What is a coma? Signs of coma, stages and classification

The Term "coma" comes from the Greek language and literally means "deep sleep".

What is a coma?

Signs of coma lies in the inhibition or strong inhibition of the function of the Central nervous system. It necessarily accompanied by loss of consciousness. The man does not respond to light, sound and other external stimuli. Disturbed regulation of the major important functions of the body. Coma, as a rule, is a dangerous complication of a disease that hinders the healing process. Depending on reasons, resulting in coma, she can develop either rapidly, as in the case of traumatic brain injury, or gradually. The main features of coma may occur over several hours or days and time to provide the treatment of deterioration can be avoided. So, who should be considered as an acute pathological condition in which the desired correxna therapy in the early stages of manifestation. Therefore, the diagnosis of "coma" is not only the patient, completely unresponsive to external factors, but in the case of disconnection of consciousness with preservation of basic reflexes.

The Clinical picture of coma is formed from understanding the algorithm of its manifestations, as well as from the knowledge of various diseases and pathologies such as diabetes, poisoning drugs and psychotropic substances, uremia, which can bring to this state.

Variety of comatose States

There are many diseases, a complication that can lead to coma. Signs of coma its etiology have studied in detail the of N. K. Bogolepov, it has counted more than 30 types of this condition. Only a small part of a scholar isolated in an independent disease, the rest have become the syndromes and complications. It should be noted that not necessarily one and the same disease in different people can cause a coma. The crux of the problem is disruption in biochemical homeostasis, hemodynamics and other problems associated with the normal functioning of the brain. Systematization of coma caused by the formation of the following sub-sections.

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Coma, neurological

They neposredstenno associated with lesions of the Central nervous system. These include:

• Who that occurs in stroke;
• Applicationmenu anyone;
• Epileptic coma;
• Coma caused by trauma, e.g., traumatic brain;

• Coma due to the occurrence of inflammatory processes, as well as non - malignant and malignant tumors in the brain and its membranes.

Coma in endocrine disorders

What caused this coma? Signs of coma are manifested in the form of a failure in the body's metabolic processes from insufficient or excessive production of hormones. If they are synthesized is small, the coma bivaet

• Diabeticheskaya;
• Gipokortitizma;
• Gipotireoidne;
• Hypopituitary.

If the body produces many hormones or incorrectly prescribed dosage of hormonal drugs, you can develop thyrotoxic and hypoglycemic coma.

If the disturbed water and electrolyte balance in the body

If the human body experiences dehydration, lack of macro - and microelements, salts and nutrients necessary for replenishing energy losses, it can also put you in a coma. In this situation there are two main kinds:

• Chlorhydrines coma that happens when the patient for a long time does not stop intense vomiting, for example, as in the case of stenosis of the pylorus;
• Nutritional-degenerative coma, in other words, a coma of hunger.

Violated gas exchange, causing coma

The Signs of this type are the lack of incoming oxygen, the respiratory problems. These include:

• Hypoxic coma, caused by lack of oxygen entering from the outside (it occurs in case of strangulation, hypobaric hypoxemia, and anemia, when the blood is saturated with enough oxygen, and in various circulatory disorders);
• Respiratory coma, which, in turn, is subdivided into respiratory-cerebral and respiratory acidotic.

Respiratory failure, caused by oxygen deprivation, hypercapnia, global violation of gas exchange processes in the lung – General characteristics of coma are of this subtype.

Coma due to intoxication

She stands out as a separate group because of her provoke endogenous intoxication accompanying toxiinfectio, a variety of infectious diseases, pancreatitis, kidney and liver failure, or the impact on the body of chemical poisons: phosphorus organic compounds, alcohol, drugs belonging to the group of "barbiturates" and other drugs.

In Addition to this rigid classification exist coma of unknown or mixed etiology, in which it is impossible to identify one clear reason, for example, in the case of heat coma caused by overheating of the body. Although some sources attribute it to neurological group.

Below is a look at the individual, occurring more often than other types of comatose States.

Diabetic coma: classification

Diabetic comasigns which will be discussed later, is caused by inadequate intake of diabetes, the insulin can be manifested in three ways: to help, hyperosmolar, hyperlactacidemia. It is sometimes called "brain coma", as in the time of its occurrence there is swelling of the brain due to the fact that reducing the level of insulin and blood osmolarity brain cell changes is mixed.

When the blood sugar level rises significantly, there comes a hyperglycemic coma. It is most dangerous for children and the elderly. It develops gradually, usually over several days.

Signs of hyperglycemic coma:

• Breathing the smell of acetone;
• Paleness and dryness of the skin;
• Lost appetite;
• Constriction of the pupils;
• Pain in the abdomen;
• Tachycardia;
• Decreased muscle tone;
• Confusion is created.

As soon As you start to show the first signs of coma, it is necessary to call "fast". If you do not do this in time, the person ceases to respond to external factors and influences.

Hypoglycemic coma

In patients with diabetes, sugar can not only dramatically increase but also decrease. This happens because long breaks between meals, excessive exercise or in case of the use of alocohol. Hypoglycemic coma, the characteristics of which are described below, are developing very rapidly. Its precursors may be:

• Strong sense of hunger;
• Anxiety;
• Irritable and restless condition;
• Decreased body temperature;
• Shallow breathing;
• Increased sweating;
• Nausea, headache;
• Palpitations;
• Visual disturbances;
• Lethargic mind;
• Dilated pupils;
• Muscular hypertonicity.

The manifestation of any or all of the characteristics you require emergency assistance, which consists in intravenous administration, repeated if necessary, glucose, and subcutaneous – adrenaline.

Stage of coma

It is Established that there are several reasons due to which develops coma Signs of coma of varying etiology to determine the severity of the process, and as a result have identified several stages of coma.

1. Precoma. Here for the patient there are some rather contradictory characteristics. On the one hand, there is a foggy mind, crashes in spatial orientation, sluggishness, and possible increased excitability, loss of coordination, but the main relfex remain intact.
2. Coma of the first degree. This is when the patient almost does not contact, does not respond to external stimuli, very little feels even severe pain, there is hypertonicity of the muscles and numbness of skin receptors. The pupils in this case and reactive, but can go in different directions, like in strabismus.
3. Coma of the second degree due to complete lack of contact, it is almost impossible to cause pain reaction: man can max to open his eyes. Observed random emptying of the bowel and bladder, chaotic movement of hands and feet, a sharp tension and rasslablenie muscles. Pupils are almost nonreactive to light.
4. Coma of the third degree. Completely disconnected consciousness, reaction to light and pain, reduced blood pressure, reflexes and temperature, the breath is slow, sparse, shallow. Man "walks by itself".
5. Coma of the fourth degree. Observed absolute lack of reaction, reflexes, tone, very low body temperature and pressure, occasionally to disappear the breath.

Coma may occur within seconds, minutes or days. Naturally, the slower it develops, the more chances to return the patient to normal. That is why it is very important not to delay treatment in the event of the yourself or your loved one the first signs of the onset of coma.

Whether the prognosis is favorable, dependent on the severity of the coma, and how quickly recognize its initial manifestations and began to eliminate them. Coma, accompanied by brain damage, when liver failure has a poor prognosis. Hope for a favorable outcome is possible in the case of diabetic, alcoholic and hypoglycemic coma, however, only if you have made timely adequate therapy.

If we are talking about an epileptic coma, the treatment does not need. The person will regain consciousness on their own after pathogenic factors cease to affect him.

Remember that even being in a coma for a few days does not go unnoticed and may adversely affect the physical and mental condition.