Coma: classification, signs, principles of treatment. Coma - degrees, treatment, prognosis, types, causes, symptoms Real cases of exit from a coma of 3 degrees

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

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

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

What is the basis of coma?

Coma is based on two mechanisms:

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

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

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

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

com classification

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

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

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

Neurological (primary) genesis:

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

secondary genesis:

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

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

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

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

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

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

Signs of a coma

Coma I degree

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

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

Coma II degree

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

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

Coma III degree

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

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

Coma IV degree

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

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

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

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

Clinical features of some types of com

Cerebrovascular coma

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

Traumatic coma

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

epileptic coma

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

Meningoencephalitic coma

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

Hypertensive coma

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

hepatic coma

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

renal coma

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

Alcoholic coma

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

Coma due to carbon monoxide poisoning

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

Coma due to poisoning with sleeping pills (barbiturates)

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

Coma with drug overdose

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

diabetic coma

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

Principles of treatment for com

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

Measures that ensure the vital functions of the body include:

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

Symptomatic measures are also used to remove existing violations:

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

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

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

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

Coma is a condition that threatens a person's life and is characterized by loss of consciousness, an absent or weakened response to external stimuli, a violation of the frequency and depth of breathing, the extinction of reflexes, a change in pulse, vascular tone, and a violation of temperature regulation.

The development of coma is due to deep inhibition in the cerebral cortex, which extends to the subcortical and lower parts of the central nervous system due to head injuries, acute circulatory disorders in the brain, poisoning, inflammation, hepatitis, diabetes mellitus, uremia.

The goal of treating coma is to eliminate the causes that caused this condition, and to carry out measures aimed at eliminating collapse, oxygen starvation, restoring breathing, and acid-base balance.

Types and causes of coma

By origin, the following types of coma are distinguished:

• neurological coma. Its cause is the depression of the central nervous system in primary brain damage (apoplectic coma in stroke, epileptic coma, traumatic coma, coma caused by brain tumors, coma in meningitis, encephalitis);
• To whom with endocrine diseases. This kind of coma is associated with metabolic disorders with an insufficient level of hormone synthesis (hypothyroid coma, diabetic, hypocorticoid), their excessive production or overdose of drugs based on hormonal agents (thyrotoxic, hypoglycemic);
• Toxic coma. This type of coma is associated with exogenous (coma with poisoning), endogenous (coma with liver or kidney failure) intoxication, toxic infections, pancreatitis, infectious diseases;
• To whom, associated with a violation of gas exchange:
• To whom, due to the loss of electrolytes, energy substances, water by the body.

Certain types of coma cannot be attributed to any group (for example, coma caused by overheating of the body), and some can be attributed simultaneously to several groups (electrolyte coma in liver failure).

Coma symptoms

The rate of development of coma symptoms can be different. Coma may occur:

Suddenly. The patient abruptly loses consciousness, and in the next minutes all the signs of a coma appear: a disorder in the depth and rhythm of breathing, noisy breathing, a drop in blood pressure, disturbances in the pace and rhythm of heart contractions, the work of the pelvic organs;

Quickly. The increase in symptoms occurs over several minutes to several hours;

Gradually (slowly). In this case, precoma first develops with an increase in the symptoms of the underlying disease, against which there is a gradual increase in neurological and mental disorders. A change in consciousness can be manifested by lethargy, drowsiness, lethargy, or, conversely, psychomotor agitation, hallucinations, delirium, delirium, twilight, which are gradually replaced by stupor and coma.

There are 4 degrees of coma:

• 1 degree coma. Symptoms of a coma of this severity are characterized by: stupor, sleep, inhibition of reactions; the patient can perform simple movements; its muscle tone is increased, the reaction of the pupils to light is preserved; pendulum-like movements of the eyeballs are sometimes noted; skin reflexes in the patient are sharply weakened;
• 2 degree coma. Characterized by deep sleep, stupor; a sharp weakening of reactions to pain; pathological types of breathing are observed; spontaneous rare movements are chaotic; involuntary defecation and urination may occur; pupils are narrowed, their reaction to light is weakened; corneal and pharyngeal reflexes are preserved, skin reflexes are absent, muscular dystonia, pyramidal reflexes, spastic contractions are observed;
• 3 degree coma. It is characterized by the absence of consciousness, corneal reflexes, reaction to pain; inhibition of pharyngeal reflexes; pupils do not react to light; muscle tone and tendon reflexes are absent; blood pressure is reduced; there are involuntary urination and defecation, arrhythmic breathing, a decrease in body temperature;
• 4 degree of coma (outrageous). It is characterized by complete areflexia, hypothermia, muscle atony, bilateral mydriasis, profound disruption of the medulla oblongata with a sharp decrease in blood pressure and cessation of spontaneous breathing.

The prognosis of coma depends on what causes it was caused and the severity of damage to the brain stem.

Rapid (within 20-30 minutes) recovery of stem and spinal reflexes, spontaneous breathing and patient consciousness determines a favorable coma prognosis. With grade 3 coma, the prognosis for the patient is usually unfavorable; the prognosis for transcendental coma is absolutely unfavorable, since this is a borderline condition, followed by brain death.

Coma treatment

The initial measures in the treatment of coma are: ensuring the patency of the airways and the correction of cardiovascular activity and respiration. Next, the nature of the disease that caused the development of coma is clarified, and appropriate treatment is carried out. If the coma is caused by an overdose of narcotic drugs, then the patient is shown the introduction of naloxone. With purulent meningitis, antibacterial drugs are prescribed, with epilepsy - anticonvulsants. With an unclear diagnosis, it is advisable to administer a dextrose solution.

In addition, symptomatic and pathogenetic treatment of coma is also used. For this use:

• Hyperventilation and osmotic diuretics (with intracranial hypertension);
• Anticoagulants and antiaggregants (in acute cerebral ischemia).

Treatment of common diseases complicated by coma is carried out: diseases of the kidneys and liver, diabetes mellitus. If necessary, prescribe plasmapheresis, detoxification therapy, hemosorption.

When leaving the state of coma, a gradual restoration of the work of the central nervous system occurs, as a rule, in the reverse order: first, the pharyngeal and corneal reflexes are restored, then the pupillary ones, and the severity of vegetative disorders decreases. Consciousness is restored, passing through the stages: confusion and stupor, delirium and hallucinations, motor restlessness.

When the patient's condition stabilizes, the underlying disease is treated, which caused the development of coma, and measures are taken to prevent possible complications.

Thus, coma is a dangerous condition, indicating the presence of certain diseases, injuries, circulatory disorders in the brain, lack of oxygen in the blood; about poisoning, the impact of psychogenic factors, which, if a certain degree is reached, can lead to death.

The prognosis for the development of this condition depends on the cause that caused it, the timeliness and adequacy of the therapeutic measures taken, and the characteristics of the patient's body.

Coma is a borderline state between life and death. The result of inhibition of nerve impulses in the cerebral cortex, subcortex, underlying sections. It is clinically manifested by lethargy or loss of consciousness, a decrease / lack of response to external stimuli, and the disappearance of reflexes. Consider why a coma develops after a stroke, what is its duration, the chances of surviving, fully recovering.

The mechanism of development of coma

Damage to neurons is accompanied by a change in the metabolism of the nervous tissue. Intracellular fluid enters the intercellular space. Accumulating, it compresses the capillaries, due to which the nutrition of nerve cells worsens even more, their work is disrupted. A coma can develop very quickly (a few seconds to minutes) or gradually (up to several hours, rarely days). Most often, coma occurs after a massive or stem stroke caused by hemorrhage, less often by blockage of the cerebral arteries.

Severity

There are 5 degrees of coma after a stroke of varying severity:

• Precoma - moderate confusion, stunning. The victim looks drowsy, slow reacts to external stimuli, or vice versa is overly active.
• 1 degree - severe stupor. The patient reacts very slowly to strong external stimuli, including pain. Can perform simple actions (swirling in bed, drinking), responding with meaningless words/single sounds, muscle tone is weak.
• Grade 2 - loss of consciousness (sopor), basic reflexes are preserved (pupil reaction to light, eye closure when touching the cornea). When referring to the patient, there is no reaction, his rare movements are chaotic. Pain reflexes are depressed. The nature of breathing changes: it becomes intermittent, superficial, non-rhythmic. Possible involuntary urination, bowel movements. There is trembling of individual muscles, twisting of the limbs.
• Grade 3 - loss of consciousness, lack of pain reaction, some basic reflexes. Involuntary urination, defecation. Muscle tone is reduced. The pulse is poorly palpable, breathing is irregular, weak, body temperature is reduced.
• 4th degree (extraordinary) - the absence of any reflexes. Agonal breathing, heartbeat, ends in death.

Why is an artificial coma needed?

An artificial state is called a coma, which is achieved by the introduction of narcotic substances (most often barbiturates) or by cooling the patient's body to a temperature of 33 degrees. They cause vasoconstriction of the brain, slowing of cerebral blood flow, and a decrease in blood volume. Medical coma in stroke is necessary for some patients to eliminate cerebral edema, the most severe complication that provokes more than 50% of deaths.

This technique is rarely used due to the large number of complications, unforeseen results.

duration of coma

The duration of a coma can be very different: from several hours to several days, weeks. Some patients die without recovering. Rarely the patient stays in a coma for several months, a year, more. But the chances of recovery after such a long coma are extremely small.

A quick exit is more likely when:

• moderate area of ​​necrosis;
• ischemic nature of stroke;
• partial preservation of reflexes;
• young age of the patient.

Prognosis, recovery from coma

Post-stroke coma is considered the most severe type of coma (1):

• only 3% of patients manage to recover, fully recover;
• 74% of com after a stroke ends in death;
• 7% of patients manage to regain consciousness, but they lose all higher functions (the ability to think, talk, perform conscious actions, follow commands);
• 12% of patients remain profoundly disabled;
• 4% of people recover with moderate impairments.

Factors affecting the prognosis:

• Localization of the focus of necrosis. If a stroke affects the medulla oblongata, where the centers for controlling breathing and heartbeat are located, death occurs very quickly.
• The duration of the coma: the longer it lasts, the less hope for a full recovery, the higher the risk of death.
• Coma depth. In medicine, the Glasgow scale is used to evaluate it. During the examination, the doctor tests the ability of a person to open his eyes when exposed to various stimuli, speech, motor reaction. For each feature, a certain score is awarded (table). The lower the score, the less favorable the outcome for the patient.

The degree of coma (according to the sum of points):

• 6-7 - moderate;
• 4-5 - deep;
• 0-3 - brain death.

Treatment, patient care

The treatment regimen for comatose patients differs little from the management of other patients after a stroke. With an ischemic stroke, the main task of the doctor is to restore the patency of the cerebral vessels, to prevent recurrent thrombosis. Both types of stroke require the appointment of diuretics, which reduce swelling of the brain, reducing intracranial pressure.

Also, patients are prescribed medications to correct the level of blood pressure, heart function. If a person cannot breathe on his own, he is connected to a ventilator.

Patients who are in a coma after a stroke require round-the-clock care. To prevent bedsores, patients are turned over every 2-3 hours, pads and rollers are placed under the protruding parts of the body. Every day a person is washed, washed away, diapers or urinals are changed.

Coma patients are fed through a probe - a plastic tube that is inserted into the stomach through the nose. The patient's diet consists of various liquid dishes: pureed soups, vegetables, infant formula.

The study showed that patients who were allowed to listen to recordings of family stories of relatives recovered faster, better. During the scrolling of the record in their brain, memory and speech zones became more active (4).

Therefore, relatives are encouraged to talk with their loved ones. Be sure to introduce yourself first. Then tell the patient how your day went, remember some events that unite you. Be sure to express love, say that you are waiting for his recovery.

Exit from a coma

The exit process is not like waking up. The first shearing sign is that the patient opens his eyes, keeps them open for a while. So far, he does not respond to voice, touch. The patient's gaze is usually not focused, he looks somewhere into the distance. Chaotic movements of arms and legs are possible.

As the person improves, he begins to “wake up” from pain (for example, a pinch), touch. Movements become more purposeful. For example, the patient may attempt to withdraw the catheter. Unfortunately, sometimes this is the maximum result that can be achieved.

They say about a stable improvement if a person begins to respond to a call by name, becomes able to follow simple instructions (shake your hand, move your foot). In a good scenario, the patient's condition will continue to improve. He can begin to recognize others, keep up a conversation, fulfill requests, be interested in what is happening. Further recovery depends on the severity of brain damage by stroke, coma.

Literature

1. Dr David Bates. The prognosis of medical coma, 2001
2. David E. Levy and others. Prognosis in Nontraumatic Coma, 1981
3. Marc Lallanilla. What Is a Medically Induced Coma? 2013
4. Theresa Louise Bender Pape. Placebo-Controlled Trial of Familiar Auditory Sensory Training for Acute Severe Traumatic Brain Injury: A Preliminary Report, 2015

Last updated: October 12, 2019

anonymous , Male, 1 year old

My son has a CHD (type 4 ala, dmzhp). Respiratory arrest occurred, heart-clinical death and cerebral edema. Now the child has been in a coma of the 3rd degree for almost 2 months. The child is 1 year and 2 months old. Results during this time: cerebral edema subsided, sodium returned to normal (was 190), is on a ventilator (somehow there were attempts to breathe ... But ... I didn’t breathe yet). I began to respond to touch: moves my arms, legs, fingers, squeezes shoulders (on legs, afraid of being tickled, strongly pulls them away). Now they are doing physical therapy with him. But he started doing all this long before exercise therapy. I wanted to ask: do I need to leave stem cells to my son (I'm just pregnant with my second one), can they somehow help or be useful to him? And what can you say about our situation (((?

Good day! Your child's condition is serious enough to require medical supervision. Regarding stem cell treatment, I would like to inform you that this type of intervention is not included in the Standards of Medical Care for Children, but there is a Medical Permission for the use of this technology. Regarding the preservation of cord blood during childbirth, this is a purely voluntary matter. Please send me the conclusion of your attending physician, I will be able to advise an exemplary exercise therapy complex for a child. Sincerely, Dr. Tarakanov O.P.

anonymously

Coma 3 degrees hello. I am sending you our extract. Can you also tell us which clinics we should contact, where such children are treated? ...

A photo is attached to the question

anonymously

Hello, Nikolai Vladislavovich. I sent you my statement right away. What can you say about our child? What are our chances? What should we do? Where is it better to transport him (where are such children taken care of)? At 3 am from September 8 to 9, 2014, my son suddenly became ill: he began to choke. I called an ambulance and after 10-15 minutes we were already in the hospital. The child either breathed or did not breathe, all pale blue, rolls his eyes ... He was taken to intensive care and the door was closed .... What happened next with the child, we do not seen. After an hour and a half, a doctor came out and said that the child had a clinical death, he was pumped out with adrenaline (as they told us). At half past seven in the morning, a city resuscitation vehicle arrived with a resuscitator and, since we have no conditions in the region, they took the child to the Republican Children's Clinical Hospital in Kazan. There he was in a medical coma for 3 days, and when he was taken off these medications, it turned out that he himself was already in a deep 3rd coma. There was a strong swelling of the brain (we were admitted with sodium 190 and separated cranial bones). The first 2 weeks we had bedsores, swelling, fed through the system (proteins, fats and carbohydrates). What our child has achieved today: - externally looks good (just sleeps and it seems that he is about to wake up). There are no edemas, there are no bedsores and they do not appear. - Feed (through a tube) 150 ml of the mixture 6 times a day, assimilates. Now we are gradually moving on to cereals. - Gained good weight (was 7.3 kg, now 8.4 kg) Sometimes they do an enema, mostly he poops himself. - Moves: it all started with small movements of the hands. We even thought that it only seems to us ... but every day the movements became stronger and stronger, he began to move his fingers and raise his hands. Then the same thing happened with the legs. Now he moves his whole body: he lifts his chest, tightens his abdominal muscles, and even began to move his head a little. When I bend his legs into his knees, he even tries to keep them in this position for a while: his legs tremble with tension, then he relaxes and they move apart. You can’t calmly cut your toenails, it tickles him and he begins to pull back, take away his leg (such a picture happened at our house when he was healthy). Once I accidentally dropped some water on his tummy, so he stirred all over. And all these movements, movements are getting stronger and stronger every day! -The first 2 teeth (lower ones) came out at the beginning of June 2014 (we were 9 months old), and the upper ones did not climb and did not climb. And just for a week he began to have a temperature with us and could not understand why. Our doctor decided to look into his mouth, it turned out that the upper gums were swollen. Now we are waiting for 2 more teeth. He himself is not breathing yet, on the ventilator. The eyes do not react to light, the pupils are dilated. The fundus was checked, they said that everything is fine there. All internal organs are in good and working condition. We feel that our son really wants to live and he must live ... he will live ...

Depending on the degree of coma, there is a shutdown of brain functions, all body functions slow down or almost stop, metabolism, the nervous system suffers significantly. In some cases of coma, the brain, which is not getting enough oxygen, begins to die. In these cases, medical workers offer the relatives of the injured person to disconnect him from the life support system, on which the whole life of the victim rests, since his body cannot support life itself.

There can be several reasons for coma:

Brain damage due to any injury;

Intoxication with alcohol or drugs;

Intoxication of drugs;

Prolonged lack of oxygen supply to the brain;

Infections that affect the brain;

Hemorrhage in the brain;

A person can fall into a coma in the event of a stroke.

Degrees of coma and their causes

It is not always possible to bring a person out of a coma, but it is possible. It all depends on the degree of coma into which the patient has fallen. There are only four of these levels:

Coma of the first degree

The patient speaks indistinctly. Responds to pain. Pupillary reaction is weak. It is quite possible to bring a person out of a first-degree coma.

Coma of the second degree

The patient is in a state of sleep. He almost does not respond to physical stimuli. His thought processes are inhibited. Blood pressure goes down. All bodily functions are inhibited. It is possible to bring a person out of a coma, although it is extremely difficult.

Third degree coma

The person is in a deep state of sleep. He does not react to any stimuli, his mental activity does not work. Sometimes a person in a state of the third degree of a coma reacts to pain, but very rarely. At the same time, a person is not able to control his natural processes of urination and feces. He is short of breath, sometimes there are muscle spasms, pupils are enlarged and blood pressure is very low. This coma is considered deep. You can bring a person out of a coma only in rare cases. From a coma of the third degree, a maximum of 4 percent of patients who fall into it come out.

Coma of the fourth degree

The patient's reflexes and reactions are absent, there is practically no breathing, or breathing is fully supported by the artificial life support system. Heartbeat irregular, blood pressure very low. At this stage, the brain begins to collapse. This is the stage of the deepest coma. Unfortunately, it is impossible to bring a person out of this coma.

Brain function deteriorates depending on the degree of coma. At the first degree, brain functions are slightly damaged, and at the fourth - they cannot be corrected.

How can a person be brought out of a coma?

To date, there is no answer to the question: how to get a person out of a coma. Medical workers advise relatives to stay close to the person, talk to him as if he is conscious, read books to him, take him by the hand. It is possible that any sound or action will be a stimulus to get him out of a coma. There was a case when the daughter of a man who fell into a coma played a musical instrument for him, and thanks to this he woke up.

Usually this condition lasts no more than three weeks, although it happens that a person is in a coma for up to several months and even years. The longest coma lasted 37 years. Upon awakening, a person will not wake up as in a fairy tale about the sleeping beauty and will not immediately get on his feet. Don't expect him to immediately speak and start functioning as before. The rehabilitation process after coming out of a coma will take some time. At first he will come to his senses in periods and for a short time, then more and more often. Then he will restore speech for a long time.

Often, waking up, a person does not understand where he is and how he got to the hospital. He needs the support of family and friends to restore his mental functions. Therefore, do not despair if your relative or loved one is in such trouble, do not bury him in advance. Have patience and faith that he will again live a full life, as before.

Thank you all in advance.

About whom I know nothing, so there is nothing to say. If it is now transportable, then it is necessary to take it to Polenov. There is nothing to do in the Peterhof hospital. :(

about Polenov unflattering reviews. You still need to ask in Special, they are aware of such things. About the chances - this is to the Lord God. Again, the chances of life are one thing, health is another.

Okito - tell me - why bad.

Kid, Lena - thanks for the support

And that the accident happened abroad.

This is just my experience.

Do not know. Our friends were unlucky simply because of banal negligence. The operation and donor materials (bone implantation) cost crazy money, and post-op care ruined everything: 005:

While, in a provincial hospital, a neurosurgeon, without any modern materials, performed the first operation for free, very, very

When they moved to Polenov, they thought that they operated in Germany or Finland.

And that the accident happened abroad.

This is just my experience.

thanks for the information.

Who was he injected into or was he himself? if entered. it took the load off the body.

My husband had a second one. the condition was terrible. weren't given a chance. but survived. the truth about health is now out of the question (((. but it seems. how to recover a year later. operated in the Elizabethan. here it seems to me. how the card will fall (sorry for the comparison).

As I understand it, I immediately fell into a slump after the accident (I was on a motorcycle). thanks for the support.

I will hold my fists for the guy, God help him!

I ask for advice and information from the almighty LV. My nephew got into a car accident on Sunday. 3rd day in a coma. Coma 2-3 degrees. There was an operation by neurosurgeons in a hospital in Peterhof (a neurosurgeon came, since the nephew is not transportable). Did an EEG today. There are signs of activity in the GM. Parents want to transfer to the Polenov Institute.

The question is what are the chances of a favorable outcome? (doctors while forecasts give unfavorable). What can be done? Do you have friends who can help? The guy is 19 years old. Polenov was advised in the hospital by the head of the intensive care unit.

Thank you all in advance.

Regarding my acquaintances: I looked at the RG (Gaz Handle, motorcycle forum), there is not a word about your nephew. It makes sense to ask friends to post information there, there will certainly be help. if anything, write in a personal

My father after a stroke lay in a coma for three days and died. I don't know what degree it was. As far as I know, it is on the third day that it becomes more or less clear what are the chances of survival, etc.

It is insanely scary when our children suffer.

My mother was in a car accident 4 years ago. The condition was extremely difficult. Without going into lyrics and accusations, I will only say: If the triponation is done in the first 3 hours after the accident, the chances increase. If later - everything becomes more difficult. We are waiting further. Usually, 3 months are given to get out of a coma. If there is no dynamics, the doctors, as a rule, give up. My mom had an emergency done 3 days later. They lay in the district (where they were brought by ambulance), and in the Military Medical, and in Polenov. The experience is HUGE! If you have any questions, then write better in a personal - I will definitely answer.

With craniocerebral injuries, everything is very unpredictable and everyone is different, someone recovers, someone does not

After an accident, my daughter was in a coma for a month (also 2-3 degrees), now 1.5 years have passed, she remained alive, but she can’t walk, sit, or speak yet :(

Many consider coma to be something of a protracted for a long time clinical death. however, the real essence of this phenomenon is well understood only by those whose relatives and friends were in the hospital under apparatus for artificial life support of the body.

Such people - as well as doctors - know that one specific state of the body cannot be called a coma. It can be of different types, which have in common only a severe pathology associated with loss of consciousness, a disorder in the regulation of important body functions and a lack of reflexes. In general, coma is, to a large extent, depression of the central nervous system, the next state of which is brain death .

During this state, relatives and friends of the victim are concerned about two main questions: will the person come out of the coma - and can he hear what is being said nearby while he is unconscious?

For both of these questions, the answer depends on the severity of the comatose category.

Coma of the first degree is expressed in inhibited reaction, long sleep and general stupor (stupor). The patient is able to move independently, eat - accordingly, he perceives most of what he hears if he is not sleeping. And when he recovers, the capabilities of his body will recover relatively quickly and easily.

Coma of the second degree of severity is characterized by deep sleep and lack of conscious contact with others. Almost no response to pain. The movements persist, but they are rare, impulsive and chaotic. Both breathing problems and the inability to control the "toilet" processes are possible. In this position, a person can hear only a small part of the information - and then by accident. If you spend a long time next to the patient's bed and constantly talk to him, repeating the same thing, you have a chance to be heard. True, not necessarily understood. It is more difficult to get out of this state than from the previous one.

The third degree of coma is the most mysterious. It is her symptoms that are considered similar to signs of clinical death. People who managed to get out of this state say that they did not perceive any voices from outside. But they mention "gray spaces" - back streets of their own consciousness and subconsciousness, where they happened to wander for some time. A deep coma, according to doctors, resembles dreamless sleep - this is a kind of survival program laid down in the body by nature. The body saves vital forces.

Finally, a coma of the fourth degree of severity - it is also called transcendental - is characterized by a complete absence of reflexes, severe damage to the central nervous system and brain. Such a coma continues for a long time, and the chances of getting out of it are minimal. As a rule, it ends with brain death, after which, according to a recently adopted law, the devices that support a person in a vegetative position are turned off.

In general, the duration of a coma is important for the subsequent recovery of a person. If the comatose state lasts longer than two weeks, there is a high probability of transition to conscious, but also vegetative (with the preservation of basic brain functions), also known as waking coma, appalic syndrome and neocortical death. This “vegetable-like” state, as it is popularly called, can last from several days to a year or more.

Is it possible to get out of a coma of 3 degrees

From the ancient Greek coma is translated as "deep sleep". During a person's stay in a coma, the nervous system is depressed. This is very dangerous, because this process progresses and failure of vital organs is possible, for example, respiratory activity may stop. Being in a state of coma, a person stops responding to external stimuli and the world around him, he has no reflexes.

Stages of a coma

Classifying coma according to the degree of depth, the following types of such a state can be distinguished:

Prekom. Being in this state, the person remains conscious, while there is a slight confusion in actions, impaired coordination. The body functions according to the concomitant disease.

Coma 1 degree. The reaction of the body is very strongly inhibited, even to strong stimuli. It is difficult to find contact with the patient, while he can make simple movements, for example, turn in bed. Reflexes are preserved, but very weakly expressed.

Coma 3 degrees. Deep state of coma. The patient does not respond to pain, the reaction of the pupils to light is completely absent, reflexes are not observed, the temperature is reduced. Violations occur in all body systems.

In this article, we will take a closer look at the condition of a person who is in a penultimate coma.

This is a very dangerous condition for human life, in which the body cannot practically function independently. Therefore, how long the unconscious state will last is impossible to predict. It all depends on the body itself, on the degree of brain damage, on the age of the person. Getting out of a coma is quite difficult, as a rule, only about 4% of people are able to overcome this barrier. At the same time, even if the person came to his senses, most likely, he will remain disabled.

In the case of being in a third-degree coma and regaining consciousness, the recovery process will be very long, especially after such serious complications. As a rule, people learn to speak, sit, read, walk again. The rehabilitation period can take quite a long time: from several months to several years.

According to studies, if in the first 24 hours after the onset of a coma a person does not feel external stimuli and pain, and the pupils do not react to light in any way, then such a patient will die. However, if there is at least one reaction, then the prognosis is more favorable for recovery. It is worth noting that the health of all organs and the age of the patient, who has a coma of 3 degrees, play a huge role.

Chances of survival after an accident

About thirty thousand people die every year as a result of road accidents and three hundred thousand become their victims. Many of them become disabled as a result. One of the most common consequences of an accident is a traumatic brain injury, which often causes a fall into a coma. If, after an accident, a person’s life needs hardware support, and the patient himself does not have any reflexes and does not respond to pain and other irritants, a coma of the 3rd degree is diagnosed. The chances of survival after the accident that led to this condition are negligible. The prognosis for such patients is disappointing, but still the chance of a return to life. It all depends on the degree of brain injury as a result of an accident.

If grade 3 coma is diagnosed, the chances of survival depend on the following factors:

Long-term consequences of TBI.

Fracture of the base of the skull.

Fracture of the cranial vault.

Fracture of the temporal bones.

Concussion.

Injury to blood vessels.

Cerebral edema.

A stroke is a disruption in the blood supply to the brain. It happens for two reasons. The first is a blockage of blood vessels in the brain, the second is a hemorrhage in the brain. One of the consequences of cerebrovascular accident is a comma (apoplektiform coma). In case of hemorrhage, a coma of the 3rd degree may occur. The chances of survival after a stroke are directly related to age and the extent of damage. Signs of this condition:

Lack of consciousness.

Change in complexion (turns red).

Noisy breathing.

Vomit.

Problems in swallowing.

Slow heart rate.

Increase in blood pressure.

The duration of a coma depends on a number of factors:

Coma stage. In the first or second stage, the chances of recovery are very high. At the third or fourth, the result is usually unfavorable.

Body condition.

The age of the patient.

Patient care.

Lack of response to pain.

Lack of muscle tone.

Decreased body temperature.

Emptying occurs uncontrollably.

Presence of a court.

Probability of survival after the decimal point of a newborn

A child may fall into a coma in case of a deep disorder of the central nervous system, accompanied by loss of consciousness. The cause of the development of coma in a child are such pathological conditions: renal and hepatic failure, meningoencephalitis, tumor and brain injury, diabetes mellitus, impaired water and electrolyte balance, cerebral hemorrhage, hypoxia during childbirth and hypovolemia. Newborns fall into a coma much easier. It is very scary when a coma of the 3rd degree is diagnosed. A child has a higher chance of survival than older people. This is due to the characteristics of the child's body.

In the case when a coma of the 3rd degree occurs, the chances of survival for the newborn are, but, unfortunately, very small. If the baby manages to get out of a serious condition, severe complications or disability are possible. At the same time, we should not forget about the percentage of children, albeit small ones, who managed to cope with this without any consequences.

The longer the unconscious state lasts, the more difficult it will be to get out of it and recover. Everyone can have a coma of 3 degrees in different ways. The consequences usually depend on the degree of damage to the brain, the duration of being unconscious, the causes that led to the coma, the state of health of the organs and age. The younger the body, the higher the chances of a favorable outcome. However, doctors rarely make a prognosis for recovery, since such patients are very difficult. Despite the fact that newborns come out of a coma more easily, the consequences can be the most deplorable. Doctors immediately warn relatives how dangerous grade 3 coma is. Of course, there are chances of survival, but at the same time, a person can remain a “plant” and never learn to swallow, blink, sit and walk.

For an adult, a long stay in a coma threatens with the development of amnesia, the inability to move and speak, eat and defecate independently. Rehabilitation after a deep coma can take from a week to several years. At the same time, recovery may not occur, and a person will remain in a vegetative state until the end of his life, when he can only sleep and breathe on his own, while not reacting to what is happening. Statistics show that the chance of a full recovery is extremely small, but such events do happen. Most often, a fatal outcome is possible, or in the event of a coma, a severe form of disability.

Complications

The main complication after an experienced coma is a violation of the regulatory functions of the central nervous system. Subsequently, vomiting often occurs, which can enter the respiratory tract, and stagnation of urine, which threatens to rupture the bladder. Complications also affect the brain. Coma often leads to respiratory failure, pulmonary edema, and cardiac arrest. Often these complications lead to biological death.

Modern medicine makes it possible to artificially support the vital activity of the body for a long time, but the question often arises about the appropriateness of these measures. Such a dilemma arises for relatives when they are told that the brain cells have died, that is, in fact, the person himself. Often the decision is made to disconnect from artificial life support.

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Coma 3 degrees: is there any chance of survival?

Classification

1. Secondary coma:

Coma symptoms

• unproductive breathing;
• drop in blood pressure;
• convulsions;

Coma after stroke

Coma after injury

hepatic coma

• petechial hemorrhages;
• general exhaustion.

• aphasia;
• dropsy of the brain;
• developed dementia;

3 degrees of coma and their signs

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 due to injury, a fall, hemorrhage (with a stroke) or be the result of a disease, including cancer. So the main reasons are:

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

In the treatment of coma, it is important to eliminate the cause that provoked it. Then procedures are carried out that eliminate the collapse. Everything must be done in the shortest possible time. The patient needs to restore the oxygen supply, normalize the acid-base balance. Often the brain in a newborn suffers if the umbilical cord is entangled. A comatose patient is always considered severe. It often takes a long time to deal with the consequences. Many factors influence the prognosis - the severity of the condition, the cause, timely qualified assistance, age, the presence of chronic diseases, etc. Worst of all is the case with stroke, cancer.

If a coma has overtaken a child, it is important not to waste a minute and start treatment. If symptoms of precoma appear, call an ambulance immediately. In children, the condition can deteriorate rapidly. The liver, lungs, heart, kidneys, and, of course, the brain suffer immediately. That's why it's important to watch for warning signs.

The rate of development of coma can be:

• Unexpected. Consciousness is abruptly lost, signs of coma develop (violation of the heart rhythm, breathing, pressure drops).
• Slow. Precoma develops first. Reactions are slow, the person is drowsy or overexcited. At this stage, hallucinations, delusions can be observed. Signs of the underlying disease gradually increase. Over time, all the functions of the central nervous system are upset.
• Fast. Symptoms develop over a period of minutes to hours.

Stages

Coma proceeds in several stages.

Precoma

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. Lethargy and stupor are periodically replaced by unhealthy excitement. Reflexes are still preserved, but coordination of movements is disturbed. Severe condition. Its severity depends on the cause. A relatively mild condition can quickly turn into a serious one.

1 degree

Its main causes are a hormonal crisis, intoxication, shock, inflammation of the brain, problems with metabolism. In a coma of the first degree, 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. Muscles are in good shape. The patient has difficulty swallowing. Mostly he drinks. Can eat something liquid. Pupils continue to respond to light. If a coma of 1 degree 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, the central nervous system suffers. Hepatic encephalopathy begins.

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

2 degree

In the second degree, stupor is observed, contact is lost. Impaired response to stimuli. Sometimes the patient may make chaotic movements. The muscles then relax, then tense up again. There is a serious violation of breathing. Intestines, bladder can be involuntarily emptied. The chances of survival are quite high. It is often possible to achieve a complete recovery. The exit from the stupor will be gradual. Its duration depends on the general condition of the patient and the timeliness of the assistance provided by doctors.

This type of coma often occurs with severe alcohol poisoning.

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

3 degree

If a person is in a grade 3 coma, the chances of survival depend on comprehensive medical treatment and the general condition of the body. The patient is unconscious. Reactions are completely absent. Pupils constrict. Seizures may develop. Decreased body temperature and blood pressure. Breathing loses rhythm. We need to stabilize the situation. If a coma of the 3rd degree 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 following symptoms signal the danger of death:

• the patient does not move the limbs, does not respond to the injection;
• muscles are inactive;
• the pressure is reduced;
• shallow breathing;
• pupils are dilated, do not react to light in any way;
• convulsions are observed.

Doctors consider the third degree the most mysterious. It is her symptoms that are very similar to the signs of death. However, some patients have come out of it. At the same time, they describe their state as a dream in which there are no dreams. The body at the same time throws all its resources into recovery, the survival program is turned on.

It is those patients who have come out of the third degree who tell conflicting 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 circulation as soon as possible. This is how the maximum number of brain cells will survive.

4 degree

At the fourth stage there are no reflexes. The temperature and pressure drop sharply. This has a general effect on the state. It is supported with the help of IVL.

Coma 4 degrees - a terminal state.

How to get out of a coma

To bring the patient out of a coma, urgent treatment, resuscitation is necessary. Its goal is to restore the functioning of the brain, central nervous system, and stimulate reflexes. It is important that the doctor prescribes therapy as soon as possible. It depends on whether a person survives. With proper treatment and favorable development, consciousness gradually returns to the patient. At first, delirium, hallucinations, anxiety, chaotic movements, and impaired coordination may be observed. Consciousness can be periodically disturbed. Convulsions worry.

Who can not be considered a disease. This is the result of serious pathological changes. Brain tissues suffer from them, the work of the central nervous system is disrupted. The type of coma directly depends on the disease or mechanical damage that caused it. The less damage, the higher the chance to survive.

Coma diabetic

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

Coma hypoglycemic

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

Coma traumatic

The reason is a head injury, a bruise during an accident, a fall, a fight, etc. In this case, the skull and brain are damaged. A characteristic manifestation is nausea, vomiting. The goal of treatment is to restore the blood supply to the brain, to resume its usual functions.

Coma meningeal

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

Another test is for Brudzinsky's symptom. It is necessary to passively tilt the patient's head forward. At the same time, he bends his knees. This movement is involuntary.

Another sign of this coma is that a rash appears on the skin, areas of necrosis are formed, including non-mucous ones. These are the smallest hemorrhages. They can also be observed on the internal organs. This causes them to fail.

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

Coma cerebral

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

The sooner the doctor prescribes treatment, the higher the chances that the patient will live. Comatosis in tumors can be very deep. Often, intervention by a neurosurgeon is required. Even with a favorable outcome, disability is possible. All sorts of complications from the central nervous system, partial and even complete paralysis are not uncommon.

During this period, it is important to provide the patient with a complete qualified therapy. Otherwise, a coma may develop. The tumor itself can be easily detected using MRI, CT. CSF analysis will show an abnormally high level of protein, leukocytes. It is important to remember that in the presence of a tumor in the region of the posterior cranial fossa, it is strictly forbidden to take a puncture of the cerebrospinal fluid. This can lead to death.

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

Coma epilepticus

This is a consequence of a severe epileptic seizure. In this case, the patient's pupils will be dilated, the skin becomes pale, most of the reflexes are reduced. A characteristic sign that the coma was the result of epileptic seizures is bites on the tongue. There is also involuntary emptying of the intestines, bladder. 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 small pauses when a person stops breathing at all. Then the breath reappears.

When the condition worsens, blood pressure drops as much as possible, reflexes completely disappear. It is extremely important that the patient receives the help of doctors as soon as possible. Otherwise, death occurs.

Coma hungry

The reason for its development is the third degree of dystrophy. It leads to starvation. Often, people who are on a protein diet bring themselves to such a pathological condition. In this case, the body is deficient in protein. Don't underestimate his role! Protein performs essential functions in the body. Its deficiency causes serious disturbances in the work of almost all systems and organs. Including begins a serious inhibition of brain functions.

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

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

artificial coma

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

State Danger

Coma is dangerous because the brain suffers from hypoxia. At the same time, his cells die. The primary task is to restore its blood circulation, restore functions. The patient undergoes detoxification measures. In the uremic form, hemodialysis may be prescribed. With hypoglycemia - glucose.

If intoxication has begun, shock has developed, the brain tissue experiences an energy deficit. The consequences may be as follows:

1. The condition is deteriorating.
2. Mortality sets in.
3. Energy deficiency is growing, oxygen starvation of the central nervous system is increasing, neurons are dying. Even if such a patient survives, the risk of disability is high.

We have given the most common classification. Coma is an extremely serious condition. Cerebral circulation is seriously disturbed. Extensive edema may develop. This is a direct threat to life. How long it will last, no one knows. Doctors can only eliminate the cause and stabilize the condition. Unfortunately, deaths are not uncommon in the development of coma of 3 and 4 degrees. The risk group is the elderly. They are more likely to develop coma. At the same time, their body reacts worse to treatment. In infants, coma can develop with prolonged umbilical cord entanglement.

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Coma 3 degrees after an accident forecasts

From the ancient Greek "coma" is translated as "deep sleep". While a person is in a state of coma, the nervous system is depressed. This is very dangerous, because this process progresses and failure of vital organs is possible, for example, respiratory activity may stop. Being in a coma, a person stops responding to external stimuli and the world around him, he may have no reflexes.

Stages of a coma

Classifying coma according to the degree of its depth, the following types of such a state can be distinguished:

• Prekom. Being in this state, a person remains conscious, while there is a slight confusion in actions, impaired coordination. The body functions according to the concomitant disease.
• Coma 1 degree. The reaction of the body is very much inhibited even to strong stimuli. It is difficult to find contact with the patient, while he can make simple movements, for example, turn in bed. Reflexes are preserved, but very weakly expressed.
• Coma 2 degrees. The patient is in a deep stage of sleep. Movements are possible, but they are performed spontaneously and in a chaotic manner. The patient does not feel touch, the pupils do not react to light in any way, there is a violation of the respiratory function.
• Coma 3 degrees. Deep state of coma. The patient does not respond to pain, the reaction of the pupils to light is completely absent, reflexes are not observed, the temperature is lowered. Violations occur in all body systems.
• Coma 4 degrees. A state from which it is already impossible to get out. A person has no reflexes, the pupils are dilated, hypothermia of the body is observed. The patient cannot breathe on his own.

In this article, we will take a closer look at the condition of a person who is in a penultimate coma.

Coma 3 degrees. chances of survival

This is a very dangerous condition for human life, in which the body cannot practically function independently. Therefore, how long the unconscious state will last is impossible to predict. It all depends on the body itself, on the degree of brain damage, on the age of the person. Getting out of a coma is quite difficult, usually only about 4% of people are able to overcome this barrier. At the same time, even if the person came to his senses, most likely, he will remain disabled.

In the case of being in a third-degree coma and regaining consciousness, the recovery process will be very long, especially after such serious complications. As a rule, people learn to speak, sit, read, walk again. The rehabilitation period can take quite a long time: from several months to several years.

According to studies, if in the first 24 hours after the onset of a coma a person does not feel external stimuli and pain, and the pupils do not react to light in any way, then such a patient will die. However, if at least one reaction is present, then the prognosis is more favorable for recovery. It is worth noting that the health of all organs and the age of the patient, who has a coma of 3 degrees, play a huge role.

Chances of survival after an accident

About thirty thousand people a year die as a result of road accidents and three hundred thousand become their victims. Many of them become disabled as a result. One of the most common consequences of an accident is a traumatic brain injury, which often causes a coma.

If, after an accident, a person’s life requires hardware support, and the patient himself does not have any reflexes and does not respond to pain and other stimuli, a coma of the 3rd degree is diagnosed. The chances of survival after the accident that led to this condition are negligible. The prognosis for such patients is disappointing, but there is still a chance for a return to life. It all depends on the degree of brain injury as a result of an accident.

If grade 3 coma is diagnosed, the chances of survival depend on the following factors:

• degree of brain injury.
• Long-term consequences of TBI.
• Fracture of the base of the skull.
• Fracture of the cranial vault.
• Fracture of the temporal bones.
• Concussion.
• Injury to blood vessels.
• Cerebral edema.

Probability of surviving after a stroke

A stroke is a disruption in the blood supply to the brain. It happens for two reasons. The first is a blockage of blood vessels in the brain, the second is a hemorrhage in the brain.

One of the consequences of cerebrovascular accident is coma (apoplektiform coma). In case of hemorrhage, a coma of the 3rd degree may occur. The chances of survival after a stroke are directly related to age and the extent of damage. Signs of this condition:

• Lack of consciousness.
• Change in complexion (becomes purplish).
• Loud breathing.
• Vomit.
• Problems in swallowing.
• Slow heart rate.
• Increase in blood pressure.

The duration of a coma depends on a number of factors:

• Coma stage. In the first or second stage, the chances of recovery are very high. With the third or fourth outcome, as a rule, unfavorable.
• Body condition.
• The age of the patient.
• Equipping with the necessary equipment.
• Patient care.

Signs of a third-degree coma with a stroke

This condition has its own distinctive features:

• Lack of response to pain.
• Pupils do not react to light stimuli.
• Lack of swallowing reflex.
• Lack of muscle tone.
• Decreased body temperature.
• Inability to spontaneously breathe.
• The bowel movements happen uncontrollably.
• Presence of seizures.

As a rule, the prognosis for exiting a third-degree coma is unfavorable due to the absence of vital signs.

Probability of survival after a coma of a newborn

A child may fall into a coma in case of a deep disorder of the central nervous system, which is accompanied by loss of consciousness. The reason for the development of coma in a child are the following pathological conditions: renal and hepatic failure, meningoencephalitis, tumor and brain injury, diabetes mellitus, impaired water and electrolyte balance, cerebral hemorrhage, hypoxia during childbirth and hypovolemia.

Newborns fall into a coma much easier. It is very scary when a coma of the 3rd degree is diagnosed. A child has a higher chance of survival than older people. This is due to the characteristics of the child's body.

In the case when a coma of the 3rd degree occurs, the chances of survival for the newborn are, but, unfortunately, very small. If the baby manages to get out of a serious condition, severe complications or disability are possible. At the same time, we should not forget about the percentage of children, albeit a small one, who managed to cope with this without any consequences.

Consequences of a coma

The longer the unconscious state lasts, the more difficult it will be to get out of it and recover. Everyone can have a coma of 3 degrees in different ways. The consequences, as a rule, depend on the degree of damage to the brain, the duration of being unconscious, the causes that led to the coma, the state of health of the organs and age. The younger the body, the higher the chances of a favorable outcome. However, doctors rarely make a prognosis for recovery, since such patients are very difficult.

Despite the fact that newborns come out of a coma more easily, the consequences can be the most deplorable. Doctors immediately warn relatives how dangerous grade 3 coma is. Of course, there are chances of survival, but at the same time, a person can remain a “plant” and never learn to swallow, blink, sit and walk.

For an adult, a long stay in a coma is fraught with the development of amnesia, the inability to move and speak, eat and defecate on their own. Rehabilitation after a deep coma can take from a week to several years. At the same time, recovery may not occur, and a person will remain in a vegetative state until the end of his life, when he can only sleep and breathe on his own, while not reacting to what is happening.

Statistics show that the chance of a full recovery is extremely small, but such events do happen. Most often, a fatal outcome is possible, or in the case of a coma, a severe form of disability is possible.

Complications

The main complication after an experienced coma is a violation of the regulatory functions of the central nervous system. Subsequently, vomiting often occurs, which can enter the respiratory tract, and stagnation of urine, which is fraught with rupture of the bladder. Complications also affect the brain. Coma often leads to respiratory failure, pulmonary edema, and cardiac arrest. Often these complications lead to biological death.

The feasibility of maintaining bodily functions

Modern medicine makes it possible to artificially maintain the vital activity of the body for a long time, but often the question arises of the appropriateness of these measures. Such a dilemma arises for relatives when they are told that the brain cells have died, that is, in fact, the person himself. Often the decision is made to disconnect from artificial life support.

Head trauma, intoxication, stroke and many other causes can lead to pathological inhibition of the central nervous system and the development of coma. The condition in which the patient balances between life and death is called a coma of the 3rd degree. The development of a coma can be caused by various factors. The first place is occupied by direct damage to the brain tissue in stroke, trauma, infectious process, epilepsy.

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

Damage to the nervous system is based on bilateral diffuse damage to the cortex and brain stem with a 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:

1. Neurological primary may develop after trauma, acute disorders of vascular blood flow, after an epileptic seizure, meningitis or encephalitis, increased intracranial pressure.
2. Secondary coma:

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

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

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Coma symptoms

A coma can develop within hours or days. The severity determines the clinical manifestations. The period of time before a coma (precoma) depends on the underlying disease. The patient develops confusion, lethargy or mental agitation, impaired coordination of movements.

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

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

Then comes a coma of the third degree. Body temperature drops, reflexes are inhibited, the reaction to painful stimuli disappears. Pupils do not react to light, consciousness is absent.

4 degree is called transcendental: life is maintained with the help of an artificial respiration apparatus. A state close to terminal develops, the outcome is death.

Prognosis for survival in grade 3 coma

What is a coma of 3 degrees cannot be answered unambiguously. Her condition is often compared to clinical death, it is like a deep sleep without dreams. And not always a coma of the 3rd degree has favorable forecasts. According to statistics, only 4% of people get out of this state, but subsequently remain disabled. Life threatening indicators 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's pupil reaction and response to stimuli and pain disappear, then there is no chance of getting out of a grade 3 coma, the prognosis is fatal. Survival is influenced by the initial level of health, the amount of associated injuries and the reason why the coma developed.

Coma after stroke

Violations of cerebral circulation can cause blockage by a blood clot of a vessel or its rupture. A cerebral hemorrhage can cause a grade 3 coma. The chances of survival depend on the size of the lesion and the age of the patient. 1 and 2 degree more often ends with the restoration of functions. Convulsions, hypothermia, lack of spontaneous respiration, and pupillary responses are unfavorable symptoms.

Coma after injury

Severe head injuries after road accidents, falls from a height, and blows with a blunt object lead to the rapid development of coma. The patient's condition is affected by concomitant damage to internal organs, blood loss. Reduce the chances of getting out of a coma fracture of the base of the skull, vault, temporal bones, damage to blood vessels, swelling of the brain, a high degree of brain contusion.

hepatic coma

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

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

Hepatic-renal syndrome often develops, kidney failure, oliguria joins. The immune system is weakened and sepsis may develop. The prognosis for such patients is extremely unfavorable.

Disability criteria 3 groups

After leaving a coma of the 3rd degree, a person remains disabled. The law determines who is entitled to the 3rd group of disability. These are people with such a state of health who cannot work, with reduced vital activity, the need for help and support from social authorities.

Disorders of the main functions are considered:

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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 skull defects or a foreign body in the brain;
• violation of the functioning of the pelvic organs.

Those who are given the 3rd group of disability are examined by the commission every year and provide it with a rehabilitation program. For sick pensioners, the group is assigned indefinitely and re-examination is not carried out.

Coma - pathological inhibition of the central nervous system, accompanied by loss of consciousness, lack of reactions and restrictions on the regulation of vital body functions. Who needs to start treating with the elimination of the cause that caused such a condition and the implementation of procedures to eliminate collapse, lack of oxygen, and establish an acid-base balance in the body.

Depending on the rate of development of the coma state, a person can fall into a coma:

• unexpectedly - a sharp loss of consciousness with subsequent symptoms of coma - respiratory paraphasia, heart beat disturbance, pressure decrease;
• quickly - signs increase from a few minutes to several hours;
• slowly - the initial development of precoma with an increase in signs of the main disease, from which the acceleration of neurological and mental disorders slowly occurs.

In this case, there is a slow reaction, drowsiness or, on the contrary, overexcitation, nonsense and visions, which are replaced by a coma.

There are four stages of coma, but we will consider the third degree, since it is the most critical, we will find out what a coma of the 3rd degree is, the chances of survival, forecasts after a third degree coma, what is after it.

Symptoms of coma 3 degrees:

• no consciousness,
• no pain reflexes
• the pharyngeal reflex is inhibited,
• there is no reaction of the pupils to light and the vital activity of the muscles,
• there is involuntary urination and emptying,
• decreased body temperature.

Depending on the causes of the coma and the severity of the brain stem disorder, the scenario of the coma depends. The following scenario is considered positive: stem and spinal reactions are restored, independent breathing and reason are restored.

But with a third-degree coma, the recovery scenario is usually not favorable. Here the medulla oblongata is touched, from which the danger to life increases, and the prognosis for a favorable recovery worsens.

The state of threat to life in coma 3 degrees is preceded by:

• lack of protective reactions, the patient does not even respond to the injection, does not move his limbs;
• lack of surface reflexes;
• decreased muscle activity;
• dilated pupils and no response to light;
• unproductive breathing;
• low pressure;
• the possibility of seizures.

In itself, the degree of coma under consideration is the most mysterious, its signs are very similar to the symptoms of clinical death. According to doctors, a deep coma resembles dreams without dreams. This is, so to speak, a program for survival embedded in the human body by nature, in which the body begins to conserve strength for life.