Topics: Coma, Traumatic brain injury, Persistent vegetative state Pages: 5 (1121 words) Published: July 22, 2013
Coma is classically defined as loss of mobility, sensation and consciousness with preservation of autonomic functions. Coma is caused by dysfunction of either or both the reticular activating system and cerebral cortex. The most common cause of coma are toxic\ metabolic de-arrangement, which are potentially treatable and reverersible. The big three are toxic/metabolic causes, trauma and stroke. CAUSES

1.Brain cancer
4.Drug abuse
6.Kidney failure
8.Pre- eclampsia
10.Reyes syndrome
12.Vasovagal syncope
13.Postural hypotension
15.Cardiac arrhythmia
18.Vertebra basilar transient ischemic attack

Toxic-metabolic encephalopathy. This is an acute condition of brain dysfunction with symptoms of confusion and/or delirium. The condition is usually reversible. The causes of toxic-metabolic encephalopathy are varied. They include systemic illness, infection, organ failure, and other conditions. •Anoxic brain injury. This is a brain condition caused by total lack of oxygen to the brain. Lack of oxygen for a few minutes causes cell death to brain tissues. Anoxic brain injury may result from heart attack (cardiac arrest), head injury or trauma, drowning, drug overdose, or poisoning. •Persistent vegetative state. This is a state of severe unconsciousness. The person is unaware of his or her surroundings and incapable of voluntary movement. With a persistent vegetative state, someone may progress to wakefulness but with no higher brain function. With persistent vegetative state, there is breathing, circulation, and sleep-wake cycles. •Locked-in syndrome. This is a rare neurological condition. The person is totally paralyzed except for the eye muscles, but remains awake and alert and with a normal mind. •Brain death. This is an irreversible cessation of all brain function. Brain death may result from any lasting or widespread injury to the brain. Signs &Symptoms

The signs and symptoms of coma commonly include:
Closed eyes
Depressed brainstem reflexes, such as pupils not responding to light •No responses of limbs, except for reflex movements
No response to painful stimuli, except for reflex movements •Irregular breathing
Symptoms of a coma include the following:
No response to outside stimuli, such as:

Spontaneous body movements, such as:
oEyes opening and closing
oIrregular breathing

Diagnosis of coma is simple; however, diagnosing the cause of the underlying disease process often proves to be challenging. The first priority in treatment of a comatose patient is stabilization following the basic ABCs (standing for airway, breathing, and circulation). Once a person in a coma is stable, investigations are performed to assess the underlying cause. Investigative methods are divided into physical examination findings and imaging (such as CAT scan, MRI, etc.) and special studies . Diagnostic steps

When an unconscious patient enters a hospital, the hospital utilizes a series of diagnostic steps to identify the coma •Perform a general examination and medical history check
Make sure patient is in an actual comatose state and is not mistaken for locked-in state (patient will either be able to voluntarily move his eyes or blink) or psychogenic unresponsiveness •Find the site of the brain that may be causing coma (i.e. brain stem, back of brain…) and assess the severity of the coma with the Glasgow coma scale •Take blood work to see if drugs were involved or if it was a result of hypoventilation/hyperventilation •Check for levels of “serum glucose, calcium, sodium, potassium, magnesium, phosphate, urea, and creatinine” •Perform brain scans to observe any abnormal brain functioning using either CT or MRI scans •...
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