Coma
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
- What is a "coma"?
- What is the Glasgow Coma Scale?
- What are the causes of a coma?
- Trauma
- Bleeding (Hemorrhage)
- Epidural, subdural, and subarachnoid hemorrhages
- Tumors
- Swelling
- Infection
- Lack of oxygen
- Hypoglycemic coma
- Poisons
- How is coma assessed?
- What tests are there for coma?
- What is the outcome and prognosis for a patient in a coma?
- Induced Coma
- Patient Comments: Coma - Cause
What is a "coma"?
Coma is a state of unconsciousness whereby a patient cannot react with the surrounding environment. The patient cannot be wakened with outside physical or auditory stimulation. The inability to waken differentiates coma from sleep. Patients can have different levels of unconsciousness and unresponsiveness depending upon how much or how little of the brain is functioning.
What is the Glasgow Coma Scale?
The Glasgow Coma Scale was developed to provide health-caregivers a simple way of measuring the depth of coma based upon observations of eye opening, speech, and movement. Patients in the deepest level of coma:
- do not respond with any body movement to pain,
- do not have any speech, and
- do not open their eyes.
Those in lighter comas may offer some response, to the point they may even seem wake, yet meet the criteria of coma because they do not respond to their environment.
The scale is used as part of the initial evaluation of a patient, but does not assist in making the diagnosis as to the cause of coma. Since it "scores" the level of coma, the Glasgow Coma Scale can be used as a standard method for any health-caregiver to assess change in patient status.
The best use of the Glasgow Coma Scale is to allow caregivers of different clinical skills and training to consistently assess a patient over longer periods of time in order to determine whether the patient is improving, deteriorating, or remaining the same. In the initial care of a comatose patient, there may be first responders, EMTs, paramedics, emergency physicians, neurologists, neurosurgeons, and nurses evaluating the patient. The Glasgow Coma Scale allows a standard assessment that can be shared.
| Glasgow Coma Scale | |
| Eye Opening | |
| Spontaneous | 4 |
| To loud voice | 3 |
| To pain | 2 |
| None | 1 |
| Verbal Response | |
| Oriented | 5 |
| Confused, Disoriented | 4 |
| Inappropriate words | 3 |
| Incomprehensible words | 2 |
| None | 1 |
| Motor Response | |
| Obeys commands | 6 |
| Localizes pain | 5 |
| Withdraws from pain | 4 |
| Abnormal flexion posturing | 3 |
| Extensor posturing | 2 |
| None | 1 |
A fully awake patient has a Glasgow Coma Score of 15. A person who has deceased has a Glasgow Coma Scale of 3 (there is no lower score).
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