For a person to be alert, two important neurological parts must work perfectly. The first part is the cortex is the gray part that covers the outer layer of the brain. The second part is the structure in the brain stem called the active mesh system. Lesion either of these parts will lead to coma.
What is
coma?
coma is a state of unconscious , a relatively uniform reaction of the brain for different endogenous or exogenous stimuli such as: lack of oxygen, replacement change pH, hypoglycemia, water -electrolyte disorders as well as endogenous and external toxins.
In a coma, the patient loses the ability to wake up (the eyes are always in a state of closing, not open naturally and not open when stimulating types with different intensity). Patients no longer respond to external stimuli agents, language disorders (unable to speak and not understand words), without active movements with orientation and significance of the Facial muscles, limb or body muscles.
coma can last from many days to weeks, in severe cases may last for more than 5 weeks, there are several cases that last for many years. Patients may gradually wake up after a coma and progress to a manifestation of a plant -living person, even death. The progression of coma or plant life depends on the cause, position, weight and magnitude of nerve damage. Complications can grow during coma including pressure pain, urinary and pneumonia.
coma is an emergency condition, so it is necessary to be in time for medical care to protect life and brain function.
Causes of Comatose's disease
In most cases, coma is often due to a spreading or localized brain damage. The possible causes are:
Traumatic brain injury due to traffic accidents or violent acts is the most common cause of coma.
stroke: loss of blood flow to the brain leads to embolism or hemorrhage in a large part of the brain body can lead to coma.
Diabetes: Excessive blood sugar (hyperglycemia) or too low (hypoglycemia) can cause coma. lack of oxygen: People who have been saved from drowning or resurrection after cardiac arrest may not be awakened because of lack of blood and oxygen to the brain. infection: encephalitis and meningitis are infections that cause encephalitis, spinal cord or tissues surrounding the brain, if severe infections can lead to coma. P>
Epilepsy can lead to coma. toxins: Exposure to toxins such as carbon monoxide or overdose of the drug can cause brain damage and coma.
Poisoning: Taking overdose or drinking can lead to coma.
Symptoms of Comatose's disease
Signs and symptoms of coma usually include:
Close eyes.
Weakness of brain body reflexes, such as not responding to light.
There is no limb response except for reflexes.
There is no reaction to pain stimuli, except for reflexes.
Not regularly breathing.
A coma:
Level of coma or aquatic coma: Due to the pathological process that inhibits the brain cover.
Patients are still awakened, but awareness and response to great decline.
Do not respond to the pain stimulation (when stimulating strong pain patients just groan, moan).
Sneezing reflexes still (when smelling ammonia). Other reflexes such as pupil reflexes with light, swallowing reflexes but slow response.
There is a sphincter disorder.
There is no respiratory and cardiovascular disorder.
coma II or medium coma, real coma: because the pathology has spread to the brain and middle brain.
When calling, asking, laying ... the patient did not answer, did not meet the eyes.
Loss of pupils with light, corneal reflexes.
Defecation, incontinence urination, body temperature disorders (often increased body temperature).
There are breathing disorders such as: Cheyne - Stokes, kussmaul or biot style. Cardiovascular disorders such as fast, small vessels, blood pressure.
It can be seen that the patient manifests a brain -type spasticity.
Insert III or deep coma: Due to the deep inhibition process affecting the structures below is the brain bridge and begin to affect Brain function.
Patients lose their deep consciousness, do not respond to all stimuli.
Lost all reflexes including swallowing reflexes, cough reflexes, pupils.
Serious neurological disorders: weak heartbeat, reduced blood pressure, pale patients, breathing disorders (often ventricular breathing or yawning), body disorders Heat (body temperature usually decreases), increased seminars.
Self -control urine.
Can see signs of brain loss.
Level IV coma or excessive coma, non -recovery coma: this period of the process of the pathology is very heavy on the brain and the brain and The whole spinal cord.
Severe respiratory disorders and cardiovascular disorders, patients can no longer breathe, need respiratory support, very low blood pressure sometimes not measured, discrete heartbeat, weak heart chili.
Lost all reflexes, pupils expand, body cold.
If the brain damage is severe, not recovered, it is called brain death and the patient will definitely die. At that time, the patient only exists thanks to the technical support and drugs in a short time.
People at risk for Comatose's disease
Risk factors that can lead to coma are:
Anemia or cerebral infarction
Serious head injury
epilepsy
Brain
Brain encephalitis
Lack of oxygen in a long time
Metabolic abnormalities such as coma increasing osmotic pressure in patients with diabetes, hypoglycemia
Toxic substances, drink alcohol or some drugs (barbiturat, sedative, amphetamine, cocaine)
Hepatic failure, kidney failure
Prevention of Comatose's disease
coma may occur due to pathological or trauma
Prevention of coma due to chronic diseases by having a scientific and reasonable living regime to enhance health, compliance with treatment, re -examination regularly according to the appointment for appointments for appointments Minimize complications such as diabetes coma.
Prevention of coma due to trauma by avoiding high -risk behaviors such as failing to comply with traffic rules when participating in road traffic.
Diagnostic measures for Comatose's disease
Ask for medical history
The important issues in the medical history should be carefully exploited, including: the time of appearance and progress of coma, the onset, the time the patient is last seen in the normal state. This information is helpful for speculating the development of the process of coma.
Clinical examination
Observe to find signs of trauma such as broken skulls showing congestion around the eyeball (panda eye sign), battle signs (manifestation of swelling and changing color of Skin on the stone bone behind the ear), hematoma behind the eardrum, cerebrospinal fluid through the nose or ear.
Touch the patient's head to seek manifestation of skull subsidence, on -site software edema.
Check blood pressure.
Temperature test
Low body temperature often seen in coma due to alcohol, sedation, Wernicking, liver brain disease, and Myxedema
Increased body temperature often found in coma due to heat, epilepsy, increased malignant body temperature due to respiratory anesthesia, poisoning drugs with cholinergic activity, melting Brain blood, hill damage
Signs of meninges irritation
Checking the pupils
Normal: Dong Tu has a diameter of 3 - 4mm, balanced and sensitive reflexes
pupils hill: light, reflexes, encountered in the early stage of compression hill, possibly due to interrupting the path of centrifugal transmission
pupils stretch, no more reflexes: pupils stand still, pupil diameter more than 7mm, usually due to compression of peripheral segment or by poisoning drugs with anti -activity Cholinergic or sympathetic nerve stimulants, but the most common cause is the hernia through the cerebellum tent of the part of the temples due to the growing block on the tent.
Eye movements: eye reflexes - head or doll eye signs, vestibular examination tests. Check the response to different stimuli.
Testing
Blood formula.
Electrolytes, blood sugar and liver and kidney function.
Quantify toxic concentration or drugs in case of suspected poisoning or overdose drugs
Spinal detection: Check the signs of infection.
CT scan of brain CT: is the best image to evaluate brain damage because it can display brain tissue or cerebral hemorrhage or brain hemorrhage.
Magnetic resonance imaging (MRI): Especially useful for checking the brain body and deep brain structures. Sometimes coloring dyes are injected into blood vessels during the shooting process, dyes can help distinguish brain tissue damaged from healthy tissues.
EEG (EEG): It is possible to determine the seizures of epilepsy
Comatose's disease treatments
Maintain the function of living and adjusting the physiological constants
Make sure respiratory function:
Keep the airway connection (remove the dentures, suck the viscous phlegm, let the patient lie on her side, ...).
Open trachea, intubation, mechanical ventilation (if necessary)
oxygen.
Make sure the circulatory function
Use heart medication, maintain heart rate.
Adjust blood pressure with drugs that increase or decrease in blood pressure and infusion. Depending on the specific disease, maintain different blood pressure indicators.
Maintain electrolytes and balance the alkaline (the amount of imported water per day is about 2000 - 2500ml), stabilizing blood sugar, adjusting liver and kidney function, ... >
Anti -cerebral edema
General measures:
Increase ventilation, oxygen breathing.
Located high 300 - 450.
Anti -cerebral drugs: Depending on the specific case, the following anti -cerebral medicine can be prescribed:
glycerin: Anti -cerebral edema effect through osmotic mechanism (used in stroke).
manitol: hypertonic properties, anti -cerebral edema effect through osmotic mechanism (increased osmotic pressure at the bloody barrier). Used in stroke, traumatic brain injury, brain tumor.
Other drugs:
magnesium sulphat: currently rarely used
corticosteroids: used in brain tumors
Current superior glucose is not used, contraindicated in cerebral infarction.
Feedback effects.
Increase the burden of the heart and acute pulmonary edema.
Symptomatic treatment
Anti -seizures
A reduction of fever
Antibiotics in case of superinfection
Full nutrition
Ensuring diet for patients with full 2500 - 3000kcal/24 hours (feeding through nasal catheter or intravenous nutrition)
Preventive prevention of secondary lesions and rehabilitation
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