A coma is a deeply unconscious state. A person in a coma cannot be awakened. They are not aware of their surroundings. They may have muscle jerking, but they cannot move on purpose, even in response to pain.
Coma can happen when a serious illness or injury damages the central nervous system (CNS). The central nervous system is made up of the brain and spinal cord. Coma may result from:
Sometimes, serious injuries or disease can be best treated if the person being treated is asleep and unaware. In these rare situations, the person is given drugs to put him or her into a coma. This is called medically induced coma. For example, someone with severe burns and fractures may be in so much pain that they thrash around when they are awake. You can think of this type of coma as very long anesthesia. The drugs are stopped and the coma goes away when enough treatment has been done to allow the person to manage while awake.
Someone in a coma appears to be asleep and does not respond to loud noises, touch, or shaking. Except for unintentional muscle jerking, they do not move.
Symptoms before a coma happens may include:
Other symptoms depend on the underlying cause of the coma.
Coma is diagnosed by a physical exam and information about what happened when the coma started. The healthcare provider will also need information about the person's medical history and any medicine he or she is taking.
To help find the cause of the coma, tests such as the following may be done:
The treatment depends on the cause of the coma. The first treatment goal for a person in a coma is support. Most people who are in a coma need intensive care. They often need a ventilator to help them breathe. Medicines and food and fluid can be given through the veins or through a feeding tube. They need family or nursing help with bathing, and they need help with bowel and bladder functions.
The second treatment goal is finding the cause and removing it, if possible. Treating infections, stopping sedative drugs, or removing things pressing on the brain are all possible treatments. Sometimes the cause is found but good treatment is not possible. For example, effective treatment may not be possible after a bad stroke or an infection that is affecting large parts of the brain.
If the cause of coma is found and treated quickly, most people recover fully after a coma. Some recover but have permanent brain damage. Others live on in a state in which they sleep and wake but do not recover awareness or the ability to interact. This is known as a persistent vegetative state. Some die without regaining consciousness.
Many hard ethical and quality-of-life questions may arise while someone is in a coma. For example, how much should be done to keep someone alive who may not regain consciousness? These questions may need to be addressed by healthcare providers, family, staff, and possibly clergy. Some people make such decisions for themselves before they become ill by completing advance medical directives. Advanced medical directives are documents drawn up ahead of time that express your wishes about treatment in case you later become unable to speak for yourself.
