The term "coma" is borrowed from the Greek language and literally means "deep sleep".
What is a coma?
Signs of coma are oppression or strong inhibition of the function of the central nervous system. It is invariably accompanied by loss of consciousness. A person does not react to light, sound and other external stimuli. The regulation of the main important functions of the body is disturbed. Coma, as a rule, is a dangerous complication of a disease that makes the healing process difficult. Depending on the causes that lead to a coma, it can develop either rapidly, as in the case of a traumatic brain injury, or gradually. The main signs of a coma can appear for several hours or days, and with timely treatment, deterioration of the condition can be avoided.
Thus, who needs to be considered as an acute pathological condition that requires complex therapy in the early stages of manifestation. Therefore, the diagnosis of "coma" is not madeonly to a patient who is completely unresponsive to external factors, but also in the case of a blackout of consciousness with the preservation of basic reflexes.
The clinical picture of the development of coma is formed from an understanding of the algorithm of its manifestation, as well as from the knowledge of diseases and various pathologies, such as diabetes mellitus, poisoning with sleeping pills and psychotropic substances, uremia, which can lead to this state.
Varieties of coma
There are a lot of diseases, a complication of which can be a coma. Signs of coma, its etiology was studied in detail by N. K. Bogolepov, counting more than 30 types of this condition. Only a small part of the scientist singled out as independent diseases, while the rest became syndromes and complications. It is worth noting that not necessarily the same disease in different people can cause a coma. The essence of the problem lies in the violation of biochemical homeostasis, hemodynamics and other problems associated with the normal functioning of the brain. The systematization of coma led to the formation of the following subsections.
Neurological coma
They are directly related to damage to the central nervous system. These include:
- to whom, arising from strokes;
- apoplectiform coma;
- epileptic state of coma;
- to whom caused by trauma, for example, craniocerebral;
coma caused by inflammatory processes, as well as benign and malignant neoplasms inthe brain and its membranes
Coma due to endocrine disorders
What caused this coma? Signs of coma are manifested in the form of a malfunction in the metabolic processes of the body due to insufficient or excessive production of hormones. If they are synthesized little, then coma happens
- diabetic;
- hypocorticoid;
- hypothyroid;
- hypopituitary.
If the body produces a lot of hormones or the dosage of hormonal drugs is incorrectly prescribed, then thyrotoxic and hypoglycemic coma may develop.
If the water and electrolyte balance of the body is disturbed
If the human body experiences dehydration, lack of macro- and microelements, s alts and substances necessary to replenish energy losses, then it can also fall into a coma. In this situation, two main types are distinguished:
- chlorhydropenic coma, which occurs if the patient does not stop vomiting for a long time, for example, as in the case of pyloric stenosis;
- alimentary-dystrophic coma, in other words, coma from hunger.
Impaired gas exchange causing coma
Signs of this type are the lack of incoming oxygen, the problems of the respiratory system. These include:
- hypoxic coma caused by a lack of oxygen coming from outside (it occurs in case of suffocation, hypobaric hypoxemia, as well as anemia, when the blood is not saturated with oxygen, and with various circulatory disorders);
- respiratorycoma, which, in turn, is divided into respiratory-cerebral and respiratory-acidotic.
Respiratory failure caused by oxygen starvation, hypercapnia, global disruption of gas exchange processes in the lungs are common signs of coma of this subspecies.
Coma due to intoxication of the body
It stands out in a separate group, as it is provoked by endogenous intoxications accompanying toxoinfections, a variety of infectious diseases, pancreatitis, kidney and liver failure, or exposure to chemical poisons on the body: phosphorus organic compounds, alcohol, drugs related to group "barbiturates", and other medicines.
In addition to this rigid classification, there are coma of unknown or mixed etiology, in which one clear cause cannot be identified, for example, in the case of a thermal coma caused by overheating of the entire human body. Although some sources refer to it as a neurological group.
Below, consider some of the more common types of coma.
Diabetic coma: classification
Diabetic coma, the signs of which will be discussed later, is caused by a lack of insulin in the body of patients with diabetes mellitus, can manifest itself in three ways: hyperketonemic, hyperosmolar, hyperlactacidemic. Sometimes it is called "cerebral coma", since during its course there is swelling of the brain due to the fact that with a decrease in insulin levels, the osmolarity of brain and bloodcells change differently.
When blood sugar rises too high, hyperglycemic coma sets in. It is most dangerous for children and the elderly. It develops gradually, usually over several days.
Signs of hyperglycemic coma:
- breath with the smell of acetone;
- pallor and dry skin;
- loss of appetite;
- pupil constriction;
- stomach pain;
- tachycardia;
- decrease in muscle tone;
- confusion of creation.
As soon as the first signs of a coma begin to appear, it is urgent to call an ambulance. If this is not done in time, a person stops responding to external factors and influences.
Hypoglycemic coma
In patients with diabetes, sugar can not only rise sharply, but also decrease. This happens due to long breaks between meals, excessive physical exertion, or in the case of drinking alcohol. Hypoglycemic coma, the symptoms of which are described below, develops very rapidly.
Her harbingers may be:
- strong feeling of hunger;
- anxiety;
- irritable and restless condition;
- low body temperature;
- shallow rapid breathing;
- excessive sweating;
- nausea, migraine;
- palpitations;
- visual impairment;
- inhibited consciousness;
- dilated pupils;
- muscle hypertonicity.
When all or part of the symptoms appear, emergency care is needed, consisting of intravenous administration, if necessary, repeated, glucose solution and subcutaneous adrenaline.
Coma stages
It has been established that there are a number of reasons why a coma develops. Signs of a coma of one etiology or another determine the severity of the process, as a result of which several stages of a coma have been identified.
- Precoma. Here, the patient is characterized by several rather contradictory signs. On the one hand, there is a blurred consciousness, failures in spatial orientation, slowness, and on the other hand, increased excitability, impaired coordination, but the main reflexes remain intact.
- Coma of the first degree. This is when the patient practically does not make contact, does not respond to external stimuli, feels very little even severe pain, muscle hypertonicity and insensitivity of skin receptors are observed. The pupils in this case react to light, but may diverge in different directions, as in strabismus.
- Coma of the second degree is due to the complete absence of contact, it is almost impossible to cause a pain reaction: a person can open his eyes as much as possible. There is an arbitrary emptying of the intestines and bladder, chaotic movement of the arms and legs, a sharp tension and relaxation of the muscles. Pupils almost do not react to light.
- Coma of the third degree. Completely disabledconsciousness, reaction to light and pain, reduced pressure, reflexes and temperature, breathing is slow, rare, shallow. A person "walks under himself".
- Coma of the fourth degree. There is a 100% absence of reaction, reflexes, tone, very low body temperature and pressure, breathing may periodically disappear.
Coma can occur in seconds, minutes or days. Naturally, the slower it develops, the more likely it is to return the patient to a normal state. That is why it is very important not to delay hospitalization if you or your loved one finds the first signs of a coma.
Whether the prognosis will be favorable depends on the severity of the coma, as well as on how quickly its primary manifestations were recognized and started to eliminate them. Coma, accompanied by brain damage, with liver failure has a poor prognosis. It is possible to hope for a favorable outcome in the case of diabetic, alcoholic and hypoglycemic coma, however, only if adequate timely therapy has been carried out.
If we are talking about an epileptic coma, then there is no need for treatment at all. A person will regain consciousness on his own after pathogenic factors cease to affect him.
It should be remembered that even being in a coma for only a few days does not pass without a trace and can negatively affect the physical and mental state.
