Coma in adults: symptoms, causes, treatment

Smirnov

Igor Valerievich

18 years of experience

Leading anesthesiologist-resuscitator of the highest category, member of the European Society of Anaesthesiology

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Coma is a life-threatening pathology of consciousness caused by damage to brain tissue. The patient completely loses contact with the outside world. Coma can occur due to metabolic (intoxication with metabolic products or chemicals), organic (deformation of brain areas) reasons.

The key symptom is an unconscious state, the patient’s pupils do not react even to strong stimuli. To diagnose pathology, CT, MRI, and laboratory tests of blood plasma are used. Therapy is aimed at combating the cause of the coma.

Symptoms and signs of coma in adults

As already noted, the main symptoms of coma are the absence of any mental activity of the patient. Other symptoms of coma depend on the cause that caused damage to the brain structures.

• Body temperature indicators. Coma, which is caused by overheating, is accompanied by elevated body temperature (up to 43 degrees) and dry skin. Intoxication with alcoholic beverages and sedatives is associated with hypothermia (temperature up to 34 degrees).
• Inhalation/exhalation frequency. Slow breathing is a sign of a hypothyroid type coma (lack of thyroid hormones). Deep breathing is common in patients with pneumonia, brain cancer, and kidney failure.
• Blood pressure, heartbeat. A decrease in the number of heart contractions indicates that the person has fallen into a coma due to an acute disease of the heart muscle. Arterial hypertension is observed in patients who have become comatose due to a stroke. Low blood pressure indicates a diabetic coma, intoxication with sedatives, or a heart attack.
• Color of the skin. The skin turns cherry color if a person is poisoned by carbon monoxide. Blue ends of the fingers indicate a reduced concentration of oxygen in the blood plasma. Pale skin is typical for patients who have lost a lot of blood.
• Contact with the environment. With a mild coma, the patient can make different sounds, which suggests a favorable prognosis. As the coma worsens, the ability to make sounds disappears.

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Stages

Coma occurs in several stages.

Prekoma

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

1st degree

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

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

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

2nd degree

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

This type of coma often occurs with severe alcohol poisoning.

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

3rd degree

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

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

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

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

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

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

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

4th degree

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

Coma 4 degrees – terminal condition.

Causes

Why do they fall into a coma? The main causes of this condition in adults:

• organic factors (stroke, gunshot wound, bruise, bleeding into the brain);
• internal chemical compounds. They are metabolic products that appear due to organ diseases;
• external chemical compounds. Poisoning of the central nervous system can occur due to an overdose of drugs, sedatives, or neurotropics.

The reasons listed above explain how people fall into a coma. Particularly worth highlighting is a factor that combines signs of organic and chemical causes. This is an increase in pressure inside the skull. A similar pathology is observed with head injuries and neoplasms in the nervous system.

When to see a doctor

If a person falls into a coma, you should immediately consult a doctor. There can be no exceptions here. First of all, the patient will need the help of a resuscitator who will try to quickly remove the patient from the pathological condition. If resuscitation measures have no effect, treatment of the patient must be started.

Which specialist will treat the patient depends on the cause that caused the disturbance in the state of consciousness. You can seek qualified medical help at our clinic. We have specialists who understand how to work with people who have fallen into a coma. The choice of a doctor who will treat coma in the Central Administrative District depends on the cause that led to the development of the pathology.

Stages of alcoholic coma: steps to death

Alcohol coma is divided into three stages, each of which has its own symptoms and characteristics. It is important to know the clinical picture of each condition, because the sooner the poisoning victim receives help, the greater the chance of his full recovery. Unfortunately, often untimely provision of assistance can cause death. At the first signs of an alcoholic coma, you must immediately call an ambulance.

First stage: superficial coma

At this stage, nausea, severe vomiting, and loss of consciousness are observed. The pupils are constricted, the reaction to pain is weak - in facial expressions and sluggish movements of the limbs, while any protective reflexes are absent. A person may react sluggishly to ammonia, but he does not regain consciousness and is not even able to turn away from the bottle of ammonia.

At this stage, blood pressure is normal or slightly elevated. There is profuse salivation, and cases of involuntary urination are also common.

Stage two: rapid deterioration

During this relatively short period, a person's blood pressure drops sharply. The victim of poisoning completely loses consciousness, even mild reactions to pain and irritants are absent. The muscles are completely relaxed and do not contract even during rehabilitation procedures.

Stage three: deep coma

There is a complete absence of reaction to pain, the pupils do not react to light. Body temperature drops to 35 degrees, the skin is pale and covered in cold sweat. Symptoms of exotoxic shock also appear - cardiovascular failure caused by severe alcohol poisoning. Breathing is shallow, slow, with long pauses. In the third stage, the victim of poisoning risks dying due to suffocation from his own vomit or a sunken tongue. Also, prolonged immobility poses a great threat to life. If a person lies on a hard surface, he puts all his weight on the muscles, which at this stage are completely relaxed. With prolonged compression, the muscles are damaged, which leads to the release of myoglobin into the blood, a bone muscle protein that is highly toxic to other organs. The consequence of the so-called crash syndrome is kidney failure and even death.

What to do if your loved one loses consciousness? First of all, try to wake him up, but if there is no reaction to stimuli, turn the person on his side to avoid asphyxia and call an ambulance. The only way to avoid the tragic consequences of an alcoholic coma is to remove alcohol from the body as quickly as possible. However, under no circumstances try to do this yourself - only a doctor can select the necessary medications and carry out the necessary procedures.

And if in the first stage of coma it is possible to stop the further development of the condition at home, then progression to the second, and even more so the third stage requires emergency hospitalization.

Diagnosis of coma in adults

To diagnose coma 1, 2, 3 degrees in the center of Moscow, the following methods are used.

CT. One of the most informative methods of radiation diagnostics. The advantages of this procedure include the following:

• fast scanning;
• it is possible to obtain thinly sliced ​​images (up to 0.1 cm) without increasing the radiation dose to the patient;
• increased resolution, which allows you to obtain clear images of internal organs.

MRI. A modern diagnostic method through which the doctor can obtain images of sections of soft tissues and organs in different planes.

Blood analysis. Performed to determine the concentration of hormones in the blood plasma.

Myths and dangerous misconceptions in the treatment of coma in adults

Based on Hollywood films, people might have the idea that a first-degree coma is a kind of vacation, a break from the outside world. In the movies, the patient after a coma looks fresh and rested. However, in reality this is not the case. Many patients never fully recover after emerging from a comatose state. It is not uncommon for a person to remain disabled and bedridden for the rest of his life. For this reason, the family of a person who has fallen into a coma needs to prepare for long-term care for their loved one and provide him with moral support.

Drug coma - symptoms

Let's look at the main symptoms of a toxic coma. An overdose in drug addicts often leads to loss of consciousness and death. How to recognize coma and take the necessary actions to eliminate it in time? The clinical picture also depends on the degree of central nervous system depression. If you provide an addict with timely emergency assistance at the first stage of development of a coma, his chances of survival are quite high. If it is too late to start treatment, or a large dose of a narcotic substance has been used, then the chances of success are low; you should completely rely on the experience and knowledge of drug treatment specialists.

initial stage

Coma has four main stages:

• falling asleep;
• superficial coma;
• deep coma;
• awakening or death.

Within half an hour, the addict develops weakness, lack of coordination of movements, and lethargy, after which he falls asleep or loses consciousness. Quite quickly, the skin acquires an unnatural color and cyanosis, blood pressure drops, the pulse quickens, and the pupils become narrow. Muscle tone decreases. In an unconscious state, addicts often choke on vomit, or their tongue sinks in, blocking the airways, which leads to asphyxia. Cramps and spasms are quite common.

Late stage

If measures are not taken in time, a late stage or deep coma occurs, which is characterized by a decrease in muscle tone, body temperature, dry skin, as well as irregular breathing and a decrease in the frequency of contractions of the heart muscle. In addition to such consequences of coma as a sharp drop in pressure, pulmonary edema and respiratory arrest are possible. The supply of oxygen to the tissues of human internal organs also decreases. In most cases, the consequence of a deep coma is death. However, in rare cases, when loved ones managed to call emergency drug treatment at home in time, the drug addict can be saved.

Prevention

Preventive measures are aimed at prompt treatment of diseases that can lead to a coma. If a person has suffered a stroke, he needs to periodically visit a doctor so that he monitors the condition of the patient’s body and can detect signs of coma in time.

You also need to stop drinking alcohol and drugs. People suffering from alcoholism and drug addiction are at risk. They are unable to control the amount of ethyl alcohol and drugs they take, so they risk getting an overdose and falling into a coma.

It is extremely important to monitor your health. You cannot ignore the recommendations of doctors and other specialists. A proper daily routine, sleep and eating patterns, giving up bad habits are just the minimum of what every person should remember.

If there are any contraindications to playing serious sports, then all of them should be abandoned. Physical activity is allowed, but it is important to maintain its degree. In some cases, only light exercises in gymnastics, fitness and any other sport where the load is minimal are allowed.

Any deviation from the general rules (especially for those people who are at risk) can lead to undesirable consequences. It is important not only to remember this, but also to follow all recommendations.

If you have any questions or do not know whether excessive loads are allowed for you, it is better to seek advice from relevant specialists. If necessary, they will carry out a series of diagnostic measures and, based on the results obtained, will give you a conclusion.

Prevention is the best measure in the fight against any pathology, regardless of its type and severity. And the health of each person is in his own hands. Doctors and other specialists can only guide you along the right path.

Causes of drug-induced coma

The composition of the drug is never disclosed to the buyer. A person takes a substance completely unaware of the consequences it can lead to. Most modern drugs contain various impurities; most often the active substance is diluted with them to reduce the cost of the product. They are the ones that most often lead to drug-induced coma.

Coma from overdose

“Designer” drugs such as salts, spices, smoking mixtures and mixes regularly change their composition and formula. From the same seller you can purchase illegal goods of different quality, with different impurities and amounts of active substance. This leads to the fact that it becomes almost impossible to calculate the required relatively safe dosage. The result is an overdose, which can lead to a coma.

Coma from intoxication

Severe intoxication with toxic substances leads to loss of consciousness. The addict develops a coma. This occurs due to changes in metabolism in brain cells and disruption of nerve impulses. Most often, coma occurs in addicts who take opiates such as morphine, heroin or methadone, as well as barbiturates, sleeping pills, spices and salts (mephedrone). Coma due to opiate poisoning quite often causes death in drug addicts.

Coma from pill overdose

Coma is quite possible after an overdose of pills or pharmaceutical drugs. An addicted person may experience irreversible consequences after a drug-induced coma. What pills can make you fall into a coma? The most common cause of coma is an overdose of sleeping pills, painkillers, neurotropic and cardiac drugs.

How to call a resuscitator

If you decide to go to our clinic in the center of Moscow for medical help, dial the ambulance number -. A team of our specialists will arrive at the address you specified to transport the patient to a medical facility and provide him with first aid.

All our specialists are highly qualified and have extensive medical experience. All diagnostic measures are carried out promptly. This is also due to the availability of modern equipment. Our doctors choose the most optimal treatment method, taking into account the characteristics of the disease and the patient’s body.

Our clinic is located at the address: Moscow, Central Administrative District, 2nd Tverskoy-Yamskaya Lane, building 10. The nearest metro station is Mayakovskaya (5 min walk).

Remember that if a person falls into a coma, he requires emergency assistance from specialists. The slightest delay can lead to the death of the patient.