Coma is defined as deep unconsciousness so that the patient is stirred even by painful stimuli. Consciousness is a State of normal brain activity in which the patient is awake, aware of the surroundings and itself and able to respond to various stimuli, endogenous and exogenous. During sleep, which is a normal alteration of consciousness, the topic can be awakened by stimuli to full consciousness. When a patient is gradually sinking in coma, following stages can be recognizable.
Confusion: the patient is conscious, but may be disoriented in time, space and persona.Muestra error environment.
Stupor: In this state of altered consciousness, only vigorous external stimuli produce excitement.Spells of conscience tend to be brief and patient slides to astonishment soon.
Coma: The patient is unrousable by all stimuli externos.En this stage all protective reflexes (coughing, sneezing and withdrawal to stimuli nociceptive, etc.) are absent.
An objective method to assess the depth of come is Glasgow.Registrar coma scale progress patient by this method is very useful for the initial evaluation and follow-up.
Glasgow COma scale (EMV Scoring)
1. The eye of punctuation
I spontaneously of-4
II. for sound-3
III. to pain-2
IV. zero-1
2 Motor movements
I obey command-6
II. adapt the pain-5
III. normal flexion-4
IV. abnormal bending-3
V. extension-2
VI. zero-1
3 Verbal response
I well oriented confined conversation-5
II. inappropriate words-4
III. incomprehensible sounds-2
IV. None-1
Scores gradually diminish as the comma becomes the deepest.
Mechanism of coma
Coma may develop due to several mechanisms.60% Of cases the result of the primary, neurological disease while the result of 40% of systemic diseases leads to metabolic dysfunction of the brain.General mechanisms leading to coma are:
1. The reduction in the supply of blood to the brain
2. injuries affecting the reticular formation
3. electrical disturbances such as seizure disorders
4. Disturbance in metabolism that leads to a dysfunction of cellular processes in neurons; and
5. Psychiatric disturbances.
Causes of coma
Neurologic causes
Ischemia to the brain and brain stem, for example, Stokes-Adam; cerebrovascular accidents attacks, says cardiac under edema cerebral.Infecciones e.g. meningitis and encefalitis.Aumento in intracranial tension due to various causes; physical agents, e.g., Cranio cerebral lesions, electrocution, hypothermia, etc.Degenerative diseases, e.g., Cruetzfeldt-Jakob.Causas last alergicas.Por and demyelination-postvaccinial infectious disease Tay Sachs disease seizure disorders, grand mal absences, temporal lobe seizure.
Systemic diseases
Metabolic in diabetic coma causes, uremia, hypoglycemia, acidosis, alkalosis, hyperosmolar States, respiratory failure, liver failure and endocrine as hypothyroidism, disease, Addison and hipopituitarismo.Tambien poisoning as narcotic drugs, alcohol and other poisons, disorders of cobra and krait bites can cause coma.
Psychiatric disorders
While these are not comatose state, your submission may seem close to of coma from which have to be distinguished, p. e.g., stupor Catatonic, hysterical comma etc..
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