Coma
If you’re in a coma, you are considered to be in a prolonged state of unconsciousness. You cannot be awakened from this state nor do you respond normally to pain, light or sound. You don’t take voluntary actions, and your sleep patterns may be erratic.
Not only can comas may be induced chemically to preserve some function following some form of traumatic brain injury, but the coma can instantly happen as a direct result of the traumatic brain injury. The coma lasts for a period of time depending on the severity of the coma as well as what caused the coma.
When doctors assess a coma, they usually start with scans such as CT scans or MRIs. After pinpointing what caused the coma, spontaneous actions or response to vocal stimuli (i.e. “Can you hear me?”) are then used. Elaborate scales like the Glascow Coma Scale are used to exactly pinpoint how bad a coma is.
In 1974, Graham Teasdale and Bryan J. Jennett, neurosurgery professors at the University of Glascow (Scotland) came up with this scale with the purpose of providing an objective and reliable way of gauging the conscious state of a person with a head injury. The patient’s results are correlated against a grading scale, and the results give doctors a good indication about the severity of a traumatic brain injury.
The scale has three different tests: eye, verbal and motor. Each function has a separate numbered scale that ranges from one to six (one being the most severe and six being the mildest). Those three numbers are then combined for a final grade.
There are four grades of eye response:
- Eyes don’t open
- Eyes respond as a result of pain
- Speech causes eyes to open
- Eyes operate on their own
There are five grades of verbal response:
- No verbal response at all
- Sounds – moans, but not necessarily words
- Inappropriate words
- Patient responds to questions, but with some confusion
- Patient responds to questions coherently and appropriately
There are six grades of motor response:
- No motor response
- Extension to pain
- Abnormal flexion to pain
- Withdrawal to pain
- Localizes to pain
- Obeys commands
Individual elements of the test and the sum of the tests are important. Generally, brain injuries are classified as severe when the GCS is less than or equal to eight, moderate when the GCS is between nine and 12 and minor when the GCS is greater than or equal to 13.
Comas generally last anywhere from a few days to a few weeks. Rarely do they last more than 5 weeks, but some comas have lasted as long as several years. The longest coma on record lasted 37 years.
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