Coma after a stroke - how to increase the chances of survival!? How many days does a coma last after a stroke and is there a chance to survive? brain coma 3

Grade 2 coma or stupor is a condition in which a person loses consciousness and does not come into contact with people, almost does not respond to painful stimuli. A coma of the second degree can deepen into a third degree with the aggravation of the condition. Occurs with strokes, craniocerebral injuries and other lesions of the central nervous system.

The reasons

A coma of the second degree occurs when the central nervous system is damaged due to intoxication, metabolic disorders,. Sopor often develops in heart failure and shock conditions leading to cerebral ischemia and hypoxia. (especially hemorrhage into the cavity of the ventricles of the brain) causes convulsions and coma.

Diabetic coma leads to accumulation of acidic blood products and metabolites of fatty acid oxidation. This leads to inhibition of the cerebral cortex and excitation of the respiratory center, increased convulsive readiness of the brain. The hypoglycemic state provokes energy deficiency in the neurons of the central nervous system, which is why there is a loss of consciousness, a decrease in the integrative functions of the cerebral cortex.

Signs of coma 2 degrees

The soporous state (coma of the 2nd degree) is caused by a deeper lesion of the central nervous system than with stupor (). The patient occasionally makes movements, but their coordination is severely impaired. Breathing pathological, noisy. Skin reflexes are absent, but corneal and pharyngeal reflexes are preserved. Patients experience involuntary urination and bowel movements. Pathological muscle contractions are noted.

Characteristic signs:

Absence of skin reflexes.
Loss of speech perception of the doctor and loved ones.
A sharp decrease in pain sensitivity.
Development of pathological types of breathing: Cheyne-Stokes, Kussmaul.
Decreased pupillary response to light.
Discoordination of muscles, chaotic movements.
Involuntary defecation and urination.

A coma of the 2nd degree is similar to deep sleep. Breathing, as a rule, is stertorous, the sound resembles snoring - the cause of the development of pneumonia and sputum discharge, as well as impaired innervation of the muscles of the palatine curtain. Nerve fibers coming from the centers of the brain approach the soft palate. They provide muscle tone. In a coma of the second degree, these muscles lose their tone, resulting in snoring.

Other types of abnormal breathing are possible:

The Cheyne-Stokes disorder is characterized by superficial movements of the chest, which gradually deepen and become more frequent, becoming as deep as possible in 5-7 respiratory movements. The cycles are repeated. This violation of the respiratory function is caused by damage to the respiratory center in the medulla oblongata, a decrease in its sensitivity to hypoxia. However, upon reaching a critical level of carbon dioxide in the blood, the respiratory center sharply increases activity, leading to a deepening and quickening of breathing. Deep breaths promote hyperventilation and a sharp inhibition of the respiratory center of the brain, which leads to shallow breathing and a change in cycle.
Kussmaul respiration in second-degree coma is caused by diabetic ketoacidosis and starvation. It is characterized by deep respiratory movements provoked by overexcitation of the respiratory center of the medulla oblongata with the breakdown products of fatty acids.

With a coma of the second degree, unlike the first, the patient is not able to perceive the speech of people, since inhibition occurs in the cerebral cortex. Pain sensitivity decreases, the patient may respond to pain by pathological extension or flexion.

The patient's pupils are constricted if the coma is not caused by poisoning with barbiturates and anticholinergic drugs. The reaction to light is inhibited and weakened, its desynchronization is possible, i.e. one of the pupils reacts more slowly.

There is a corneal reflex, in which, in response to irritation with a piece of cotton wool over the iris, the patient's eyes close. The pharyngeal reflex is also preserved. When the spatula touches the soft palate, a spasm occurs, corresponding to vomiting.

Pyramid signs appear, which are a sign of damage to the conductive motor pathways - efferent fibers. Perhaps spastic contraction of individual muscle groups, dyssynergy of rare movements of the patient. It should be noted that the motor function is sharply weakened, compared with the coma of the first degree. Among the motor symptoms with stupor, hormeotonia occurs, characterized by flexion of the arms and extension of the legs.

Consequences of a coma

In grade 2 coma, the consequences include reversible and irreversible dysfunction of the cerebral cortex. Sometimes patients after recovery are forced to restore practical, speech, motor skills. In this case, a long rehabilitation is necessary.

The consequences depend on the duration of being in a coma. The less time a person spent in a coma, the better the prognosis. Sopor is an unstable condition that can change to a milder degree - stupor, or to a more severe one.

Conclusion

With a coma of the 2nd degree, the chances of survival are high in the case of timely medical care. At the same time, the brain is in a hypoxic state, which leads to the death of nerve cells. When leaving the stupor, it is possible to receive disability, loss of skills and memory, if the condition lasted for a long time. It is also possible to move into a more serious coma - the third degree.

With grade 2 coma, the chances of survival and successful rehabilitation are high with timely hospitalization and treatment. However, in especially severe conditions, the condition may worsen to 3 and 4 degrees of coma or to biological brain death.

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 afternoon! 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, he is ticklish 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 ...

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 state of coma, a person stops responding to external stimuli and the world around him, he may have no reflexes.

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 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:

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

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

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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 deprivation 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.

The responses of people who managed to survive and come out of a coma of 3 degrees are based on stories of "empty spaces" that they had to wander through for some period of time and where voices were not perceived.

With the right and timely actions, it is possible to get out of a coma of the third degree. A life-threatening condition requires immediate resuscitation, in which brain cells and human life as a whole will be saved.

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,.

Classification

Types of pathology are distinguished based on the cause:

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

toxic: poisoning with ethanol, carbon monoxide, medicines, drugs;
endocrine cause: 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.

Coma symptoms

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

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. can cause 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

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

Disorders of the main functions are considered:

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

The consequences of coma for determining disability are:

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

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 with stroke, epileptic coma, traumatic coma, coma caused by brain tumors, coma with 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;

Fast. 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, there is a gradual restoration of the work of the central nervous system, as a rule, in the reverse order: first, the pharyngeal and corneal reflexes are restored, then the pupillary ones, and the severity of autonomic 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.