home Thyroid Real cases of recovery from a 3rd degree coma. How many days does a coma last after a stroke and is there a chance of survival? Probability of survival after neonatal coma

Real cases of recovery from a 3rd degree coma. How many days does a coma last after a stroke and is there a chance of survival? Probability of survival after neonatal coma

Coma is a disorder of human consciousness in which brain damage occurs. A patient in this condition cannot contact the environment. Coma of the 3rd degree is also called atonic. Causes and symptoms vary. Coming out of a coma is possible with the necessary care. Diagnosis is carried out using CT and MRI, laboratory blood tests. Treatment involves eliminating the main cause of the pathology.

A person's eyes are closed, and he does not react to sounds and pain. It can lie in this state for a very long time. This is different from other damage to consciousness. Other signs may appear, it all depends on the causes of the atomic coma. Often the patient is connected to a life support device.

The chances of survival depend on the degree of coma. This determines the prognosis for improving human health. The duration of the condition can last from several days to years. When a person comes out of a coma, professional rehabilitation is necessary.

Coma in the 3rd degree is not recognized as an independent disease; it occurs from complications of the nervous system when the nerve pathways are damaged. The brain receives signals using the reticular formation. It serves as a filter that is used to transmit nerve impulses. When its cells become damaged, the brain will have loss of life. As a result, a comatose period occurs.

Damage to nerve fibers occurs physically. For example, in case of stroke, injuries. Chemical causes include the presence of other diseases, as well as incoming external metabolic products. Internal factors are a low oxygen content, acetone components, and ammonia.

External intoxication occurs with an overdose of drugs, sleeping pills, poisons, and the influence of toxins during infections. A special factor is the increase in pressure that occurs with injuries. Treatment is prescribed when the causes of the coma are determined.

Types of states

Coma is divided into 2 groups: depending on the factors of occurrence and the degree of state of consciousness. Based on the first sign, the disease is divided into:

This distribution of the disease is rarely used, since it does not reveal the real condition of the person.

The state of coma can be determined using the Glazko scale, which allows you to determine the severity of the condition, determine treatment procedures and the prognosis for recovery. Speech, movements, and eye opening must be taken into account.

In resuscitation, the stages of coma are as follows:

coma 1st degree: also called stupor;
coma 2: called stupor;
coma 3: atonic;
coma 4: extreme coma.

A person can remain in these states for a long period. Patients lie motionless, which is necessarily controlled by the doctor. He must be able to perform various types of procedures. The prognosis for recovery depends on the condition of the body. Depending on the type of condition, different procedures are prescribed. Constant monitoring by a doctor is important here.

Symptoms

The main sign of the condition is that the patient is not in contact with the surrounding reality, and there is also a lack of mental activity. Other symptoms may vary markedly because the causes of brain damage vary. The most common symptoms include:

if the condition appears due to overheating, then the body temperature rises to 43 degrees, the skin becomes dry, and in case of alcohol poisoning, hypothermia is observed;
slow breathing appears with hypothyroidism, an overdose of sleeping pills, and deep breathing occurs with bacterial intoxication;
there may be a decreased or increased number of heartbeats;
in case of poisoning due to carbon monoxide, the skin takes on a red tone, and with a small amount of oxygen in the blood, the tips of the fingers turn blue, pallor of the skin characterizes massive blood loss: this is a deep coma;
superficial coma can be manifested by the production of different sounds: this shows a positive prognosis.

The type of recovery depends on the symptoms. Signs of coma affect the healing process. There is always a chance of improvement, but this is determined by the characteristics of the body.

Diagnostics

Coma in the third degree or any other requires an examination. What it is? This procedure is necessary to determine the diagnosis. It also allows you to determine how long the coma may last. With its help, you can understand how much a person has a chance of improving his health. Diagnostics determines the causes, as well as similarities with other similar conditions. After all, not many patients immediately recover from this state.

Who can help determine the reasons? Usually the patient’s close people help determine this. It is important for the doctor to find out whether there were any complaints before or not, as well as heart and vascular diseases. The medications taken can also affect a comatose state of 2 or 3 degrees.

The condition can last a long time; rarely it lasts a day. This is influenced by the speed of onset of symptoms and the age of the patient. The occurrence of third-degree or second-degree coma is observed in young people due to poisoning with drugs or sleeping pills. In older people, this is usually associated with heart and vascular disease. Thanks to the examination, the doctor determines the cause of the coma. Any stage is checked based on blood pressure, pulse, respiratory status, bruises, and injection marks.

The doctor analyzes the person's position. An overturned head with high muscle tone indicates an irritating effect of the brain. Convulsions occur due to an epileptic factor.

When a first-degree coma lasts for a long time, doctors sometimes decide to bring him out of this state. This is also required for stages 2, 3, 4. What is important is a person’s ability to open their eyes to sounds. When the phenomenon occurs voluntarily, it is not called coma. A person in this state remains with his eyes closed for a long time.

The reaction of the eyes to light must be detected. This method allows not only to determine the expected location of the disease, but also finds the factors for the occurrence of the condition. Narrow pupils that do not react to light are observed with the consumption of alcohol and drugs. If they are wide, then this indicates a disease of the midbrain. When the pupils become dilated and there is no reaction to light, this indicates a deterioration in the person’s condition.

Thanks to modern methods, diagnosis is one of the main things in examining a patient with deteriorating consciousness. Computed tomography is often used to identify changes in the brain. Based on the diagnosis, the treatment method is selected: classical or surgery.

If CT or MRI cannot be performed, then X-rays of the skull and spinal column are performed. A blood test can identify the metabolic factor. It is important for the doctor to determine the level of glucose, urea, and ammonia. If this is not due to a malfunction of the nervous system, then the blood is checked for hormones. An EEG will help determine who has stage 2 or other degrees. Once the procedure is completed, it will be possible to distinguish a comatose state from other ailments. Based on the diagnosis, you can understand how long a person can remain in a coma.

Features of treatment

How to bring a person out of a coma? A patient in this condition can be treated with 2 options:

supporting his functions as a patient to prevent his death;
eliminating the causes that caused the condition.

The doctor gives a prognosis for recovery after examination. Often, coma occurs after an accident or accident, when a person urgently needs help. The patient's condition is supported in the ambulance. It involves ensuring improvement of the respiratory system and blood circulation.

Two stages of treatment will help a person come out of a coma. In the intensive care unit, the patient may be placed on a ventilator. Also, if necessary, anticonvulsants, intravenous infusion of glucose, temperature restoration, and gastric lavage are administered. Only then does the person in a coma feel relief.

The following procedures are carried out only after the examination has been carried out, and the following medical measures are applied depending on the underlying cause. In case of a tumor or hematoma, surgery is performed. If this is a diabetic coma, then sugar levels must be monitored. For kidney failure, hemodialysis is performed.

Opportunities for improvement

In a comatose state, the prognosis is determined by the degree of brain disease, as well as the causes. A person who has been in a coma has a chance of improving his condition, based on injuries, age, and medications. In any case, the doctor provides the necessary treatment.

The consequences of a coma can be as follows:

favorable: when the condition improves and no adverse effects are observed;
doubtful: both a positive and negative outcome is possible;
unfavorable: when the patient dies.

Recovery from a coma involves a number of therapeutic measures. They are usually prescribed by a doctor. The procedures consist of taking medications, doing physical exercise, and maintaining proper nutrition. An integrated approach will significantly improve a person’s condition in a short time.

Any condition is easier to prevent than to treat. Prevention involves performing diagnostics, using the necessary treatment methods, and correcting the condition. Thanks to this, you can prevent its occurrence.

In a stage 4 coma, the chances of survival are negligible. If within 20-30 minutes during resuscitation measures it was possible to achieve restoration of spontaneous breathing, spinal or brainstem reflexes, electrical impulses of the brain, then stabilization of such a patient is possible.

The severe unstable condition of a patient with a 3rd degree coma can progress until a 4th degree coma develops. This is a transcendental state, which is characterized by deep depression of all body functions. Life support is possible with the help of artificial respiration devices, parenteral nutrition and medications

Causes

A terminal condition occurs as a complication of a serious illness that cannot be treated:

Diabetes mellitus, hypothyroidism.
Brain injuries.
Tumors and cerebrovascular disorders.
Severe intoxication, poisoning with ethanol, drugs.

Clinical manifestations

The patient's reflexes completely disappear, muscle atonia develops, and he does not respond to pain and exogenous stimuli.
Blood pressure is maximally reduced, pulse is frequent or pathologically slow.
Breathing is difficult, unproductive, and apnea may develop.
The pupils are dilated and do not constrict to light.
Body temperature drops.
The EEG shows the absence of bioelectrical activity of the brain.

Management of a patient in a coma

If the patient’s condition sharply worsens and there are suggestions of brain death, emergency measures are necessary:

Connecting an artificial respiration device.
Maintaining blood pressure with medications.
Providing venous access by installing a catheter in the central vein.
Feeding through a gastric tube.
Prevention of bedsores and pneumonia.

Forecast! In a stage 4 coma, the chances of survival are negligible. If within 20-30 minutes during resuscitation measures it was possible to achieve restoration of spontaneous breathing, spinal or brainstem reflexes, electrical impulses of the brain, then stabilization of such a patient is possible. Otherwise, the outcome will be brain death.

Brain death

Based on data indicating the cessation of functioning of the brain and its stem, brain death is confirmed by a council of doctors. This concept is legally enshrined and defines the death of a person, despite the presence of cardiac activity and breathing supported artificially.

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Life support systems have a high cost, so at a certain stage the question is raised about disconnecting the patient from life support devices. This creates the possibility of obtaining donor organs for transplantation.

The following criteria for brain death have been defined:

Damage to the brain structure. There must be a history of trauma, after which it is impossible to definitely restore its structure. Diagnosis is carried out using CT.
A full examination confirms that the depressed state is not caused by intoxication.
Body temperature 32°C or more. A hypothermic state can lead to a decrease in electrical activity on the EEG, but when the temperature rises, the indicators are restored.
The observation period for injuries ranges from 6 to 24 hours; after drug intoxication and in children, the observation time is increased.
Does not react with movement to severe pain, there are no reflex reactions to pain in the form of rapid breathing or heartbeat.
Apnea is confirmed by a special test. Ventilation of the lungs is carried out with pure humidified oxygen or mixed with carbon dioxide for 10 minutes. After this, its feed is reduced. Spontaneous breathing should return within 10 minutes. If this does not happen, brain death is diagnosed.
Absence of corneal reflexes: no eye movement during cold testing, fixed pupils, corneal, pharyngeal, gag reflexes, blinking, swallowing disappear.
EEG in the form of an isoelectric line.
According to angiography, there is no blood flow. During ophthalmoscopy, glued red blood cells are found in the retina - a sign of stopping blood flow.

Pseudocomatose states

Coma state 4 must be differentiated from other conditions that are accompanied by similar symptoms:

1. Locked-in syndrome. Damage to the motor tract leads to paralysis of the muscles of the limbs, neck and face, and is a consequence of blockage of the main artery or tumor of the bridge, a demyelinating process. Patients cannot move or pronounce words, but understand speech, blink, and move their eyes.

2. Akinetic mutism. Stroke, injury to the thalamus, midbrain, caudate nucleus, motor and sensory pathways are damaged, paresis or paralysis of the muscles of the limbs develops, and speech is lost. A person can open his eyes, sometimes perform some movements or pronounce words in response to a painful stimulus. But wakefulness takes place without the participation of consciousness. After recovery, the patient remains amnesic.

3. Abulia. The lesions are located in the temporal lobes, midbrain and caudate nucleus. The ability to move and speak is impaired. Sometimes patients can emerge from this state and respond adequately to stimuli, and then return to their original state.

4. Severe depression. Accompanied by a state of stupor, complete immobilization and loss of contact are possible. The condition develops gradually. Diagnostic CT or MRI does not reveal signs of brain damage.

5. Hysteria. People with pronounced affective behavior after a traumatic situation experience complete immobilization and withdrawal. There are no signs of organic damage to brain structures.

Results

The outcome of coma 4 can be a vegetative state. It is characterized by alternating sleep and wakefulness, but it is impossible to establish contact, there is no awareness of the individual. Breathing is spontaneous, blood pressure and cardiac activity are stable. Movements are possible in response to stimuli.

This condition lasts for at least a month. It will never be possible to get out of it. Higher brain functions are not restored. The patient's death occurs from additional complications. published .

P.S. And remember, just by changing your consciousness, we are changing the world together! © econet

Intoxication, stroke and many other causes can lead to pathological inhibition of the central nervous system and the development of coma. A condition in which the patient balances between life and death is called third-degree coma. The development of a coma can be caused by various factors. The first place is occupied by direct damage to brain tissue during a stroke, injury, infectious process, etc.

Toxic substances that accumulate due to liver or kidney failure, infection, alcohol poisoning, and drug poisoning also damage the brain. Metabolic changes in any pathology, imbalance of hormones, and brain hypoxia can lead to coma.

Damage to the nervous system is based on bilateral diffuse damage to the cortex and brain stem with the reticular formation. This area maintains the tone of the cortical sections; its shutdown leads to inhibition of the central nervous system.

Classification

Types of pathology are distinguished based on the cause:

Neurological primary can develop after trauma, acute disturbances of vascular blood flow, after an epileptic seizure, or encephalitis, increased intracranial pressure.
Secondary coma:

toxic: poisoning with ethanol, carbon monoxide, medicines, drugs;
endocrine cause: development of hyper- or hypoglycemia, with hypothyroidism, thyrotoxicosis;
hypoxic coma occurs with heart and vascular diseases, anemia;
damage by physical factors (temperature, electric shock);
coma from dehydration or starvation.

There are 4 types based on severity. Their boundaries are arbitrary; a gradual or rapid transition from one degree to another is possible. Each of them has its own clinical symptoms.

Coma symptoms

A coma state can develop over several hours or days. The severity is determined by clinical manifestations. The period of time before a coma (precoma) depends on the underlying disease. The patient develops confusion, lethargy or mental agitation, and impaired coordination of movements.

Next, a 1st degree coma develops - a state of stupor. The response to stimuli is inhibited, but the patient can take liquid food, drink, and change position in bed. Tendon reflexes increase, and the pupils react to light.

2nd degree, or stupor, is characterized by depression of consciousness, loss of contact with the person. The muscles twitch fibrillarily, the pupils are in a state of miosis and do not react, the rhythm of breathing is disturbed, and it takes on a pathological form. The patient involuntarily empties.

Then comes a third degree coma. Body temperature drops, reflexes are suppressed, and the reaction to painful stimuli disappears. The pupils do not react to light, there is no consciousness.

Stage 4 is called beyond: life is maintained with the help of an artificial respiration apparatus. A condition close to terminal develops, the outcome being death.

Survival prognosis for stage 3 coma

What is a 3rd degree coma cannot be answered unambiguously. Her condition is often compared to clinical death; it is similar to deep sleep without dreams. And stage 3 coma does not always have a favorable prognosis. According to statistics, only 4% of people recover from this condition, but subsequently remain disabled. Indicators of threat to life are:

mydriasis, or enlarged pupils;
unproductive breathing;
drop in blood pressure;
convulsions;
lack of response to pain, decreased muscle activity.

Important! Studies show that if within 24 hours the patient loses the reaction of the pupils and the response to irritants and pain, then there is no chance of emerging from a 3rd degree coma, the prognosis is death. Survival is influenced by the initial level of health, the extent of associated injuries and the reason for which the coma developed.

Coma after stroke

Cerebral circulation disorders can be caused by blockage of a blood clot or rupture of a blood vessel. may cause third degree coma. The chances of survival depend on the size of the lesion and the age of the patient. Grades 1 and 2 often end with restoration of function. Seizures, hypothermia, lack of spontaneous breathing and pupillary reactions are unfavorable symptoms.

Coma after injury

Severe head injuries after an accident, a fall from a height, or blows with a blunt object lead to the rapid development of coma. The patient's condition is affected by concomitant damage to internal organs and blood loss. Fractures of the base of the skull, vault, temporal bones, damage to blood vessels, cerebral edema, and a high degree of brain contusion reduce the chances of emerging from a coma.

Hepatic coma

Develops as a result of liver failure. Patients have a characteristic appearance:

pale or icteric skin;
abdomen enlarged due to ascites;
veins on the anterior wall of the abdominal cavity as a sign of portal hypertension;
petechial hemorrhages;
general exhaustion.

Hepatorenal syndrome often develops, along with renal failure and oliguria. The immune system is weakened and sepsis may develop. The prognosis for such patients is extremely unfavorable.

Group 3 disability criteria

After emerging from a stage 3 coma, the person remains disabled. The law determines who is entitled to group 3 disability. These are persons with such a state of health who cannot work, with reduced vital activity, and in need of help and support from social bodies.

Disorders of basic functions are considered:

The consequences of coma for determining disability are:

significant impairment of the ability to move (hemiplegia, hemiparesis);
aphasia;
dropsy of the brain;
developed dementia;
large defects of the skull or foreign body in the brain;
dysfunction of the pelvic organs.

Those who are given group 3 disability are examined by a commission every year and provided with a rehabilitation program. For sick pensioners, the group is assigned for an indefinite period and re-examination is not carried out.

From ancient Greek “coma” is translated as “deep sleep”. While a person is in a coma, the nervous system is depressed. This is very dangerous, because this process progresses and failure of vital organs is possible, for example, respiratory activity may stop. While in a coma, a person stops responding to external stimuli and the world around him; he may have no reflexes.

Prekoma. While in this state, the person remains conscious, but there is slight confusion in actions and lack of coordination. The body functions according to the concomitant disease.
Coma 1st degree. The body's reaction is very inhibited even to strong stimuli. It is difficult to find contact with the patient, but he can make simple movements, for example, turning over in bed. Reflexes are preserved, but are very weakly expressed.
Coma 2nd degree. The patient is in a deep stage of sleep. Movements are possible, but they are performed spontaneously and in a chaotic manner. The patient does not feel touch, the pupils do not react to light in any way, and respiratory function is impaired.
Coma 3rd degree. Deep state of coma. The patient does not respond to pain, the reaction of the pupils to light is completely absent, reflexes are not observed, the temperature is low. Disturbances occur in all body systems.
Coma 4 degrees. A state from which it is no longer possible to get out. The person has no reflexes, the pupils are dilated, and the body is hypothermic. The patient cannot breathe on his own.

In this article we will take a closer look at the condition of a person in a penultimate degree coma.

Coma 3rd degree. Chances of survival

This is a very dangerous condition for human life, in which the body cannot practically function independently. Therefore, it is impossible to predict how long the unconscious state will last. It all depends on the body itself, on the degree of brain damage, and on the age of the person. Coming out of a coma is quite difficult; as a rule, only about 4% of people are able to overcome this barrier. Moreover, even if the person has regained consciousness, most likely he will remain disabled.

If you are in a third-degree coma and return to consciousness, the recovery process will be very long, especially after such serious complications. As a rule, people learn to speak, sit, read, and walk again. The rehabilitation period can take quite a long time: from several months to several years.

According to studies, if in the first 24 hours after the onset of a coma a person does not feel external irritants and pain, and the pupils do not react to light in any way, then such a patient will die. However, if at least one reaction is present, then the prognosis is more favorable for recovery. It is worth noting that the health of all organs and the age of the patient who has developed a 3rd degree coma play a huge role.

Chances of survival after an accident

About thirty thousand people a year die as a result of road accidents and three hundred thousand become their victims. Many of them become disabled as a result. One of the most common consequences of a road accident is traumatic brain injury, which often causes a person to fall into a coma.

If, after an accident, a person’s life requires hardware support, and the patient himself has no reflexes and does not respond to pain and other stimuli, a 3rd degree coma is diagnosed. The chances of survival after an accident that leads to this condition are negligible. The prognosis for such patients is disappointing, but there is still a chance of returning to life. It all depends on the degree of brain injury as a result of the accident.

If a stage 3 coma is diagnosed, the chances of survival depend on the following factors:

Probability of survival after a stroke

A stroke is a disruption of the blood supply to the brain. It happens for two reasons. The first is blockage of blood vessels in the brain, the second is bleeding in the brain.

One of the consequences of cerebrovascular accident is coma (apoplectiform coma). In case of hemorrhage, a 3rd degree coma may occur. The chances of surviving a stroke are directly related to age and the extent of the damage. Signs of this condition:

The duration of the coma depends on a number of factors:

Coma stage. In the first or second stage, the chances of recovery are very high. With the third or fourth, the outcome is usually unfavorable.
Condition of the body.
Patient's age.
Equipping with necessary equipment.
Patient care.

Signs of third degree coma during stroke

This condition has its own distinctive features:

Lack of response to pain.
The pupils do not respond to light stimuli.
Lack of swallowing reflex.
Lack of muscle tone.
Reduced body temperature.
Inability to breathe independently.
Bowel movements occur uncontrollably.
Presence of seizures.

As a rule, the prognosis for recovery from a third-degree coma is unfavorable due to the absence of vital signs.

Probability of survival after neonatal coma

A child may fall into a coma in the event of a deep disorder of the central nervous system, which is accompanied by loss of consciousness. The reasons for the development of coma in a child are the following pathological conditions: renal and liver failure, meningoencephalitis, brain tumor and trauma, diabetes mellitus, water and electrolyte imbalance, cerebral hemorrhage, hypoxia during childbirth and hypovolemia.

Newborns fall into a comatose state much more easily. It is very scary when a third degree coma is diagnosed. A child has a higher chance of survival than older people. This is explained by the characteristics of the child’s body.

In the case when a 3rd degree coma occurs, the newborn has a chance of survival, but, unfortunately, it is very small. If the baby manages to get out of a serious condition, severe complications or disability are possible. At the same time, we must not forget about the percentage of children, albeit small, who managed to cope with this without any consequences.

Consequences of coma

The longer the unconscious state lasts, the more difficult it will be to get out of it and recover. A 3rd degree coma can occur differently for everyone. The consequences, as a rule, depend on the degree of brain damage, the length of time spent in an unconscious state, the reasons that led to the coma, the health of the organs and age. The younger the body, the higher the chances of a favorable outcome. However, doctors rarely make a prognosis for recovery, since such patients are very sick.

Despite the fact that newborns recover from a coma more easily, the consequences can be very sad. Doctors immediately warn relatives how dangerous a 3rd degree coma is. Of course, there are chances of survival, but at the same time a person may remain a “plant” and never learn to swallow, blink, sit and walk.

For an adult, a prolonged stay in a coma is fraught with the development of amnesia, the inability to move and speak, eat and defecate independently. Rehabilitation after a deep coma can take from a week to several years. In this case, recovery may never occur, and the person will remain in a vegetative state for the rest of his life, when he can only sleep and breathe independently, without reacting in any way to what is happening.

Statistics show that the chance of a full recovery is extremely small, but such events do happen. Most often, death is possible, or in case of recovery from a coma - a severe form of disability.

Complications

The main complication after a coma is a violation of the regulatory functions of the central nervous system. Subsequently, vomiting often occurs, which can enter the respiratory tract, and stagnation of urine, which can lead to bladder rupture. Complications also affect the brain. Coma often leads to breathing problems, pulmonary edema and cardiac arrest. Often these complications lead to biological death.

The feasibility of maintaining body functions

Modern medicine makes it possible to artificially maintain the vital functions of the body for quite a long time, but the question often arises about the feasibility of these measures. This dilemma arises for relatives when they are informed that the brain cells have died, that is, in fact, the person himself. Often a decision is made to remove artificial life support.

Head injuries, intoxication, stroke and many other causes can lead to pathological inhibition of the central nervous system and the development of coma. A condition in which the patient balances between life and death is called third-degree coma. The development of a coma can be caused by various factors. The first place is occupied by direct damage to brain tissue due to stroke, trauma, infectious process, epilepsy.

Classification

Types of pathology are distinguished based on the cause:

Neurological primary can develop after trauma, acute disturbances of vascular blood flow, after an epileptic seizure, meningitis or encephalitis, increased intracranial pressure.
Secondary coma:

toxic: poisoning with ethanol, carbon monoxide, medicines, drugs;
endocrine cause: development of hyper- or hypoglycemia, with hypothyroidism, thyrotoxicosis;
hypoxic coma occurs with heart and vascular diseases, anemia;
damage by physical factors (temperature, electric shock);
coma from dehydration or starvation.

There are 4 types based on severity. Their boundaries are arbitrary; a gradual or rapid transition from one degree to another is possible. Each of them has its own clinical symptoms.

Find out why coma occurs after brain surgery.

Read what the prognosis for patients with stage 1 coma is.

Coma symptoms

Then comes a third degree coma. Body temperature drops, reflexes are suppressed, and the reaction to painful stimuli disappears. The pupils do not react to light, there is no consciousness.

Stage 4 is called beyond: life is maintained with the help of an artificial respiration apparatus. A condition close to terminal develops, the outcome being death.

Survival prognosis for stage 3 coma

mydriasis, or enlarged pupils;
unproductive breathing;
drop in blood pressure;
convulsions;
lack of response to pain, decreased muscle activity.

Important! Studies show that if within 24 hours the patient loses the reaction of the pupils and the response to irritants and pain, then there is no chance of emerging from a 3rd degree coma, the prognosis is death. Survival is influenced by the initial level of health, the extent of associated injuries and the reason for which the coma developed.

Coma after stroke

Cerebral circulation disorders can be caused by blockage of a blood clot or rupture of a blood vessel. A cerebral hemorrhage can cause a third degree coma. The chances of survival depend on the size of the lesion and the age of the patient. Grades 1 and 2 often end with restoration of function. Seizures, hypothermia, lack of spontaneous breathing and pupillary reactions are unfavorable symptoms.

Coma after injury

Hepatic coma

Develops as a result of liver failure. Patients have a characteristic appearance:

pale or icteric skin;
abdomen enlarged due to ascites;
veins on the anterior wall of the abdominal cavity as a sign of portal hypertension;
petechial hemorrhages;
general exhaustion.

Hepatorenal syndrome often develops, along with renal failure and oliguria. The immune system is weakened and sepsis may develop. The prognosis for such patients is extremely unfavorable.

Group 3 disability criteria

Disorders of basic functions are considered:

Read how coma manifests itself during a stroke and what the prognosis is for patients.

Find out how a 2nd degree coma can end. Treatment of pathology and consequences.

Do you know what an induced coma is and why patients are put into such a state?

The consequences of coma for determining disability are:

significant impairment of the ability to move (hemiplegia, hemiparesis);
aphasia;
dropsy of the brain;
developed dementia;
large defects of the skull or foreign body in the brain;
dysfunction of the pelvic organs.

Coma is a pathological inhibition of the central nervous system, accompanied by deprivation of consciousness, lack of reactions and restrictions on the regulation of vital functions of the body. To begin treatment for anyone, it is necessary to eliminate the cause that caused this condition and implement procedures to eliminate collapse, lack of oxygen, and establish the acid-base balance in the body.

Depending on the speed of development of the coma state, a person may fall into a coma:

unexpectedly - a sharp loss of consciousness followed by symptoms of coma - respiratory paraphasia, cardiac arrhythmia, decreased blood pressure;
quickly - symptoms intensify from a few minutes to several hours;
slowly - the initial development of precoma with an increase in signs of the main disease, from which the acceleration of neurological and mental disorders gradually occurs.

In this case, slow reactions occur, drowsiness or, on the contrary, overexcitation, nonsense and visions, which are replaced by a comatose state.

There are four stages of coma, but we will look at the third degree, since it is the most critical, find out what a third degree coma is, the chances of survival, prognosis after a third degree coma, what comes after it.

Symptoms of stage 3 coma:

there is no consciousness,
no pain reflexes,
the pharyngeal reflex is suppressed,
there is no reaction of the pupils to light and muscle activity,
there is involuntary urination and defecation,
reduced body temperature.

Depending on the causes of the coma and the severity of the brainstem disorder, the coma scenario depends. The following scenario is considered positive: brainstem and spinal reactions are restored, independent breathing and reason are restored.

But with a third-degree coma, the scenario for recovery is usually not favorable. Here the medulla oblongata is affected, which increases the danger to life and worsens the prognosis for a favorable recovery.

A life-threatening state in stage 3 coma is preceded by:

lack of defensive reactions, the patient does not even react to the injection, does not move his limbs;
lack of surface reflexes;
muscle activity decreases;
dilated pupils and lack of response to light;
unproductive breathing;
low pressure;
possibility of seizures.

The degree of coma under consideration in itself is the most mysterious; its symptoms are very similar to the symptoms of clinical death. According to doctors, deep coma is similar to dreamless sleep. This is, so to speak, a survival program laid down by nature in the human body, in which the body begins to conserve strength for life.

Reviews of people who managed to survive and come out of a third-degree coma are based on stories about “empty spaces” in which they had to wander for a certain period of time and where voices were not perceived.

With the right and timely actions, it is possible to come out of a third-degree coma. A life-threatening condition requires immediate resuscitation, which will save brain cells and human life in general.

Coma is a condition that threatens a person’s life and is characterized by loss of consciousness, absent or weakened response to external stimuli, impaired frequency and depth of breathing, extinction of reflexes, changes in pulse, vascular tone, and impaired temperature regulation.

The development of coma is caused by deep inhibition in the cerebral cortex, which spreads to the subcortical and lower parts of the central nervous system due to head injuries, acute circulatory disorders in the brain, poisoning, inflammation, hepatitis, diabetes mellitus, uremia.

The goal of treating coma is to eliminate the causes that caused this condition and to take measures aimed at eliminating collapse, oxygen starvation, restoring breathing, and acid-base balance.

Types and causes of coma

Based on their origin, the following types of comatose states are distinguished:

Neurological coma. Its cause is inhibition of the central nervous system due to primary brain damage (apoplectic coma due to stroke, epileptic coma, traumatic coma, coma caused by brain tumors, coma due to meningitis, encephalitis);
To whom with endocrine diseases. This kind of coma is associated with metabolic disorders with insufficient levels of hormone synthesis (hypothyroid coma, diabetic, hypocorticoid), their excessive production or overdose of drugs based on hormonal drugs (thyrotoxic, hypoglycemic);
Toxic coma. This type of coma is associated with exogenous (coma due to poisoning), endogenous (coma due to liver or kidney failure) intoxication, toxic infections, pancreatitis, infectious diseases;
To whom, associated with gas exchange disorders:
To whom, due to the loss of electrolytes, energy substances, and water by the body.

Certain types of comatose states cannot be classified into any group (for example, coma caused by overheating of the body), and some can be classified simultaneously into several groups (electrolyte coma with liver failure).

Coma symptoms

The rate at which coma symptoms develop varies. Coma may occur:

Suddenly. The patient suddenly loses consciousness, and in the next minutes all the signs of coma appear: disturbances in the depth and rhythm of breathing, noisy breathing, a drop in blood pressure, disturbances in the rate and rhythm of heart contractions, and the functioning of the pelvic organs;

Fast. Symptoms increase over a period of several minutes to several hours;

Gradually (slowly). In this case, precoma first develops with an increase in the symptoms of the underlying disease, against the background of which there is a gradual increase in neurological and mental disorders. A change in consciousness can manifest itself as lethargy, drowsiness, lethargy or, conversely, psychomotor agitation, hallucinations, delirium, delirium, a twilight state, which are gradually replaced by stupor and coma.

There are 4 degrees of coma:

1st degree coma. Symptoms of a coma of this severity are characterized by: stupor, sleep, inhibition of reactions; the patient can perform simple movements; its muscle tone is increased, the reaction of the pupils to light is preserved; sometimes pendulum-like movements of the eyeballs are observed; the patient's skin reflexes are sharply weakened;
2nd degree coma. Characterized by deep sleep, stupor; a sharp weakening of reactions to pain; pathological types of breathing are observed; spontaneous rare movements are chaotic; involuntary bowel movements and urination may occur; the pupils are constricted, their reaction to light is weakened; Corneal and pharyngeal reflexes are preserved, skin reflexes are absent, muscular dystonia, pyramidal reflexes, and spastic contractions are observed;
3rd degree coma. Characterized by a lack of consciousness, corneal reflexes, and reaction to pain; suppression of pharyngeal reflexes; pupils do not react to light; muscle tone and tendon reflexes are absent; blood pressure is reduced; involuntary urination and defecation, arrhythmic breathing, and decreased body temperature are observed;
4th degree coma (exorbitant). It is characterized by complete areflexia, hypothermia, muscle atony, bilateral mydriasis, profound disruption of the medulla oblongata with a sharp decrease in blood pressure and cessation of spontaneous breathing.

The prognosis of coma depends on what caused it and the severity of the damage to the brain stem.

Rapid (within 20-30 minutes) restoration of brainstem and spinal reflexes, spontaneous breathing and consciousness of the patient determines a favorable prognosis for coma. With stage 3 coma, the prognosis for the patient is usually unfavorable; The prognosis for extreme coma is absolutely unfavorable, since it is a borderline state followed by brain death.

Treatment of coma

The initial measures in the treatment of coma are: ensuring airway patency and correcting cardiovascular activity and breathing. Next, the nature of the disease that caused the development of coma is clarified, and appropriate treatment is carried out. If the coma is caused by a drug overdose, then the patient is advised to administer naloxone. For purulent meningitis, antibacterial drugs are prescribed, for epilepsy - anticonvulsants. If the diagnosis is unclear, it is advisable to administer a dextrose solution.

In addition, symptomatic and pathogenetic treatment of coma is also used. For this use:

Hyperventilation and osmotic diuretics (for intracranial hypertension);
Anticoagulants and antiplatelet agents (for acute cerebral ischemia).

Treatment is provided for common diseases that are complicated by coma: kidney and liver diseases, diabetes mellitus. If necessary, plasmapheresis, detoxification therapy, and hemosorption are prescribed.

When emerging from a coma state, the functioning of the central nervous system is gradually restored, usually in the reverse order: first, the pharyngeal and corneal reflexes are restored, then the pupillary reflexes, and the severity of autonomic disorders decreases. Consciousness is restored, going through the following stages: confusion and stupor, delirium and hallucinations, motor restlessness.

When the patient’s condition has stabilized, the underlying disease that caused the development of coma is treated, and measures to prevent possible complications are applied.

Thus, coma is a dangerous condition indicating the presence of certain diseases, injuries, circulatory disorders in the brain, and lack of oxygen in the blood; about poisoning, the impact of psychogenic factors, which, when reaching a certain degree, can lead to death.

The prognosis for the development of this condition depends on the cause that caused it, the timeliness and adequacy of the therapeutic measures taken, and the characteristics of the patient’s body.