1) A coma is an extremely altered state of consciousness where the person does not relate to ordinary reality and exhibits no voluntary movements or behaviors, even in response to painful stimuli. 2) Comas are caused by conditions that interfere with the functioning of the brain structures responsible for consciousness, such as disruptions to the physical brain architecture or changes in the brain's chemical environment from things like toxins, drugs, or metabolic disorders. 3) Treatment of a coma focuses first on maintaining respiration and circulation, and determining and treating the underlying reversible cause to end the coma state.

1. comas

2. Consciousness
Consciousness is defined by two fundamental elements.
 Awareness
• Allows one to receive and process all the information communicated by
the five senses and allows them to relate to the outside world.
 Arousal
• Regulated by physiological functioning, the involuntary responses to a
stimuli.

3. What is a coma?
• Comas are an extremely altered state
of consciousness.
• While in a coma a person does not
relate to ordinary reality.
• Also, a person in a coma exhibits no
voluntary movements or behaviors
and even painful stimuli will result in
no reaction.

4. Causes and Symptoms
 Comas are the results of something that interferes with the functioning
of the cerebral cortex and/or the functioning structures which make up
the RAS.
 There are two categories of coma conditions.
 Atomic
• Those conditions which that disrupt the normal physical architecture of the
brain structures responsible for consciousness.
 Metabolic
• Those conditions that change the chemical environment of the brain.
• Examples
 The presence or absents of certain substances that dispute the
functioning of neurons.
 Drugs or alcohol in toxic quantities
 Electrolyte disorders, inadequate glucose, acid-base disorders
 hypoxia, carbon monoxide poisoning, carbon dioxide excess

5. Diagnosis
† As in any neurological condition, the patients history must be accessed
and they must be examined; however, since the patient is not relating to
ordinary reality, their history must be obtained from family and medical
records.
† The Glasgow Coma Scale is used to examine a comatose patient. It is
helpful for evaluating the depth of the coma, tracking the patient’s
progress, and somewhat predicting the ultimate outcome of the coma.

6. The Glasgow Scale
† the scale assigns a different number of points for exam results in three
categories:
› Opening the eyes
› Verbal response
› Motor response
† Fifteen is the largest possible number of total points, indicating the
highest level of functioning.
† Three is the least possible number of total points and would be given to a
patient for whom even a painful stimuli is insufficient to provoke a
response.
† A score of 3 to 5 points often suggests that the patient is likely to have
suffered fatal brain damage.
† a score of 8 t0 15 indicates that the patient’s chances for recovery are
good.

7. Treatment
» Comas are medical emergencies
» Attention must first be directed to maintaining the patient’s respiration
and circulation.
» Then it’s on to the administration of intravenous fluids or blood and other
supportive care.
» If a head trauma hasn’t been excluded, the neck should be stabilized in
the event of a possible fracture.
» It is extremely important for a physician to determine quickly the cause of
the coma, so that potentially reversible conditions can be treated
immediately.