness 590:traumatic brain injury 521:which consists of the 505:is the outer layer of 378:traumatic brain injury 37:Comas (disambiguation) 3859:10.4324/9781315723983 3785:Finding Consciousness 3535:Acta Neurochir (Wien) 3200:10.4329/wjr.v5.i4.143 3140:The Journal of Trauma 2426:www.sciencedirect.com 2288:www.sciencedirect.com 2093:10.3233/NRE-2010-0531 1853:: 40–3. July 7, 2007. 1742:www.sciencedirect.com 1718:www.sciencedirect.com 1481:Near-death experience 1063:Decerebrate posturing 1051:Decorticate posturing 1043:decerebrate posturing 1023:Decorticate posturing 1021: 969:Lightly touching the 788:nasopharyngeal airway 572:(low blood sugar) or 421:myocardial infarction 33:Coma (disambiguation) 3825:10.1086/ahr/71.2.709 3022:Neuroscience Letters 2782:"Glasgow Coma Scale" 2025:Ann. N. Y. Acad. Sci 1958:"Glasgow Coma Scale" 1926:10.1093/brain/awm332 1267:aspiration pneumonia 1225:, administration of 878:Oculocephalic reflex 844:oculocephalic reflex 784:oropharyngeal airway 725:improve this article 171:must be maintained. 31:For other uses, see 3584:on December 4, 2010 3450:10.7759/cureus.1590 2632:10.2147/IJGM.S28478 2134:10.3390/jpm12111763 2080:NeuroRehabilitation 2037:2009NYASA1157...32Y 1499:Suspended animation 1368:Reversal of Fortune 1360:Society and culture 1300:Aruna Shanbaug case 1215:Intensive Care Unit 1191:Tentorium cerebelli 928:(Cold Caloric Test) 918:fibers) are intact. 804:computed tomography 798:Imaging and testing 558:reticular formation 556:which includes the 417:atrial fibrillation 315:functioning in the 4209:Emergency medicine 4178:Locked-in syndrome 4015:External resources 3912:has a profile for 3895:. Merriam-Webster. 1862:2017-08-26 at the 1475:Locked-in syndrome 1168:(lack of oxygen). 1047: 978:supraorbital nerve 769:Glasgow Coma Scale 697:Initial evaluation 657:Glasgow Coma Scale 641:locked-in syndrome 445:Respiratory arrest 297:Glasgow Coma Scale 269:Signs and symptoms 219:Hippocratic corpus 184:activation of the 161:Glasgow Coma Scale 4186: 4185: 4158:Vasovagal episode 4038: 4037: 3918: 2594:978-0-429-15897-1 2585:10.1201/b15214-12 1535:978-0-323-02261-3 1172: 1171: 1016: 1015: 792:endotracheal tube 780:airway management 757: 756: 749: 689:of patient using 645:psychogenic comas 433:cardiogenic shock 235:De anima brutorum 154:medically induced 142:voluntary actions 126: 125: 52:Medical condition 16:(Redirected from 4221: 4065: 4058: 4051: 4042: 3927: 3916: 3906: 3905: 3896: 3873: 3872: 3846: 3837: 3836: 3819:. January 1966. 3812: 3806: 3805: 3780: 3769: 3763: 3758: 3748: 3730: 3706: 3697: 3696: 3694: 3693: 3665:(9): 1300–1303. 3650: 3644: 3643: 3637: 3629: 3618: 3612: 3611: 3600: 3594: 3593: 3591: 3589: 3580:. Archived from 3573: 3567: 3566: 3530: 3524: 3519: 3513: 3508: 3502: 3501: 3499: 3498: 3487: 3481: 3480: 3470: 3452: 3428: 3422: 3421: 3419: 3418: 3412: 3406:. Archived from 3405: 3397: 3386: 3385: 3360: 3354: 3353: 3347: 3339: 3314: 3308: 3307: 3296: 3290: 3289: 3279: 3261: 3237: 3231: 3230: 3220: 3202: 3178: 3172: 3171: 3131: 3125: 3124: 3114: 3074: 3068: 3067: 3065: 3064: 3058: 3052:. Archived from 3019: 3010: 3004: 3003: 3001: 3000: 2994: 2988:. Archived from 2955: 2946: 2940: 2939: 2937: 2936: 2930: 2924:. 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1539: 1521: 1457: 1452: 1451: 1450: 1409:views on comas. 1292:vegetative state 1244:physical therapy 1157: 1146:oculomotor nerve 1141: 1117: 1105: 1090: 960:trigeminal nerve 866: 814:in the brain or 752: 745: 741: 738: 732: 709: 701: 667:hyperventilation 371:brain hemorrhage 346:, also known as 213: 212: 67: 55: 47: 40: 21: 4229: 4228: 4224: 4223: 4222: 4220: 4219: 4218: 4189: 4188: 4187: 4182: 4169: 4162: 4139: 4108:Brainstem death 4080:Unconsciousness 4074: 4069: 4039: 4034: 4033: 4010: 4009: 3938: 3924: 3923: 3922: 3907: 3903: 3885: 3882: 3877: 3876: 3869: 3848: 3847: 3840: 3814: 3813: 3809: 3803: 3782: 3781: 3772: 3708: 3707: 3700: 3691: 3689: 3652: 3651: 3647: 3630: 3626:Cosmos Magazine 3620: 3619: 3615: 3602: 3601: 3597: 3587: 3585: 3575: 3574: 3570: 3532: 3531: 3527: 3520: 3516: 3509: 3505: 3496: 3494: 3489: 3488: 3484: 3430: 3429: 3425: 3416: 3414: 3410: 3403: 3399: 3398: 3389: 3383: 3362: 3361: 3357: 3340: 3328: 3316: 3315: 3311: 3298: 3297: 3293: 3239: 3238: 3234: 3180: 3179: 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