A coma is a deep state of unconsciousness.

It can happen as a result of a traumatic accident, such as

a blow to the head, or a medical condition, for example, some types of infection.

Coma is different from sleep because the person is unable to wake up.

It is not the same as brain death. The person is alive, but they cannot respond
in the normal way to their environment.

Whether or not they are conscious, or how many people are conscious during
a coma, or the level of consciousness, is a question that scientists are
currently investigating.

Levels of consciousness and responsiveness will depend on how much of the

brain is functioning. A coma often lasts for a few days or weeks. Rarely, it can
last for several years.

If a person enters a coma, this is a medical emergency. Rapid action may be

needed to preserve life and brain function.

 During a coma, a person does not react to external stimuli and

they will not show normal reflex responses.

 Comatose patients do not have sleep-wake cycles.

 Reasons for a coma include intoxication, nervous system disease,

metabolic disease, infections, or a stroke.

 Depending on the cause and the extent of damage, a coma can

occur rapidly or gradually, and it can last from several days to several
years, though most last from days to weeks.

A person who is experiencing a coma cannot be awakened, and they do not react to
the surrounding environment. They do not respond to pain, light, or sound in the usual
way, and they do not make voluntary actions.
 Although they do not wake up, their body follows normal sleep patterns. Automatic
functions, such as breathing and circulation, normally continue to function, but the
person's thinking ability is suppressed.

According to the National Institutes of Neurological Disorders and Stroke (NINDS),

the person may sometimes grimace, laugh, or cry as a reflex.

Coma may occur for various reasons, such as intoxication, a disease or infection that
affects the central nervous system (CNS), a serious injury, and hypoxia, or oxygen
deprivation.

Sometimes, a doctor will induce a coma using medications, for example, to protect the
patient from intense pain during a healing process, or to preserve higher brain function
following another form of brain trauma.

A coma does not usually last for more than a few weeks. If the patient's condition does
not change after an extended period, it may be reclassified as a persistent vegetative
state.

If a persistent vegetative state lasts for months, the person is unlikely to wake up.

Symptoms
During a coma, a person cannot communicate, so diagnosis is through the
outward signs.

These include:

 closed eyes

 limbs that do not respond or voluntarily move, except for reflex

movements

 lack of response to painful stimuli, except for reflex movements

How long these will take to develop, and how long they will continue, depend
on the underlying cause.
Before entering a coma, a person with worsening hypoglycemia (low blood
sugar), or hypercapnia (higher blood CO2 levels), for example, will first
experience mild agitation. Without treatment, their ability to think clearly will
gradually decrease. Finally, they will lose consciousness.

If a coma results from a severe injury to the brain or a subarachnoid

hemorrhage, symptoms may appear suddenly.

Anyone who is with the person should try to remember what occurred just
before the coma started, because this information will help determine the
underlying cause and give a better idea of what treatment to apply.

Recognizing symptoms
A first responder may start by using the AVPU scale, try to gauge the level of
consciousness.

The AVPU scale looks at the following areas:

Alertness: How alert is the person?

Vocal stimuli: Do they respond to another person's voice?

Painful stimuli: Do they respond to pain?

Unconscious: Are they conscious?

Alert is the most conscious state, and unconscious is the least. This helps the
health professional assess whether this is likely to be an emergency. If the
person is alert, there is no risk of coma.

In the hospital, doctors may apply the Glasgow coma scale (GCS) to assess
the person's condition in more detail.
Patients with deep unconsciousness may be at risk of asphyxiation. They may
need medical help to secure the airways and ensure they continue to breathe.
This could be a tube that passes through the nose or mouth, into the lungs.

Causes
Causes or a coma vary, but they all involve some level of injury to the brain or
CNS.

They include:

Diabetes: If the blood sugar levels of a person with diabetes rise too much,

this is known as hyperglycemia. If they become too low, this is hypoglycemia.
If hyperglycemia or hypoglycemia continue for too long, a coma can result.

Hypoxia, or lack of oxygen: If the supply of oxygen to the brain is reduced or

cut off, for example, during a heart attack, stroke, or near drowning, a coma
may result.

Infections: Severe inflammation of the brain, spinal cord, or tissues

surrounding the brain can result in coma. Examples
include encephalitis or meningitis.

Toxins and drug overdose: Exposure to carbon monoxide can result in brain
damage and coma, as can some drug overdoses.

Traumatic brain injuries: Road traffic accidents, sports injuries, and violent
attacks that involve a blow to the head can cause coma.

Diagnosis
A medical and recent history, blood tests, physical tests, and imaging scans
can help find out the cause of a coma, and this helps decide which treatment
to apply.
 Medical history
Friends, family, police, and witnesses, if appropriate, may be asked:

 whether the coma or symptoms beforehand started slowly or

suddenly

 if the person had or appeared to have any vision problems, dizziness,

stupor or numbness before the coma

 whether the patient has diabetes, any history of seizures or stroke, or

any other condition or disease

 what medications or other substances the patient may have been

taken

Physical tests
The aim is to check the person's reflexes, how they respond to pain, and their
pupil size. Tests may involve squirting very cold or warm water into the ear
canals.

These tests will trigger varying reflexive eye movements. The type of
response varies according to the cause of the coma.

Blood tests
These will be taken to determine:

 blood count

 signs of carbon monoxide poisoning

 presence and levels of legal or illegal drugs or other substances

 levels of electrolytes

 glucose levels

 liver function
Lumbar puncture (spinal tap)
This can check for any infection or disorder of the CNS. The doctor inserts a
needle into the patient's spinal canal, measures pressure, and extracts fluid to
send for tests.

Imaging scans of the brain

These will help determine whether there is any brain injury or damage, and
where. A CT or CAT scan or an MRI will check for blockages or other
abnormalities. An electroencephalography (EEG) will measure electrical
activity within the brain.

Glasgow Coma Scale

The Glasgow Coma Scale (GCS) can be used to assess the severity of brain
damage following a head injury.

It gives patients a score, according to verbal responses, physical responses,

and how easily they can open their eyes.

Eyes: Scores range from 1 to 4, where 1 is when a person does not open their
eyes, 2 is when they open their eyes in response to pain, 3 is when they open
them in response to voice, and 4 is when they open them spontaneously.

Verbal: Scores range from 1 to 5, where 1 means the person makes no

sound, 2 means they mumble but cannot be understood, 3 is when they utter
inappropriate words, 4 is when they speak but are confused, and 5 is normal
communication.

Motor, or physical reflexes: Scores range from 1 to 6, and 1 to 5 describe a

person's response to pain. A person who scores 1 makes no movement, 2 is
when they straighten a limb in response to pain, 3 is when they react in an
unusual way to pain, 4 is when they move away from pain, and 5 is when they
can pinpoint where the pain is. A score of 6 means the person can obey
commands.
A score of 8 or less overall indicates a coma. If the score is from 9 to 12, the
condition is moderate. If the score is 13 or more, the impairment to
consciousness is minor.

Treatment
A coma is a serious medical emergency.

Health professionals will start by ensuring the immediate survival of the patient
and securing their breathing and circulation to maximize the amount of oxygen
that reaches the brain.

A doctor may administer glucose or antibiotics even before the results of blood

tests are ready, in case the patient is in diabetic shock or has a brain infection.

Treatment will depend on the underlying cause of the coma, for example,
kidney failure, liver disease, diabetes, poisoning, and so on.

If there is brain swelling, surgery may be needed to relieve the pressure.