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Coma: Treatment, Procedure, Cost and Side Effects

Last Updated: Nov 01, 2019

What is Coma?

Coma is also known as blackout, insensibility, knockout, swim, swoon, syncope. A coma is a prolonged state of unconsciousness. During a coma, a person is unresponsive to his or her environment. The person is alive and looks like he or she is sleeping. However, unlike in a deep sleep, the person cannot be awakened by any stimulation, including pain.Treatment for a coma depends on the cause. People close to the comatose patient should give doctors as much information as possible to help the doctors determine the cause of coma. Prompt medical attention is vital to treat potentially reversible conditions. For example, if there is an infection that's affecting the brain, antibiotics may be needed.

Glucose may be required in the event of a diabetic shock. Surgery may also be necessary to relieve the pressure on the brain due to swelling or to remove a tumor.Certain drugs may also help relieve the swelling. Medication may also be given to stop seizures if necessary.In general, treatment for a coma is supportive. People in comas are looked after in an intensive care unit and may often require full life support until their situation improves.Sometimes the cause of a coma can be completely reversed and the affected person will regain normal function. But if the affected person has suffered severe brain damage, he or she may sustain permanent disabilities or may never regain consciousness. The person may enter a persistent vegetative state or become brain dead.

How is the treatment done?

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.A coma is a medical emergency. Doctors will first check the affected person's airway and help maintain breathing (respiration) and circulation. Doctors may give breathing assistance, blood transfusions and other supportive care.

Emergency personnel may administer glucose or antibiotics intravenously, even before blood test results return, in case of diabetic shock or an infection affecting the brain.Treatment varies, depending on the cause of the coma. A procedure or medications to relieve pressure on the brain due to brain swelling may be needed.If the coma is the result of drug overdose, doctors will give medications to treat the condition. If the coma is due to seizures, doctors will administer medications to control seizures.Other treatments may focus on medications or therapies to address an underlying disease, such as diabetes or liver disease.

Who is eligible for the treatment?

Comas are caused by an injury to the brain. Brain injury can be due to increased pressure, bleeding, loss of oxygen, or buildup of toxins. The injury can be temporary and reversible. It also can be permanent.More than 50% of comas are related to head trauma or disturbances in the brain's circulatory system. Problems that can lead to coma include:Trauma: Head injuries can cause the brain to swell and/or bleed. When the brain swells as a result of trauma, the fluid pushes up against the skull.Bleeding: Bleeding in the layers of the brain may cause coma due to swelling and compression on the injured side of the brain.

Stroke : When there is no blood flow to a major part of the brain stem or loss of blood accompanied with swelling, coma can occur.Blood sugar : In people with diabetes, coma can occur when blood sugar levels stay very high. That's a condition known as hyperglycemia. Hypoglycemia, or blood sugar that's too low, can also lead to a coma. This type of coma is usually reversible once the blood sugar is corrected.

Who is not eligible for the treatment?

The signs and symptoms of a coma commonly include:Closed eyes, Depressed brainstem reflexes, such as pupils not responding to light,No responses of limbs, except for reflex movements,No response to painful stimuli, except for reflex movements,Irregular breathing.If a person does not face any of the signs then he or she is not in coma.

Are there any side effects?

Although many people gradually recover from a coma, others enter a vegetative state or die. Some people who recover from a coma may have major or minor disabilities.Complications may develop during a coma, including pressure sores, bladder infections, blood clots in the legs and other problems 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.

What are the post-treatment guidelines?

In the longer term, healthcare staff will give supportive treatment on a hospital ward. This can involve providing nutrition, trying to prevent infections, moving the person regularly so they don't develop bedsores, and gently exercising their joints to stop them becoming tight.A person in a coma may become restless, or seize and need special care to prevent them from hurting themselves. Medicine may be given to calm such individuals. Patients who are restless may also try to pull on tubes or dressings so soft cloth wrist restraints may be put on. Side rails on the bed should be kept up to prevent the patient from falling.Coma has a wide variety of emotional reactions from the family members of the affected patients, as well as the primary care givers taking care of the patients. Common reactions, such as desperation, anger, frustration, and denial are possible. The focus of the patient care should be on creating an amicable relationship with the family members or dependents of a comatose patient as well as creating a rapport with the medical staff

How long does it take to recover?

The chances of a person's recovery depend on the cause of the coma, whether the problem can be corrected, and the duration of the coma. If the problem can be resolved, the person can often return to his or her original level of functioning. Sometimes, though, if the brain damage is severe, a person may be permanently disabled/never regain consciousness.Comas that result from drug poisonings have a high rate of recovery if prompt medical attention is received. Comas that result from head injuries tend to have a higher rate of recovery than comas related to lack of oxygen.

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What is the price of the treatment in India?

No specific information is available.

Are the results of the treatment permanent?

It can be very difficult to predict recovery when a person is a coma. If the cause of the coma can be successfully treated, the person may eventually awaken with no permanent damage.They are likely to be confused at first, but then they usually remember what happened before the coma, and be able to continue their life. Typically, some rehabilitation therapy is necessary.If brain damage has occurred, long-term impairment may result. If the person awakens, they may need to relearn basic skills, and they may not remember what happened.

References

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Written ByDr. Arun Sharma MBBS,MS - General Surgery,MCh - Neuro SurgeryNeurology
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Reviewed ByDr. Bhupindera Jaswant SinghMD - Consultant PhysicianGeneral Physician
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