Coma after a stroke - how to increase your chances of survival!? Coma: degrees and types of coma. Coming out of coma 3rd degree coma prognosis

Coma is a severe pathology that threatens life. The central nervous system is depressed, the person loses consciousness. The operation of critical systems is also disrupted.

The main reason lies in damage to the structure of the brain. It can be caused by injury, fall, hemorrhage (stroke) or be the result of a disease, including cancer. So, the main reasons:

mechanical damage to the brain (hemorrhage due to hemorrhagic or ischemic stroke, trauma, road accident, tumor due to oncology);
infectious diseases;
poisoning, drowning, disruption of the glands, etc.

When treating coma, it is important to eliminate the cause that provoked it. Then procedures are carried out to eliminate the collapse. Everything needs to be done as quickly as possible. The patient needs to restore the oxygen supply and normalize the acid-base balance. The brain of a newborn often suffers if the umbilical cord is entangled. A comatose patient is always classified as severe. Often you have to struggle with the consequences for a long time. The prognosis is influenced by many factors - the severity of the condition, the cause, timely qualified assistance, age, the presence of chronic diseases, etc. The situation is worse with stroke and cancer.

If a coma overtakes a child, it is important not to waste a minute and begin treatment. If symptoms characteristic of precoma appear, call an ambulance immediately. In children, the condition can worsen quickly. The liver, lungs, heart, kidneys, and, of course, the brain are immediately affected. That's why it's important to watch for warning signs.

The rate of development of coma can be:

Unexpected. Consciousness is sharply lost, signs of coma develop (heart rhythm disturbance, breathing, blood pressure drops).
Slow. Precoma develops first. Reactions are slow, the person is drowsy or overly excited. At this stage, hallucinations and delusions may occur. Signs of the underlying disease gradually increase. Over time, all functions of the central nervous system are disrupted.
Fast. Symptoms develop over a period of several minutes to several hours.

Stages

Coma occurs in several stages.

Prekoma

This stage precedes the immediate onset of coma. Its length varies from 5 minutes to 1-2 hours. At this time, the patient's consciousness is confused. His lethargy and stupor are periodically replaced by unhealthy excitement. Reflexes are still preserved, but coordination of movements is impaired. The condition is serious. Its severity directly depends on the cause. A relatively mild condition can quickly turn into a serious one.

1st degree

Its main causes are hormonal crisis, intoxication, shock, brain inflammation, and metabolic problems. In a first-degree coma, the reaction is clearly inhibited. While a person is aware of his actions, he feels pain. It is difficult to establish contact with the patient. The muscles are in good shape. The patient has difficulty swallowing. Mostly he drinks. May eat something liquid. The pupils continue to react to light. If a 1st degree coma has begun, the chances of survival are high.

If the liver fails, the body can be poisoned by its own waste products. From the intestines, poisons enter the circulatory system. The body is quickly poisoned and the central nervous system suffers. Hepatic encephalopathy begins.

Before coma, vomiting is often observed. This is a signal that the body is trying to get rid of poisons that have begun to poison it.

2nd degree

In the second degree, stupor is observed and contact is lost. The reaction to stimuli is impaired. Sometimes the patient may make chaotic movements. The muscles either relax or tense again. Serious breathing problems occur. The intestines and bladder may empty themselves involuntarily. The chances of survival are quite high. It is often possible to achieve a full recovery. The exit from the stupor will be gradual. Its duration depends on the general condition of the patient and the timeliness of the care provided by doctors.

This type of coma often occurs with severe alcohol poisoning.

When a stage 2 coma develops, the chances of survival depend on timely medical attention and quality care. You can't give up. The scenario can develop positively for the patient. It is important to quickly restore spinal and brainstem reactions, restore breathing, and restore consciousness.

3rd degree

If a person is in a stage 3 coma, the chances of survival depend on comprehensive medical treatment and the general condition of the body. The patient is unconscious. There are no reactions at all. The pupils narrow. Seizures may develop. Body temperature and blood pressure decrease. Breathing loses rhythm. The condition needs to be stabilized. If a 3rd degree coma has begun, the chances that a person will come out of it are not so high. There is a possibility of mortality. Young and middle-aged adults are more likely to survive.

The development scenario of the third stage is often unfavorable. The medulla oblongata is severely affected. This is extremely life-threatening.

The danger of death is signaled by the following preceding symptoms:

the patient does not move his limbs and does not respond to the injection;
muscles are inactive;
blood pressure is low;
shallow breathing;
pupils are dilated and do not react to light;
convulsions are observed.

Doctors consider the third degree the most mysterious. It is its symptoms that closely resemble the signs of death. However, some patients came out of it. At the same time, they describe their state as a dream in which there are no dreams. At the same time, the body devotes all its resources to recovery, and the survival program is activated.

It is those patients who have emerged from the third degree who tell contradictory stories about the journey to God in empty space. At the same time, they heard voices, but did not perceive them.

In order for the victim to survive, resuscitation should begin immediately. It is important to restore blood circulation as soon as possible. This way, the maximum number of brain cells will survive.

4th degree

At the fourth stage there are no reflexes. Temperature and pressure drop sharply. This has an overall effect on the condition. It is supported by mechanical ventilation.

Coma 4 degrees – terminal condition.

How to come out of a coma

To bring the patient out of a coma, urgent treatment and resuscitation are necessary. Its goal is to restore the functioning of the brain, central nervous system, and stimulate reflexes. It is important that the doctor prescribe therapy as soon as possible. Whether a person survives depends on this. With proper treatment and favorable development, consciousness gradually returns to the patient. At first, delusions, hallucinations, anxiety, chaotic movements, and loss of coordination may occur. Consciousness may be periodically impaired. Convulsions are a concern.

Kinds

Who should not be considered a disease. This is the result of serious pathological changes. They damage brain tissue and disrupt the functioning of the central nervous system. The type of coma directly depends on the disease or mechanical damage that caused it. The less damage, the higher the chance of survival.

Diabetic coma

The reason for its development is the advanced stage of diabetes mellitus. Coma can be hypoglycemic or hyperglycemic. At the first, the glucose level goes off scale. The first sign of impending danger is the strong smell of acetone from the patient’s mouth. It is important to quickly establish a diagnosis and bring the patient out of a coma.

Hypoglycemic coma

It also develops in diabetes mellitus. Its reason, on the contrary, lies in a sharp decrease in blood glucose (less than 2 mmol/l). In the precoma stage there is severe hunger. It is characteristic that the patient experiences irresistible hunger, regardless of when he last ate.

Coma traumatic

The reason is a head injury, bruise in an accident, fall, fight, etc. This damages the skull and brain. Characteristic manifestations are nausea and vomiting. The goal of treatment is to restore blood supply to the brain and resume its normal functions.

Meningeal coma

The reason is brain intoxication due to the penetration of meningococcal infection into the body. A lumbar puncture will definitely be required. It will help to accurately identify the presence of infection. In precoma, this type is characterized by severe headaches. The patient has problems with simple physical functions. He cannot lift his leg in a supine position or straighten it. A test for the presence of Kernig's sign can be performed. The patient will not be able to bend the leg only at the hip joint. She will also involuntarily bend at the knee.

Another test is for Brudzinski's symptom. The patient's head should be tilted forward passively. At the same time, he will bend his knees. This movement is involuntary.

Another sign of this coma is that a rash appears on the skin, areas of necrosis form, including non-mucosal areas. These are tiny hemorrhages. They can also be observed on internal organs. This leads to a malfunction in their work.

Despite the listed groups of tests and symptoms, the final diagnosis is made after a lumbar puncture. If the cerebrospinal fluid is cloudy, has a high protein content, and a high number of blood cells, then the test is positive.

Coma cerebral

Occurs when brain tumors form. The previous disease develops slowly. Clinical symptoms are varied. It all starts with regular headaches. They are often accompanied by vomiting. Over time, the patient finds it difficult to swallow liquid food. He often chokes. He also has difficulty drinking. These are symptoms of bulbar syndrome. It can last quite a long time. The life and health of the patient is already at risk.

The sooner the doctor prescribes treatment, the higher the chances that the patient will live. Comatosis due to tumors can be very deep. Intervention by a neurosurgeon is often required. Even with a favorable outcome, disability is possible. All sorts of complications from the central nervous system, partial and even complete paralysis are common.

During this period, it is important to provide the patient with full qualified therapy. Otherwise, a coma may develop. The tumor itself can be easily detected using MRI and CT. Analysis of the cerebrospinal fluid will show abnormally high levels of protein and leukocytes. It is important to remember that if there is a tumor in the posterior cranial fossa, it is strictly forbidden to take a puncture of the cerebrospinal fluid. This can cause death.

Similar symptoms are observed with a brain abscess. But this species has its own differences. Coma is preceded by inflammatory processes (otitis, sinusitis, tonsillitis, etc.), an increase in temperature, and the level of leukocytes increases. It is important here that the patient is examined by an infectious disease specialist.

Coma epileptic

This is a consequence of a severe epileptic seizure. In this case, the patient’s pupils will be dilated, the skin will become pale, and most of the reflexes will decrease. A characteristic sign that coma was a consequence of epileptic seizures is biting on the tongue. Involuntary emptying of the intestines and bladder is also observed. The pulse is frequent, the pressure is low. As the condition worsens, the pulse will become thready. Shallow breathing can be replaced by deep breathing and vice versa. Cheyne-Stokes respiration may be observed. It consists in the fact that between periods of deep and shallow breathing there are short pauses when a person stops breathing altogether. Then the breath appears again.

When the condition worsens, blood pressure drops to a maximum and reflexes completely disappear. It is extremely important that the patient receives medical help as soon as possible. Otherwise, death occurs.

Coma hungry

The reason for its development is the third degree of dystrophy. Fasting leads to it. Often people who are on a protein diet bring themselves to such a pathological state. In this case, the body experiences a protein deficiency. His role cannot be underestimated! Protein performs essential functions in the body. Its deficiency causes serious disruptions in the functioning of almost all systems and organs. This includes serious depression of brain functions.

This pathological condition develops gradually. The first alarm signal to which the patient must respond is hungry fainting. Over time, they become more frequent, as the body experiences an increasing lack of vital protein. Fainting is accompanied by increased heartbeat, general weakness, and rapid breathing. When a hungry coma sets in, a person’s temperature drops significantly, blood pressure drops, and convulsions appear. In this case, the intestines and bladder may spontaneously empty.

A blood test will reveal reduced levels of white blood cells, cholesterol, protein, and platelets. The amount of glucose in the blood is greatly reduced.

Artificial coma

In case of severe traumatic injuries and other conditions, the patient may be put into a coma on purpose. This is a medicinal form, artificial.

Danger of condition

Coma is dangerous because the brain suffers from hypoxia. At the same time, its cells die. The primary task is to restore its blood circulation and restore functions. The patient undergoes detoxification measures. In case of uremic type, hemodialysis may be prescribed. When hypoglycemic - glucose.

If intoxication begins, shock develops, and brain tissue experiences energy deficiency. The consequences may be as follows:

The condition is getting worse.
Lethality sets in.
Energy deficiency increases, oxygen starvation of the central nervous system increases, and neurons die. Even if such a patient survives, the risk of disability is high.

Coma is a disorder of human consciousness in which brain damage occurs. A patient in this condition cannot contact the environment. Coma of the 3rd degree is also called atonic. Causes and symptoms vary. Coming out of a coma is possible with the necessary care. Diagnosis is carried out using CT and MRI, laboratory blood tests. Treatment involves eliminating the main cause of the pathology.

A person's eyes are closed, and he does not react to sounds and pain. It can lie in this state for a very long time. This is different from other damage to consciousness. Other signs may appear, it all depends on the causes of the atomic coma. Often the patient is connected to a life support device.

The chances of survival depend on the degree of coma. This determines the prognosis for improving human health. The duration of the condition can last from several days to years. When a person comes out of a coma, professional rehabilitation is necessary.

Coma in the 3rd degree is not recognized as an independent disease; it occurs from complications of the nervous system when the nerve pathways are damaged. The brain receives signals using the reticular formation. It serves as a filter that is used to transmit nerve impulses. When its cells become damaged, the brain will have loss of life. As a result, a comatose period occurs.

Damage to nerve fibers occurs physically. For example, in case of stroke, injuries. Chemical causes include the presence of other diseases, as well as incoming external metabolic products. Internal factors are a low oxygen content, acetone components, and ammonia.

External intoxication occurs with an overdose of drugs, sleeping pills, poisons, and the influence of toxins during infections. A special factor is the increase in pressure that occurs with injuries. Treatment is prescribed when the causes of the coma are determined.

Types of states

Coma is divided into 2 groups: depending on the factors of occurrence and the degree of state of consciousness. Based on the first sign, the disease is divided into:

traumatic;
epileptic;
apoplectic;
meningeal;
tumor;
endocrine;
toxic.

This distribution of the disease is rarely used, since it does not reveal the real condition of the person.

The state of coma can be determined using the Glazko scale, which allows you to determine the severity of the condition, determine treatment procedures and the prognosis for recovery. Speech, movements, and eye opening must be taken into account.

In resuscitation, the stages of coma are as follows:

coma 1st degree: also called stupor;
coma 2: called stupor;
coma 3: atonic;
coma 4: extreme coma.

A person can remain in these states for a long period. Patients lie motionless, which is necessarily controlled by the doctor. He must be able to perform various types of procedures. The prognosis for recovery depends on the condition of the body. Depending on the type of condition, different procedures are prescribed. Constant monitoring by a doctor is important here.

Symptoms

The main sign of the condition is that the patient is not in contact with the surrounding reality, and there is also a lack of mental activity. Other symptoms may vary markedly because the causes of brain damage vary. The most common symptoms include:

if the condition appears due to overheating, then the body temperature rises to 43 degrees, the skin becomes dry, and in case of alcohol poisoning, hypothermia is observed;
slow breathing appears with hypothyroidism, an overdose of sleeping pills, and deep breathing occurs with bacterial intoxication;
there may be a decreased or increased number of heartbeats;
in case of poisoning due to carbon monoxide, the skin takes on a red tone, and with a small amount of oxygen in the blood, the tips of the fingers turn blue, pallor of the skin characterizes massive blood loss: this is a deep coma;
superficial coma can be manifested by the production of different sounds: this shows a positive prognosis.

The type of recovery depends on the symptoms. Signs of coma affect the healing process. There is always a chance of improvement, but this is determined by the characteristics of the body.

Diagnostics

Coma in the third degree or any other requires an examination. What it is? This procedure is necessary to determine the diagnosis. It also allows you to determine how long the coma may last. With its help, you can understand how much a person has a chance of improving his health. Diagnostics determines the causes, as well as similarities with other similar conditions. After all, not many patients immediately recover from this state.

Who can help determine the reasons? Usually the patient’s close people help determine this. It is important for the doctor to find out whether there were any complaints before or not, as well as heart and vascular diseases. The medications taken can also affect a comatose state of 2 or 3 degrees.

The condition can last a long time; rarely it lasts a day. This is influenced by the speed of onset of symptoms and the age of the patient. The occurrence of third-degree or second-degree coma is observed in young people due to poisoning with drugs or sleeping pills. In older people, this is usually associated with heart and vascular disease. Thanks to the examination, the doctor determines the cause of the coma. Any stage is checked based on blood pressure, pulse, respiratory status, bruises, and injection marks.

The doctor analyzes the person's position. An overturned head with high muscle tone indicates an irritating effect of the brain. Convulsions occur due to an epileptic factor.

When a first-degree coma lasts for a long time, doctors sometimes decide to bring him out of this state. This is also required for stages 2, 3, 4. What is important is a person’s ability to open their eyes to sounds. When the phenomenon occurs voluntarily, it is not called coma. A person in this state remains with his eyes closed for a long time.

The reaction of the eyes to light must be detected. This method allows not only to determine the expected location of the disease, but also finds the factors for the occurrence of the condition. Narrow pupils that do not react to light are observed with the consumption of alcohol and drugs. If they are wide, then this indicates a disease of the midbrain. When the pupils become dilated and there is no reaction to light, this indicates a deterioration in the person’s condition.

Thanks to modern methods, diagnosis is one of the main things in examining a patient with deteriorating consciousness. Computed tomography is often used to detect changes in the brain. Based on the diagnosis, the treatment method is selected: classical or surgery.

If CT or MRI cannot be performed, then X-rays of the skull and spinal column are performed. A blood test can identify the metabolic factor.

It is important for the doctor to determine the level of glucose, urea, and ammonia. If this is not due to a malfunction of the nervous system, then the blood is checked for hormones. An EEG will help determine who has stage 2 or other degrees. Once the procedure is completed, it will be possible to distinguish a comatose state from other ailments. Based on the diagnosis, you can understand how long a person can remain in a coma.

Features of treatment

How to bring a person out of a coma? A patient in this condition can be treated with 2 options:
supporting his functions as a patient to prevent his death;

The doctor gives a prognosis for recovery after examination. Often, coma occurs after an accident or accident, when a person urgently needs help. The patient's condition is supported in the ambulance. It involves ensuring improvement of the respiratory system and blood circulation.

Two stages of treatment will help a person come out of a coma. In the intensive care unit, the patient may be placed on a ventilator. Also, if necessary, anticonvulsants, intravenous infusion of glucose, temperature restoration, and gastric lavage are administered. Only then does the person in a coma feel relief.

The following procedures are carried out only after the examination has been carried out, and the following medical measures are applied depending on the underlying cause. In case of a tumor or hematoma, surgery is performed. If this is a diabetic coma, then sugar levels must be monitored. For kidney failure, hemodialysis is performed.

Opportunities for improvement

In a comatose state, the prognosis is determined by the degree of brain disease, as well as the causes. A person who has been in a coma has a chance of improving his condition, based on injuries, age, and medications. In any case, the doctor provides the necessary treatment.

The consequences of a coma can be as follows:

favorable: when the condition improves and no adverse effects are observed;
doubtful: both a positive and negative outcome is possible;
unfavorable: when the patient dies.

Recovery from a coma involves a number of therapeutic measures. They are usually prescribed by a doctor. The procedures consist of taking medications, doing physical exercise, and maintaining proper nutrition. An integrated approach will significantly improve a person’s condition in a short time.

Any condition is easier to prevent than to treat. Prevention involves performing diagnostics, using the necessary treatment methods, and correcting the condition. Thanks to this, you can prevent its occurrence.

Intoxication, stroke and many other causes can lead to pathological inhibition of the central nervous system and the development of coma. A condition in which the patient balances between life and death is called third-degree coma. The development of a coma can be caused by various factors. The first place is occupied by direct damage to brain tissue during a stroke, injury, infectious process, etc.

Toxic substances that accumulate due to liver or kidney failure, infection, alcohol poisoning, and drug poisoning also damage the brain. Metabolic changes in any pathology, imbalance of hormones, and brain hypoxia can lead to coma.

Damage to the nervous system is based on bilateral diffuse damage to the cortex and brain stem with the reticular formation. This area maintains the tone of the cortical sections; its shutdown leads to inhibition of the central nervous system.

Classification

Types of pathology are distinguished based on the cause:

Neurological primary can develop after trauma, acute disturbances of vascular blood flow, after an epileptic seizure, or encephalitis, increased intracranial pressure.
Secondary coma:

toxic: poisoning with ethanol, carbon monoxide, medicines, drugs;
endocrine cause: development of hyper- or hypoglycemia, with hypothyroidism, thyrotoxicosis;
hypoxic coma occurs with heart and vascular diseases, anemia;
damage by physical factors (temperature, electric shock);
coma from dehydration or starvation.

There are 4 types based on severity. Their boundaries are arbitrary; a gradual or rapid transition from one degree to another is possible. Each of them has its own clinical symptoms.

Coma symptoms

A coma state can develop over several hours or days. The severity is determined by clinical manifestations. The period of time before a coma (precoma) depends on the underlying disease. The patient develops confusion, lethargy or mental agitation, and impaired coordination of movements.

Next, a 1st degree coma develops - a state of stupor. The response to stimuli is inhibited, but the patient can take liquid food, drink, and change position in bed. Tendon reflexes increase, and the pupils react to light.

2nd degree, or stupor, is characterized by depression of consciousness, loss of contact with the person. The muscles twitch fibrillarily, the pupils are in a state of miosis and do not react, the rhythm of breathing is disturbed, and it takes on a pathological form. The patient involuntarily empties.

Then comes a third degree coma. Body temperature drops, reflexes are suppressed, and the reaction to painful stimuli disappears. The pupils do not react to light, there is no consciousness.

Stage 4 is called beyond: life is maintained with the help of an artificial respiration apparatus. A condition close to terminal develops, the outcome being death.

Survival prognosis for stage 3 coma

What is a 3rd degree coma cannot be answered unambiguously. Her condition is often compared to clinical death; it is similar to deep sleep without dreams. And stage 3 coma does not always have a favorable prognosis. According to statistics, only 4% of people recover from this condition, but subsequently remain disabled. Indicators of threat to life are:

mydriasis, or enlarged pupils;
unproductive breathing;
drop in blood pressure;
convulsions;
lack of response to pain, decreased muscle activity.

Important! Studies show that if within 24 hours the patient loses the reaction of the pupils and the response to irritants and pain, then there is no chance of emerging from a 3rd degree coma, the prognosis is death. Survival is influenced by the initial level of health, the extent of associated injuries and the reason for which the coma developed.

Coma after stroke

Cerebral circulation disorders can be caused by blockage of a blood clot or rupture of a blood vessel. may cause third degree coma. The chances of survival depend on the size of the lesion and the age of the patient. Grades 1 and 2 often end with restoration of function. Seizures, hypothermia, lack of spontaneous breathing and pupillary reactions are unfavorable symptoms.

Coma after injury

Severe head injuries after an accident, a fall from a height, or blows with a blunt object lead to the rapid development of coma. The patient's condition is affected by concomitant damage to internal organs and blood loss. Fractures of the base of the skull, vault, temporal bones, damage to blood vessels, cerebral edema, and a high degree of brain contusion reduce the chances of emerging from a coma.

Hepatic coma

Develops as a result of liver failure. Patients have a characteristic appearance:

pale or icteric skin;
abdomen enlarged due to ascites;
veins on the anterior wall of the abdominal cavity as a sign of portal hypertension;
petechial hemorrhages;
general exhaustion.

Hepatorenal syndrome often develops, along with renal failure and oliguria. The immune system is weakened and sepsis may develop. The prognosis for such patients is extremely unfavorable.

Group 3 disability criteria

After recovering from a stage 3 coma, the person remains disabled. The law determines who is entitled to group 3 disability. These are persons with such a state of health who cannot work, with reduced vital activity, and in need of help and support from social bodies.

Disorders of basic functions are considered:

speech and language functions;
blood circulation;
sensory;
psyche;
physical;
static-dynamic.

The consequences of coma for determining disability are:

significant impairment of the ability to move (hemiplegia, hemiparesis);
aphasia;
dropsy of the brain;
developed dementia;
large defects of the skull or foreign body in the brain;
dysfunction of the pelvic organs.

Those who are given group 3 disability are examined by a commission every year and provided with a rehabilitation program. For sick pensioners, the group is assigned for an indefinite period and re-examination is not carried out.

Still from the film “Talk to Her” by Piedro Almodovar (2002)

Movies lie

In May 2006, the journal Neurology published an article by the American doctor E. Wijdix entitled “Depiction of coma in modern feature films.” A very unexpected topic for a serious medical journal that publishes the results of scientific research in the field of human brain activity and its diseases.

It is clear that viewers do not expect complete life truth from a film, even a realistic one; film critics do not evaluate a work of art by how accurately a medical episode corresponds to the description of the disease in a textbook; what is more important is the symbolic level of the image, a certain global statement of the author. For example, in the film “Talk to Her,” the outstanding Spanish director Pedro Almodovar tells the story of a young talented ballerina who not only awakens after a many-year coma, but also almost completely recovers. At the end of the film, a girl comes to the theater to watch her favorite ballet, leaning only lightly on a cane. Dr. Wijdix harshly criticizes the film for the implausibility of such an outcome, but in fact this is the director’s deeply labored message about the great transformative power of love.

Meanwhile, Dr. Wijdix's concerns are not unfounded. Having analyzed 30 films produced between 1970 and 2004, he came to the conclusion that only in two patients in a coma are shown realistically, in the rest they are beautiful in appearance, like the heroine of the fairy tale “Sleeping Beauty,” and immediately after emerging from a coma they become cheerful and active, and even perform feats, defeating superior enemy forces (as in the American TV series “24 Hours”). Doctors in such films are depicted as caricatures and do not inspire any credibility.

But the most important thing was something else: out of 72 non-medical respondents, 28 viewers, that is, 39%, reported that when making decisions regarding loved ones who find themselves in a coma, they would rely on knowledge gleaned from watching movies. And this is a worrying sign.

It is difficult to say how representative this result is, but it can be assumed with a high probability that the “sleep of reason” is mythologized for most of us, and when we find ourselves in a severe stressful situation, if a misfortune has happened to a person close to us, we do not really know what to expect, but what to hope for and how to act.

What is known about coma

Coma is a state of prolonged absence of consciousness, which is characterized by a sharp weakening or lack of response to external stimuli, extinction of reflexes until they completely disappear, disturbance of the depth and frequency of breathing, changes in vascular tone, increased or slowed pulse, and impaired temperature regulation.

Coma develops as a result of damage to the brain, causing an acute circulatory disorder in it, the consequence of which is deep inhibition in the cortex with its spread to the subcortical parts of the central nervous system.

The causes of coma are varied:

– head injury that leads to brain hemorrhage or swelling;
– a stroke, in which the brain stem is left without blood supply, or a cerebral hemorrhage occurs in combination with edema;
– a sharp increase in blood sugar levels (hyperglycemia) or a sharp decrease (hypoglycemia) in patients with diabetes;
– hypoxia, that is, oxygen starvation caused by drowning, suffocation or cardiac arrest;
– central nervous system infection such as meningitis or encephalitis;
– poisoning by decay products in the body that are not excreted due to failure of excretory systems or organs, for example, ammonia during liver disease, carbon dioxide during a severe attack of asthma, urea during kidney failure;
– epileptic seizures that recur over a short period of time.

There is also such a thing as a medically induced coma. It is induced by doctors in order to protect the body from disorders that negatively affect the activity of the cerebral cortex, such as hemorrhages with compression of the brain and its swelling. Artificial coma is also used instead of anesthesia when a series of complex emergency operations is necessary, during neurosurgical operations, as well as to bring the body out of epileptic status if other methods have proven ineffective.

Coma can develop suddenly or gradually, over a period of several minutes to several hours or even days. There are several classifications of types of coma, both according to its origin and degree of depth. In Russian sources, a gradation of depth from precoma to 4th degree coma is most often found.

In a state of precoma, the patient is either severely inhibited or, conversely, demonstrates psychomotor agitation; with preserved reflexes, coordination of movements is impaired, consciousness is confused.

In a state of 1st degree coma, there is sleep or stupor, marked inhibition of reactions to external stimuli, including pain, but the patient can perform simple movements, swallow water and liquid food, although contact with him is significantly difficult.

Coma of the 2nd degree is a deep sleep, lack of contact, rare spontaneous chaotic movements, pathological forms of breathing, the change of sharp tension in the muscles of the limbs with their relaxation, spastic contractions and fibrillation of individual muscles, weakened reaction of the pupils to light.

In a 3rd degree coma, which is also called atonic, there is no consciousness, no reaction to pain, reflexes are depressed or lost, there is no reaction of the pupils to light, convulsions are possible, breathing is arrhythmic, blood pressure and body temperature are reduced.

Coma 4th degree (extraordinary) is a state of complete absence of reflexes, muscle atony, a sharp decrease in pressure and temperature. The medulla oblongata stops functioning, so spontaneous breathing stops. The patient's condition is maintained using an artificial lung ventilation device (ALV) and parenteral (injection) nutrition. Often, an extreme coma ends in death, but if it is possible to bring the patient out of this state within half an hour and positive dynamics subsequently develop, then in this case, complete or partial restoration of brain functions is possible.

During coma, the central nervous system ceases to perform its regulatory function, therefore, the clear interaction of organs and systems is disrupted, the ability to self-regulate and maintain the constancy of the internal environment of the body is reduced.

How is it treated

Treatment for coma depends on the cause that caused it. A complete cure is possible if the patient is provided with medical assistance to eliminate the underlying disorder in a very short time and supportive measures are carried out correctly. So, if the coma is caused by diabetic shock, administration of glucose is necessary; for an infection that has spread to the brain, antibiotics are required; if pressure on the brain due to edema or tumor, surgical intervention is required. Swelling can be treated with medication, and medications are also used to stop seizures.

Supportive measures are necessary for coma, so patients are placed in intensive care units, where life support systems are used until significant improvements occur in the patient’s condition.

The prognosis for coma is highly individual and depends on many factors, the main ones being its cause and duration. If the cause can be eliminated, the person can return to normal life, but with severe brain damage, the patient remains disabled or does not return to consciousness at all.

In case of coma caused by drug poisoning, the patient's chance of full recovery is quite high. Coma caused by traumatic brain injury more often ends in recovery than coma resulting from oxygen deprivation. Rehabilitation of a patient in a diabetic coma is often successful if his blood glucose level is adjusted quickly enough.

If the patient is in a deep coma and does not respond to painful stimuli, then the significant improvement for him will be the appearance of a response to pain. Improvement may continue. Coming out of a coma is considered a state in which the patient can consciously perform some simple action (for example, open his eyes) in response to a doctor’s request.

As a rule, the longer the patient is in a coma, the chances of recovery decrease. Often patients emerge from a coma after many weeks of being in it, but, as a rule, with consequences leading to severe disability.

Modern life support systems are capable of artificially maintaining a person’s biological life for as long as desired, and the issue of disconnecting a patient in a coma from the system is quite complex from an emotional and ethical point of view, both for the patient’s relatives and for doctors. It is important to know that a sufficient basis for such a disconnection is only a statement of brain death, which is regulated by order of the Ministry of Health of the Russian Federation dated December 25, 2014 N908n “On the procedure for establishing the diagnosis of human brain death.”

For family and friends

In addition to feature films, there are many stories, oral and written, about how relatives refused to believe in the hopelessness of a loved one and were rewarded with his subsequent awakening and restoration. Here you need to keep in mind that, as a rule, in such stories there is no documentary data about what exactly doctors understood by the word “hopeless” and whether all 9 signs of brain death were recorded and recorded.

As for recovery after a long coma, in cases of famous people followed by numerous fans, we observe a very slow and far from complete recovery. Miracles did not happen, sadly, neither with Michael Schumacher, nor with Nikolai Karachentsov, who received excellent medical care and care.

For loved ones, however, the very fact that a loved one is alive, provides the opportunity for care and at least limited contact, is often a joy. Here is a story told by a woman who spent 19 years fighting for the recovery of her son, who was injured in an accident and spent 4 months in a coma. Nathan, 36, remains severely disabled, but his mother is happy that they are together.

And one more inspiring fact for the relatives of patients in a coma.

In January 2015, the journal Neurorehabilitation and Neural Repaire published data from a study of American doctors demonstrating the fact that comatose patients recovered faster and better than other patients in the same condition if they listened to recordings of their family members' stories. about the events of family history known to them. These were the voices of parents, brothers and sisters, whom the patients listened to through headphones. Using magnetic resonance imaging while listening to the recordings, the scientists were able to track increased neural activity in the areas of the patient's brain responsible for language and long-term memory, and after 6 weeks of such stimulation, the patients began to respond better to other external stimuli.