![Coma [1978] Coma [1978]](http://2.bp.blogspot.com/-qxQSZKzfJxw/TtzJR9QsXXI/AAAAAAAAAwk/gL6RfD55UZA/s1600/Coma.jpg)
Furthermore, in a deep coma, even painful stimuli (actions which, when performed on a healthy individual, result in reactions) are unable to affect any response, and normal reflexes may be lost. Description. Coma lies on a spectrum with other alterations in consciousness. The level of consciousness required by, for example, someone reading this passage lies at one extreme end of the spectrum, while complete brain death lies at the other end of the spectrum. In between are such states as obtundation, drowsiness, and stupor.
All of these are conditions which, unlike coma, still allow the individual to respond to stimuli, although such a response may be brief and require stimulus of greater than normal intensity. In order to understand the loss of function suffered by a comatose individual, it is necessary to first understand the important characteristics of the conscious state. Consciousness is defined by two fundamental elements: awareness and arousal. Awareness allows one to receive and process all the information communicated by the five senses, and thus relate to oneself and to the outside world. Awareness has both psychological and physiological components. The psychological component is governed by an individual's mind and mental processes.
- Come definition, to approach or move toward a particular person or place: Come here. Don't come any closer!
- Coma:Mortuary is the introduction part of a trilogy about events in the world of the dead. The game`s genre is Adventure-Ambient with Horror-quest element.
![Coma [1978] Coma [1978]](http://fc04.deviantart.net/fs12/f/2006/321/d/7/coma_by_Jno_J.jpg)
With Lauren Ambrose, Steven Pasquale, Geena Davis, James Woods. A young medical student discovers that something sinister is going on in her hospital after routine procedures send more than a few seemingly healthy patients. COMA - Missing Piece (Official Video) music by Georg Conrad and Marius Bubat Starring: Maria and Carl Special Guest: Oskar Direction: Dominique Lucien Garaudel Art Direction and Illustration: Thea. The coma is the nebulous envelope around the nucleus of a comet. It is formed when the comet passes close to the Sun on its highly elliptical orbit; as the comet warms, parts of it sublimes. This gives a comet a 'fuzzy.
![Coma [1978] Coma [1978]](http://www.rockmetal.pl/pliki/pics/c/coma/coma.rosol-warszawa.3.2009.jpg)
The physiological component refers to the functioning of an individual's brain, and therefore that brain's physical and chemical condition. Awareness is regulated by cortical areas within the cerebral hemispheres, the outermost layer of the brain that separates humans from other animals by allowing for greater intellectual functioning. Arousal is regulated solely by physiological functioning and consists of more primitive responsiveness to the world, as demonstrated by predictable reflex (involuntary) responses to stimuli. Arousal is maintained by the reticular activating system (RAS). This is not an anatomical area of the brain, but rather a network of structures (including the brainstem, the medulla, and the thalamus) and nerve pathways, which function together to produce and maintain arousal. Causes and symptoms. Coma, then, is the result of something that interferes with the functioning of the cerebral cortex and/or the functioning of the structures which make up the RAS.
In fact, a huge and varied number of conditions can result in coma. A good way of categorizing these conditions is to consider the anatomic and the metabolic causes of coma. Anatomic causes of coma are those conditions that disrupt the normal physical architecture of the brain structures responsible for consciousness, either at the level of the cerebal cortex or the brainstem, while metabolic causes of coma consist of those conditions that change the chemical environment of the brain, thereby adversely affecting function.
There are many metabolic causes of coma, including: A decrease in the delivery to the brain of substances necessary for appropriate brain functioning, such as oxygen, glucose (sugar), and sodium. The presence of certain substances that disrupt the functioning of neurons. Drugs or alcohol in toxic quantities can result in neuronal dysfunction, as can substances normally found in the body, but that, due to some diseased state, accumulate at toxic levels.
Accumulated substances that might cause coma include ammonia due to liver disease, ketones due to uncontrolled diabetes, or carbon dioxide due to a severe asthma attack. The changes in chemical levels in the brain due to the electrical derangements caused by seizures. Diagnosis. As in any neurologic condition, history and examination form the cornerstone of diagnosis when the patient is in a coma; however, history must be obtained from family, friends, or EMS. The Glasgow Coma Scale is a system of examining a comatose patient. It is helpful for evaluating the depth of the coma, tracking the patient's progress, and predicting (somewhat) the ultimate outcome of the coma. The Glasgow Coma Scale assigns a different number of points for exam results in three different categories: opening the eyes, verbal response (using words or voice to respond), and motor response (moving a part of the body). Fifteen is the largest possible number of total points, indicating the highest level of functioning.
The highest level of functioning would be demonstrated by an individual who spontaneously opens his/her eyes, gives appropriate answers to questions about his/her situation, and can carry out a command (such as . Three is the least possible number of total points and would be given to a patient for whom not even a painful stimulus is sufficient to provoke a response. In the middle are those patients who may be able to respond, but who require an intense or painful stimulus, and whose response may demonstrate some degree of brain malfunctioning (such as a person whose only response to pain in a limb is to bend that limb in toward the body). When performed as part of the admission examination, a Glasgow score of three to five points often suggests that the patient has likely suffered fatal brain damage, while eight or more points indicates that the patient's chances for recovery are good.
Expansion of the pupils and respiratory pattern are also important. Metabolic causes of coma are diagnosed from blood work and urinalysis to evaluate blood chemistry, drug screen, and blood cell abnormalities that may indicate infection. Anatomic causes of coma are diagnosed from CT (computed tomography) or MRI (magnetic resonance imaging) scans.
Treatment. Coma is a medical emergency, and attention must first be directed to maintaining the patient's respiration and circulation, using intubation aand ventilation, administration of intravenous fluids or blood as needed, and other supportive care. If head trama has not been excluded, the neck should be stablized in the event of fracture. It is obviously extremely important for a physician to determine quickly the cause of a coma, so that potentially reversible conditions are treated immediately.
For example, an infection may be treated with antibiotics; a brain tumor may be removed; and brain swelling from an injury can be reduced with certain medications. Various metabolic disorders can be addressed by supplying the individual The four brain conditions that result in coma.(Illustration by Hans & Cassady.)with the correct amount of oxygen, glucose, or sodium; by treating the underlying disease in liver disease, asthma, or diabetes; and by halting seizures with medication. Because of their low incidence of side effects and potential for prompt reversal of coma in certain conditions, glucose, the B- vitamin thiamine, and Narcan (to counteract any narcotic- type drugs) are routinely given.
Prognosis. Some conditions that cause coma can be completely reversed, restoring the individual to his or her original level of functioning. However, if areas of the brain have been sufficiently damaged due to the severity or duration of the condition which led to the coma, the individual may recover from the coma with permanent disabilities, or may even never regain consciousness.
Take, for example, the situation of someone whose coma was caused by brain injury in a car accident. Such an injury can result in one of three outcomes. In the event of a less severe brain injury, with minimal swelling, an individual may indeed recover consciousness and regain all of his or her original abilities.
In the event of a more severe brain injury, with swelling that resulted in further pressure on areas of the brain, an individual may regain consciousness, but may have some degree of impairment. The impairment may be physical (such as paralysis of a leg) or may even result in a change in the individual's intellectual functioning and/or personality. The most severe types of brain injury, short of death, result in states in which the individual loses all ability to function and remains deeply unresponsive. An individual who has suffered such a severe brain injury may remain in a coma indefinitely. This condition is termed persistent vegetative state.
Outcome from a coma is therefore quite variable and depends a great deal on the cause and duration of the coma. In the case of drug poisonings, extremely high rates of recovery can be expected following prompt medical attention.
Patients who have suffered head injuries tend to do better than do patients whose coma was caused by other types of medical illnesses. Leaving out those people whose coma followed drug poisoning, only about 1. Those adult patients who remain in a coma for greater than four weeks have almost no chance of eventually regaining their previous level of functioning. On the other hand, children and young adults have regained functioning even after two months in a coma.
Resources. Organizations. American Academy of Neurology. Montreal Ave., St.
Elmont Rd., Suite 1. Elmont, NY 1. 10.