is a state of profound unconsciousness in which the patient is incapable
of conscious behavior. It can be said that coma is a state wherein
there is very little brain activity, and the patient hovers between
life and death. Coma implies dysfunction of the cerebral hemespheres,
the upper brain stem, or both areas. In other words, damage to the
brain's "thinking, and life support centers" are thought to cause the coma.
injuries you see bleeding into the brain, swelling and congestion of damaged
tissue, and to a lesser degree invaision of infectious organizms.
Each of which cause brain tissue to die off, this is known as secondary
damage. In extreme cases the swelling is so extensive that portions
of the brain are forcibly squeezed outside of the skull. The dead
and dying tissue is then surgicaly removed. In other cases the skull
is sawed off and placed in cold storage to better accommodate the swollen
There are two principle types of coma
associated with head and spinal trauma. The first type results from
bruising, swelling, and tearing of delicate brain tissue. Often, they are
accompanied by severe head injuries, and by fractures of the skull.
Respiration is labored due to pulmonary congestion, or chest wounds.
Hemiplegia, decorticate rigidity (arms flexed and adducted; legs and often
trunk extended, or decerebrate rigidity (jaws clenched, neck retracted,
all limbs extended) is common. Lumbar puncture reveals bloody Cerebrospinal
Fluid, CSF accompanied by elevated blood pressure (intracranial pressure),
coupled with a slowing pulse and respiration.
The second type of coma is caused by
damage to the brainstem. Signs include coma. laborious breathing,
pinpoint pupils, quadrispasticity with arms flexed and trunk and legs extended,
but without intracranial pressure (elevated blood pressure). Such
cases almost always imply severe brain damage and carry a poor prognosis.
Since severe head injuries are often accompanied
by thoracic damage, pulmonary edema (some of which is undoubtedly neurogenic),
hypoxia, and an unstable circulation often complicate the neurologic problems
created by the injury. Damage to the cervical spine also a common
accompaniment, can cause fatal respiratory paralysis or permanent quadriplegia
from spinal cord injury; other cord damage can be almost as disastrous.
Complications: Acute subdural
or intracerebral hematomas are common in severe head injury and, together
with severe brain edema, are present in most fatal cases. All three
conditions cause signs of progressive rostral-caudal neurologic deterioration
in the form of : deepening coma, widening pulse, dilated pupils,
spastic heimplegia with hyperreflexia, quadrispasticity, pupillary fixation
to light, decorticate rigidity, decerebrate rigidity.
(See: TBI Glossary)
has two principle stages and many intermediary stages. During the first
stage of coma patients are incapable of voluntary activities such as eye
opening, and speech. In some cases primitive avoidance responses,
such as gag reflex, response to noxious stimuli, and responce to pain might
be absent. In the second stage of coma, they open their eyes,
but they don't do anything. They don't follow commands. They don't speak.
They don't interact with their loved ones, this is called a vegitative
About 5% to 10%
of all coma patients are incapable of conscious behavior, and end up vegetative,
which most of the public think of as prolonged coma. So, when the patient
opens his or her eyes, he or she is no longer in coma, but s/he's not doing
anything. So, s/he's just aroused, which means s/he's in a vegetative state.
Even today, with all of our impressive medical advances, there remain more
questions than answers regarding coma.
used to think that all the damage to the brain occurred at the moment of
impact. But now, they know that a lot of the damage actually occurs afterwards,
in the first week in the hospital. The brain swells up, which compromises
its ability to get enough blood and oxygen, and then, parts of the brain
die. That damage in itself can be far worse than the first injury.
the moment of impact, the patient's brain is violently thrusted back and
forth inside the skull, tearing blood vessels and pulling nerve fibers.
These injuries cause the brain to swell, blocking the flow of oxygen-carrying
blood. Such a condition could result in massive strokes and/or brain death.
There's this period of time which
can last from a few days to a week -- It can even last up to months --
where there's no conscious behavior.
The most common cause of death and disability in young people in the age
of one to 44 is head injury. In other words, every ten minutes head
injury claims the life of yet another child.
brain is one of the most complicated organs of the body, subject to much
study and misunderstanding.
discovered an alarming number of discrepancies in coma management when
he gathered leading neurosurgeons to develop a protocol called the Guidelines.
They spent two years meeting all over the country, reviewing 3,000 scientific
research articles on head injury, and then came together with a document
which provides guidelines for treatment and managment of patients with
severe head injury. It presents a radical new approach to the
treatment of severe brain injury, one which not all neurosurgeons agree
is best for coma patients. Available through the Brain
Trauma Foundation, the Guidelines for treating head trauma were
approved by the World Health Organization on May 15, 1997.
The family and
friends of the victim feel the psychic repercussions of
the head injury acutely as well. Caring for an injured family member can
be very demanding and result in economic loss and emotional burdens.
It can change
the very nature of family life; the resultant emotional difficulties can
affect the cohesiveness of the family unit.
the emotional damage is intense, affecting family and friends for years
afterward and sometimes leading to the breakup of previously stable family
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