How is Coma or Comatose Treated?
The emergency care persons will carry and provide the basic essentials like glucose or antibiotics by injections even if the blood test is in progress and not yet returned. This is done to eliminate the situations of diabetic shock or brain infections.
Coma or comatose which is classified as a medical emergency needs the check-up from the doctor where he will check the blood circulation in the affected person, his/ her airway passage and helps in respiration. Doctors may give, blood transfusions and breathing assistance and some other supportive care if these two primary requirements are not met.
Depending on the reasons treatment varies for coma or comatose. A medical procedure to decrease the pressure on the brain due to brain swelling, might be necessary. Doctors will provide medications as a treatment to the condition if coma or comatose occurs due to the over dosage of drug. Doctors will recommend and follow the medications to control seizures if the coma or comatose occurs due to seizures.
Other treatments may include focus on therapies or medications for addressing a disease that is underlying, such as liver disease or diabetes.
The reason of the coma or comatose may be completely reversed sometimes and person affected will regain to the normal function. But in the case if the affected person suffers due to severe brain damage, then there is a possibility of permanent disabilities or the patients may never regain to original condition which means consciousness. The person is said to be brain dead or may enter a persistent vegetative state.
The “Coma Cocktail” Treatment for Coma or Comatose
Even though the treatment options depend on the underlying reasons of coma or comatose, some rules for general treatment can also be made use of. When a reason of the coma is unknown, then “coma cocktail” should be provided to the person. Coma cocktail is a combined mixture of glucose (glucose can help diabetic patients with low blood sugar), naloxone (Naloxone is a chemical which is used in treating the patients who are overdosed) and thiamin (thiamin is a vitamin combination which helps who are deprived of nutrition, e.g. alcoholics).
Correction of Electrolyte Imbalance or Toxic Substances in Coma or Comatose
Correction of electrolyte imbalance or toxic substances can help the patient come out of coma or comatose sometimes. Electrolytes are chemicals commonly like salts, such as chlorine and sodium salts, which can be found in the tissues and blood throughout the body and play a major role in most of the physiological mechanism. Depending on the reason of the coma or comatose, there may be necessity to correct any electrolyte abnormalities. For example a kidney dialysis which is a process that maintains normal electrolyte balance in the kidneys and removes toxins.
Decreasing Intracranial Pressure for Coma or Comatose
Decreasing intracranial pressure in the brain can help the patients of coma or comatose. Various things such as diuretics, hyperventilation and surgery can be done to reduce pressure in the brain if high pressure it is a reason of coma or comatose in a person. Hyperventilation is the process of increasing the depth and rate of breathing by which the blow flow slows down and blood vessels in the brain constrict, which may decrease the pressure in the brain. Diuretics, reduces the pressure in the brain by removing fluid that are excess in the brain. Intracranial pressure can be decreased by a surgery which is mainly done to remove the excess fluid known as hydrocephalus if there is any accumulation of fluid in ventricles.
Glasgow Coma Scale or GCS Scale for Coma or Comatose
Glasgow Coma Scale (GCS) is used before the decision making stage whether to use CT scan for coma or comatose. Severity of brain damage can be analyzed by the Glasgow Coma Scale (GCS) which helps doctors in case of a head injury. It scores patients according to, motor responses, how easily they open their eyes and verbal responses.
Glasgow Coma Scale (GCS) of Eyes
- Grade of 1 – Eyes should not be open.
- Grade of 2 – Response to painful stimuli in the form of opens eyes (when pain is sensed).
- Grade of 3 – Response to voice by opening eyes.
- Grade of 4 – Spontaneous reply in the form of opening eyes.
Glasgow Coma Scale (GCS) on Verbal Grades
- Grade of 1 – Patient cannot make any kind of noise.
- Grade of 2 – Sounds that are incomprehensible (mumbles).
- Grade of 3 – Use of inappropriate words.
- Grade of 4 – Disorientated and confused use of words.
- Grade of 5 – chats normally, topic oriented words.
Glasgow Coma Scale (GCS) for Motor (Physical Reflexes) Grades
- Grade of 1 – No movements are made by the patient.
- Grade of 2 – Extension is made by the patient with movement in the limbs to painful stimuli.
- Grade of 3 – Abnormal flexion with moves in a strange way to painful stimuli.
- Grade of 4 – Withdrawal/ flexion with moves to painful stimuli.
- Grade of 5 – Localizes the painful stimuli. The patient can know where the pain is originating from.
- Grade of 6 – understands and obeys requests.
Brain Injury will be Classified in the Glasgow Coma Scale (GCS) As:
- Coma is the output when the score is 8 or less.
- Moderate is the condition when the score is ranging between 9 and 12.
- Minor when the score is 13 or higher.
Even a person who is awaken is said to be in coma (lighter coma) when the score is high as specified above as there is no response to the surrounding situations.
Initial evaluation process has the scale as part, but does not helps in diagnosing the reason of coma. Glasgow Coma Scale (GCS) can be used as a standard method since scores are used as a level of coma to assess change in patient status for any health-caregiver.
What is the Prognosis/ Outlook for Coma or Comatose?
The prognosis or the outlook for a coma or comatose varies from situation to situation. Chances of recovery of a person depend on the duration of the coma comatose, the cause of slipping into coma and whether the problem can be corrected. The person can return to his or her original condition when the problem is resolved. A person may be permanently disabled or never regain consciousness sometimes, if the brain damage is severe.
If the medical treatment is provided correctly and on time, coma or comatose that result from drug poisonings, can be recovered easily. Higher rate of recovery can be seen in head injury compared to the coma that occurs due to lack of oxygen supply to the brain.
Coma cannot be easily predicted when a person is in coma since everyone is different. The best option is to consult a doctor. The prognosis will get worse when the person remains in coma. After so many weeks in coma condition a person may recover but may have or suffer due to significant disabilities.
What is the Recovery Period for Coma or Comatose?
A coma or comatose usually can last for few weeks, during which time the patient may recover slowly by gaining consciousness, gradual wakeup or the patient can progress into a different state of unconsciousness which is known as vegetative state or minimally conscious state.
- A vegetative state: The person will be awake without any knowledge about themselves or environment around him/ her.
- A minimally conscious state: Limited awareness consciousness arrives and goes randomly.
The recovery depends where some may recover gradually where others cannot, even after long years.
Gradual recovery will be there for people who do wake up from a coma or comatose. The patients may be very confused and agitated to start with.
Some may gain complete recovery and will be unaffected by the cause of coma or comatose. Others may get affected due to the disabilities reasoned by the damage to the brain. Occupational therapy, support physical therapy (PT), and psychological assessment are required during a period of rehabilitation, and also require good care for the rest of their own life.
The severity and the reason for the injury in brain decides the chances of recovery from coma or comatose. Apart from this the coma duration, the patient’s age is also important for recovery. Accurate prediction is impossible about the recovery and the time coma or comatose may last and about the side-effects that may have long term problems.
- “Coma: Causes, Diagnosis, and Treatment” – Cleveland Clinic Link: https://my.clevelandclinic.org/health/diseases/9638-coma
- “Coma: Definition, Causes, and Treatment” – Mayo Clinic Link: https://www.mayoclinic.org/diseases-conditions/coma/symptoms-causes/syc-20370987
- “Coma: Treatment and Prognosis” – MedlinePlus Link: https://medlineplus.gov/ency/article/000791.htm
- “Coma: Definition and Management” – Medscape Link: https://emedicine.medscape.com/article/217146-overview