Coma and brain death
The difference between coma and brain death is that patients can recover from coma. They can't recover from brain death. Kind of like the difference between having a cold, and being Welsh.
New Onset Coma
Medical Emergency - New onset coma is an immediate reason to worry, start crying, and perhaps call a real doctor!
Causes
There are three main categories that cause new onset coma: metabolic, infective and neurological: Metabolic causes of new coma:
- Drug - Alcohol abuse, drug abuse and carbon monoxide poisoning are all good.
- Sugar - Low sugar (hypoglycaemia), or high sugar (ketoacidosis) both cause coma in diabetics.
Infective causes of new coma:
Neurological causes of new coma:
- Trauma - Head injury is a good one for putting you in a coma.
- Tumour - A brain tumour in the wrong place can cause a coma.
- Vascular - A stroke or a haemorrhagic bleed.
Management
Diagnosis
A coma is a deep state of unconciousness. Unlike sleep, they cannot wake up, respond to pain or perform voluntary actions. The most widely recognised way of diagnosing a coma is through the Glasgow Coma Scale:
Motor
- Makes no movements.
- Extension on pain
- Abnormal flexion on pain.
- Withdrawal/flexion on pain.
- Localises painful stimuli.
- Moves on command.
Verbal
- Makes no sounds.
- Makes noises.
- Makes words, but no sense.
- Confused conversation.
- Normal conversation.
Eyes
- Does not open eyes.
- Opens eyes to pain.
- Opens eyes to voice.
- Opens eyes spontaneously.
Score Your score is out of 15.
- <9. Well done! You have a severe coma.
- 9-12. You have a moderate coma. With a little work, you may still make it!
- >13. Sorry, you only have a mild problem. Maybe try another bottle of whisky?