3 degree coma consequences. What is a coma and how to get a person out of it. Exit from a coma

Intoxication, stroke and many other causes can lead to pathological inhibition of the central nervous system and the development of coma. The condition in which the patient balances between life and death is called a coma of the 3rd degree. The development of a coma can be caused by various factors. The first place is occupied by direct damage to the brain tissue in stroke, trauma, infectious process,.

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

Damage to the nervous system is based on bilateral diffuse damage to the cortex and brain stem with a 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 may develop after trauma, acute disorders 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: the development of hyper- or hypoglycemia, with hypothyroidism, thyrotoxicosis;
hypoxic coma occurs with diseases of the heart and blood vessels, anemia;
damage by physical factors (temperature, electric shock);
coma from dehydration or starvation.

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

Coma symptoms

A coma can develop within hours or days. The severity determines the clinical manifestations. The period of time before a coma (precoma) depends on the underlying disease. The patient develops confusion, lethargy or mental agitation, impaired coordination of movements.

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

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

Then comes a coma of the third degree. Body temperature drops, reflexes are inhibited, the reaction to painful stimuli disappears. Pupils do not react to light, consciousness is absent.

4 degree is called transcendental: life is maintained with the help of an artificial respiration apparatus. A state close to terminal develops, the outcome is death.

Prognosis for survival in grade 3 coma

What is a coma of 3 degrees cannot be answered unambiguously. Her condition is often compared to clinical death, it is like a deep sleep without dreams. And not always a coma of the 3rd degree has favorable forecasts. According to statistics, only 4% of people get out of this state, but subsequently remain disabled. Life threatening indicators 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's pupil reaction and response to stimuli and pain disappear, then there is no chance of getting out of a grade 3 coma, the prognosis is fatal. Survival is influenced by the initial level of health, the amount of associated injuries and the reason why the coma developed.

Coma after stroke

Violations of cerebral circulation can cause blockage by a blood clot of a vessel or its rupture. can cause grade 3 coma. The chances of survival depend on the size of the lesion and the age of the patient. 1 and 2 degree more often ends with the restoration of functions. Convulsions, hypothermia, lack of spontaneous respiration, and pupillary responses are unfavorable symptoms.

Coma after injury

Severe head injuries after road accidents, falls from a height, and blows with a blunt object lead to the rapid development of coma. The patient's condition is affected by concomitant damage to internal organs, blood loss. Reduce the chances of getting out of a coma fracture of the base of the skull, vault, temporal bones, damage to blood vessels, swelling of the brain, a high degree of brain contusion.

hepatic coma

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

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

Hepatic-renal syndrome often develops, kidney failure, oliguria joins. The immune system is weakened and sepsis may develop. The prognosis for such patients is extremely unfavorable.

Disability criteria 3 groups

After leaving a coma of the 3rd degree, a person remains disabled. The law determines who is entitled to the 3rd group of disability. These are people with such a state of health who cannot work, with reduced vital activity, the need for help and support from social authorities.

Disorders of the main functions are considered:

functions of speech and language;
blood circulation;
sensory;
psyche;
physical;
static-dynamic.

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 skull defects or a foreign body in the brain;
violation of the functioning of the pelvic organs.

Those who are given the 3rd group of disability are examined by the commission every year and provide it with a rehabilitation program. For sick pensioners, the group is assigned indefinitely and re-examination is not carried out.

All reviews

For any person who does not even have anything to do with medicine and does not encounter the nuances of such a diagnosis as a coma, this word sounds intimidating.

The state in which the person is comatose, dangerous for the person himself and very scary for loved ones, because. the process of coming out of a coma is always unpredictable. Even doctors can never be sure when a person will come out of a coma, or if he can come out at all.

Medically, stay in a coma characterized by the unconscious state of the patient, in which there are no reactions to external stimuli. Some compare this state to sleep, but this is not at all the case. The brain of a person in a coma functions at the most extreme level of vigilance.

Length of stay in a coma may vary from a few days to significant and prolonged periods of unconsciousness. Most often, the coma lasts for several weeks. However, there are cases in history when people were in a coma for several years.

Cause of coma almost always precedes coma, traumatism. Head injuries, brain damage, stroke, severe drug poisoning, exposure to drugs and even alcohol are often the source of a person falling into a coma. People react differently to various external negative influences. That is why for different people the duration of stay in a coma can differ even with the same reasons for its occurrence.

In medicine, there are several types of coma, depending on the duration of stay in it and the degree of impact on the basic functions of life.

Coma is deep - this is the most dangerous variety, in which a person does not react in any way to any external stimuli (voice, tactile touch). In such a patient, the activity of any life support system may also stop or be superficially carried out. So, often the patient cannot breathe on his own, then he is connected to an artificial respiration apparatus. Nutrients necessary for normal life are introduced into the body intravenously.

Another type of coma is characterized by the possibility of a person's partial reaction to the voice, external stimuli. Sometimes the patient can even make some incoherent sounds, make minor movements, open his eyes. Such a coma, although less deep than the first type, nevertheless poses a significant threat to human life. The longer a person stays in this state, the more negative consequences may be in the future.

The third type of coma is superficial coma, which, based on its name, is characterized by a shorter duration. Such a coma can last only a couple of hours. In addition, in a state of superficial coma, a person has a reaction to the external environment, of course, unconscious. The patient can open his eyes, even answer some questions.

For a person in a state of coma, special care is important, such a patient must constantly be under the supervision of a doctor in order to be able to track the slightest changes in the patient's condition and respond in a timely manner.

Exit from a coma always very complex and prolonged, even when there is a superficial coma. A person gradually and slowly comes to his senses. Partially and temporarily, the ability to speak, see, and adequately respond to an external reaction initially returns to him. Then the patient can again fall into a state of deep sleep. Only after months, and sometimes even years of rehabilitation, a full-fledged life activity returns to a person.

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MY SON IS IN A COMA AFTER MAY 2 AFTER SURGERY. HEAVY BRAIN INJURY WITH COMPRESSION BY ACUTE EPIDURAL HEMATOMA OF THE RIGHT HEMISPHERE. PNEUMOCEPHALIA. DISLOCATION SYNDROME.COMA ON MAY 1.4 OF DECOMPRESSIVE CRANIECTOMY..REMOVAL OF EPIDURAL HEMATOMA OF THE RIGHT PARETIOL-TEMPORAL REGION.TRACHEOSCOMA.MAY 3 WAS OUT OF A COMA BUT THE CONDITION WORSE AGAIN.

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From a medical point of view, an artificial coma is an unconscious state into which a person is introduced for a certain time. In this case, there is a deep inhibition of the activity of the subcortex and the brain, a complete shutdown of all reflexes.

This measure is justified in the case when doctors see no other way to stop irreversible changes that threaten life. These include compression effects, hemorrhages and bleeding.

If the patient is going to have a major operation or complex surgery, a coma can replace general anesthesia.

If the patient is put into a drug-induced coma, the metabolism of brain tissues slows down and the intensity of blood flow decreases. The introduction into a coma should be carried out only in intensive care units and intensive care units, under the constant supervision of doctors. Drugs that depress the central system are used - barbiturates and their derivatives. Doses are selected individually and correspond to the stage of surgical anesthesia.

The symptoms of drug coma are as follows:

immobilization and complete relaxation of muscles; unconscious state, absence of all reflexes; body temperature drops; blood pressure decreases; heart rate decreases: atrioventricular conduction slows down; the work of the gastrointestinal tract is blocked.

This condition causes oxygen deficiency, so the patient is immediately connected to a ventilator - a respiratory mixture of oxygen and dried air is supplied. Due to this, carbon dioxide leaves the lungs, and the blood is saturated with oxygen.

The duration of medical, or artificial, coma may vary. When the patient is in this state, all vital signs are recorded on special equipment. They are constantly monitored by specialists and an anesthesiologist.

To date, several methods are used for this purpose. First of all, with the help of encephalography, the activity of the cerebral cortex is monitored. The patient is connected to this device permanently.

Cerebral blood flow is measured using the following methods:

local laser flowmetry, when a sensor is inserted into the brain tissue; radioisotope measurement of blood circulation.

A ventricular catheter is placed to measure intracranial pressure. Periodically, it is necessary to take a blood test from the patient from the jugular vein to avoid cerebral edema.

For diagnosis, the following imaging methods are used:

computed tomography; magnetic resonance imaging: positron emission computed tomography.

It is very difficult to say when a coma can be considered hopeless. Experts are still debating about this. In many Western countries, it is believed that the patient has no chance of recovery if the vegetative state continues for more than six months. This takes into account other factors: a clinical assessment of the general condition, the causes of the syndrome.

It is important to understand that an artificial coma is not a disease. It is a cycle of targeted actions to ensure that patients are brought into coma due to medical conditions, such as stroke or pneumonia.

The duration of the coma depends on the nature and severity of the disease. This period can range from several days to several months. The conclusion from this state can be carried out only after the cause and signs of the disease have been eliminated.

Before this, a comprehensive examination of the patient is necessarily carried out, his condition is determined.

Neurosurgeons believe that the consequences that may be after a drug-induced coma depend on the reason that became the basis for entering a person into this state. IVL has many side effects. Complications can go to the respiratory system, which will provoke the development of tracheobronchitis, pneumonia, stenosis, and there is also a possibility of fistula formation in the walls of the esophagus.

Due to medical coma, consequences such as impaired blood flow, pathological changes in the functionality of the gastrointestinal tract, which has not worked for a long time, and renal failure can occur. It is not uncommon for a patient to develop neurological disorders after leaving this state.

A stroke provokes brain damage, and irreversible consequences can occur in a matter of hours. To reduce the risk and carry out the removal of a blood clot, a person is put into a state of artificial coma.

But this method of treating certain diseases is quite dangerous.

The saddest prognosis can be with subarachnoid hemorrhage. It occurs as a result of TBI or rupture of an arterial aneurysm, with a stroke. The shorter the period of being in a coma, the greater the patient's chances to recover.

Of course, this method of treatment is risky, but a successful outcome is not uncommon. After such anesthesia, a person will have a long period of rehabilitation. To restore all the functions of the body, time must pass. Some people manage to return to normal within a year, others take a little longer. During the rehabilitation period, it is imperative to undergo a comprehensive examination and follow all the doctor's prescriptions.

The most common complications after a coma can be the following:

brain damage of a different nature; respiratory disorders; pulmonary edema; jumps in blood pressure; heart failure.

Such complications can cause first clinical and then biological death. Vomiting is no less dangerous - masses can enter the respiratory tract. Urinary retention can lead to bladder rupture and peritonitis.

People can stay in this state for a very long time. Modern equipment makes it possible to maintain vital functions. But is it advisable?

To answer this question, it is necessary to take into account not only the state of the brain, but also many factors: is it possible to care for the patient, how high is the quality of medical supervision.

No less important is the moral side of this issue. Sometimes a real war breaks out between medical personnel and relatives.

To understand whether it makes sense to save the patient's life, you need to take into account his age, the reasons that caused the coma and many other factors.

Stroke is a dangerous disease - every year about 5.7 million people around the world die from acute cerebrovascular accident. Causing numerous disturbances in the functioning of the brain, the disease often leaves many negative consequences. A severe complication of a stroke is coma - a condition in which the central nervous system is depressed, the regulation of the most important functions of the body is disrupted, consciousness is completely absent, the patient does not respond to any, even very intense stimuli.

One of the complications of a stroke is coma.

The mechanism of development of coma in stroke

The correct functioning of the central nervous system depends on the fullness and continuity of the delivery of oxygen and glucose from the blood to the brain tissues. In a stroke, as a result of blockage or rupture of a vessel, a violation of cerebral blood flow occurs, the delivery of energy substances to the most important centers of regulation of vital processes is difficult or even stops. In the absence of oxygen and glucose, the brain can work for 2 minutes, while consciousness is lost after 10-15 seconds. Hypoxia has a detrimental effect on neuronal connections in the brain, causing their death, metabolites and sodium ions accumulate in the tissues, which leads to the accumulation of intracellular fluid, cerebral edema, increased intracranial pressure, and impaired water and electrolyte balance. All these pathological changes lead to the development of coma, which in stroke is cerebrovascular in nature.

Characteristics of coma after a stroke

The main question that worries the relatives of a patient who is in a coma after a stroke is how many days or weeks this condition can last, and what are the chances of a full recovery after leaving the coma.

Unfortunately, the forecasts of experts are disappointing - the chance for a full life for a person who has fallen into a deep coma is very small. Of great importance is also how long the patient was unconscious. For example, in a coma that lasts more than 4 months, the chances of recovery are only 15%.

In isolated cases, patients woke up several years after falling into a coma.

The duration of the coma largely depends on its depth and the degree of damage to the brain structures:

The first degree is characterized by pronounced lethargy of the patient, confusion, inhibited reaction to external stimuli, even quite strong ones. The patient is able to follow simple commands, he can change his position in bed, the swallowing reflex is preserved. A patient in a first-degree coma has increased muscle tone. Quite often such patients hardly make contact. The exit from this state occurs quite quickly, within the first 3 hours after a stroke. After awakening, a person may experience severe drowsiness and lethargy, but a repeated incident rarely occurs. As a rule, this condition has a favorable prognosis, with proper rehabilitation, recovery can be very fast. The second degree of coma after a stroke is the onset of deep sleep. The patient's consciousness is depressed, it is impossible to establish contact with the patient. The reaction to painful stimuli is sharply weakened, all muscle movements are spontaneous and uncontrollable. The function of breathing also suffers - it can be superficial and frequent. Coma of the second degree can last from several tens of hours to 2-3 days, how much depends on the characteristics of the disease. The chances of a full recovery remain. The third degree is characterized by a complete lack of consciousness and reaction to stimuli. There is a suppression of the swallowing reflex, the pupils do not react to light. Muscle tone is significantly reduced, the development of a convulsive seizure is possible. Third-degree coma is accompanied by a drop in blood pressure to critical values, a sharp drop in body temperature, and inhibition of vital functions. Such a condition can last from several days to several months, the exit occurs in rare cases, there may be no chance of recovery. The fourth or transcendent stage of coma is combined with a complete absence of reflexes, muscle atony, hypothermia, respiratory arrest and heart rhythm disturbance. Most of the brain is affected, so recovery is not possible.

After falling into a coma, a person can be unconscious from several hours to several days, most often 2-3 days. Sometimes the patient may fall into a vegetative state, in which the function of the cerebral cortex is disturbed and the person loses the ability to carry out higher nervous activity, while the basic functions of life are preserved. The longer the unconscious state persists, the less likely it is to fully recover. It is very difficult to predict how long this will last.

How to recognize the onset of a coma?

The duration of being in an unconscious state can be reduced if the symptoms of an impending coma are recognized in time. Signs of a stroke followed by the development of coma are:

Incoherent speech, confused consciousness, delirium. Facial expression. A few minutes after the first signs of a stroke, the patient stops responding to stimuli, vomiting, spontaneous urination and defecation are possible. There is numbness of the limbs on one or both sides, which gradually develops into paralysis. The pulse slows down, breathing becomes frequent and superficial, the skin turns pale.

With ischemic stroke, the gradual development of coma is often observed.

In some cases, the increase in symptoms can occur very slowly, within a few days after the onset of the first signs of a stroke, so it is important to monitor the patient's condition around the clock during the first 2-3 days after the stroke.

Factors contributing to the prolongation of coma

It is known that the duration of the coma is affected by the extent of the lesion, but there are factors that can lengthen the period of being in an unconscious state.

These include:

The presence of a transient ischemic attack or a complete stroke in history. The patient's age is over 65 years. The presence of concomitant diseases, especially diabetes mellitus and cardiovascular pathologies. Incorrect first aid. How does the coma come out?

The exit from a coma is characterized by a gradual restoration of the functions of the central nervous system

The exit from the coma occurs gradually, with a slow restoration of lost functions. The return sequence is as follows:

Reflexes are muscular, skin, pharyngeal. Movements of fingers, limbs. The ability to make sounds, individual words. Recovery of vision. Memory recovery. Ability to sit and walk appears.

Many factors influence how many hours or days a coma lasts, including the speed of first aid. It is important to recognize the onset of a stroke in time and call an ambulance in time.

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People who are in deep sleep cannot make decisions, and therefore this heavy responsibility falls on the shoulders of their next of kin. To understand what to do in such a situation, you need to know what a coma is, how you can get a person out of it and what are its consequences. We'll talk about this.

What is a coma and why can people enter this state?

Coma is a severe coma, in which a person is immersed in a deep sleep. Depending on what degree of coma the patient has, various functions of the body can be slowed down, brain activity is turned off, metabolism is completely stopped or significantly slowed down, the functioning of the nervous system.

The cause of whom can be: stroke, brain injury, meningitis, epilepsy, encephalitis, hypothermia or overheating of the body.

Are there coma qualifications?

Coma is conditionally divided into 5 degrees of severity, namely:

1 degree - precoma. Those who have been affected by this gradually begin to experience general lethargy, a drop in reaction, a feeling of drowsiness, lack of sleep, and confusion in consciousness. Rarely, but still it happens that everything happens the other way around, in excessive excitement. Reflexes at this stage are preserved, while the work of all internal organs is already inhibited. Sometimes precoma is called nothing more than a state before a coma, and is not referred to as a coma at all.
Grade 2 - the initial level of severity. They begin to slow down reactions to external stimuli. A person still retains the ability to swallow liquid food and water, he can move his limbs, but only slightly.
Grade 3 - medium severity. The patient is already entering a state of deep sleep, contact with him becomes impossible. Only sometimes movements of the limbs can be observed, but rarely they are realized. The skin already has low sensitivity, a person walks under himself.
4 degree - high level of severity. There is a lack of pain, consciousness, tendon reflexes, no reaction to light. Reduced not only body temperature but also the pressure with breathing.
Grade 5 - severe coma. Violation of consciousness becomes deep, reflexes are absent. There is a cessation of breathing and the patient is transferred to the artificial respiration apparatus.

By what signs to recognize whom?

Only specialists can recognize who. For these purposes, they conduct the following studies:

The level of alcohol in the blood is determined to exclude alcohol intoxication, in which consciousness can be turned off for a while.
Determine the presence of drugs in the blood to exclude drug syncope.
Conduct an electrocardiogram.

These are only general studies, special ones can be prescribed by doctors if necessary.

How long can a person stay in a coma?

Doctors still cannot answer the question of how long people can be in a coma. The thing is that history knows cases when, after 12 years, people managed to get out of a coma. This is purely individual and one can get out of this state in three days, and someone will spend years of his life in it.

How does a person feel when in a coma?

The reactions have already been mentioned earlier, depending on the severity, a person may feel touch, or may not feel it. All people who survived who claim that they heard everything that happened around them, but could not understand whether it was a dream or reality.

Doctors also say that when relatives often communicate with patients in a coma, they begin active activity in the area of \u200b\u200bthe brain responsible for face recognition. Also, active impulses appear in the centers responsible for emotions.

Someone claims to have met with deceased relatives, all this happens in patients in a state of sleep, in which, as you know, anything can happen.

How can a person be brought out of a coma?

Unfortunately, there is no answer to the question of interest to everyone “how to get a loved one out of a coma”, today. All that doctors advise is to talk to a person, hold his hand, let him listen to music, read books. Sometimes some sound or phrase contributes to the fact that a person, grabbing it like a string, comes out of a coma.

How do they get out of it?

The exit from the coma occurs gradually. At first, a person can wake up for a couple of minutes, look around and fall back into a dream. An hour or two will pass, and he will wake up again, and this happens several times.

At this moment, a person will need the help of loved ones more than ever, everything around him will be alien to him, and he, as if a child, will begin to learn to walk and talk again.

Are there any consequences?

Due to the fact that a coma is characterized by brain damage, it must be understood that it will take time to restore some functions. For rehabilitation, special developing simulators will be required.

Memory problems, up to amnesia, can be attributed directly to the consequences. There may be lethargy, absent-mindedness, aggressiveness. Do not be afraid, all this is recoverable, you just need time and patience. A person may have lost everyday skills, so he will need to be taught everything again. It is easy to understand what consequences await those who have spent more than five years in a coma, during this time much has changed around and then a person needs to be introduced to everything around.

A coma is certainly scary, but if your loved ones got into it, you don’t need to give up, because people get out of it, and after that they begin to live their old life again, albeit not immediately.

How many people can be in a coma

The problem of coma today has gone beyond the scope of medicine. Is it worth supporting the life of a person who cannot communicate with the outside world? How to determine how deep he has “gone”, does he hear what is happening around, does he experience emotions, or is he in a “vegetative” state in which he can no longer be helped?

Considering that the possibility of euthanasia (voluntary departure from the life of terminally ill patients) is widely discussed in the world today, and in some countries it has already been resolved, the issue of distinguishing between such conditions in order to determine the hopelessness of the patient or the prospects for a cure is of particular importance.

deep sleep, drowsiness

To talk on this topic, of course, you first need to tell in more detail what, in fact, a coma, what are its causes, duration, in which cases there is hope for a way out of a coma, and in which not. The topic of hope for recovery is especially important to us, because today the views on its criteria are changing.

So, coma (Greek koma - deep sleep, drowsiness) is a life-threatening condition in which a person loses consciousness, shows little or no reaction at all to external stimuli. His reflexes fade until they disappear completely, the depth and frequency of breathing are disturbed, vascular tone changes, the pulse quickens or slows down, and the temperature regulation regime is disturbed.

The causes of this condition may be different, but they all lead to deep inhibition in the cerebral cortex with its spread to the subcortex and the underlying parts of the central nervous system. This can occur due to acute circulatory disorders in the brain, head injuries, any inflammation (with encephalitis, meningitis, malaria), as a result of poisoning (by barbiturates, carbon monoxide, etc.), as well as diabetes mellitus, uremia, hepatitis.

As a rule, a coma is preceded by a so-called pre-coma state, during which a person develops symptoms of deep inhibition in the cerebral cortex, and along the way, acid-base balance disorders in the nervous tissue, oxygen starvation, ion exchange disorders and energy starvation of nerve cells occur.

The insidiousness of a coma is that it can last only a few hours, or maybe several months, and even years. It is the duration of the coma that differs from fainting, which usually lasts for several minutes.

It is often quite difficult for doctors to find out the cause of a coma. As a rule, it is judged by the rate of development of the disease. For example, a coma suddenly develops after acute vascular disorders of the brain, but the gradual “extinction” of a person is characteristic of infectious lesions, the symptoms of a coma increase even more slowly with endogenous (internal) intoxications in diabetes, kidney and liver diseases.

For doctors dealing with people who have fallen into a coma, there are many nuances by which they determine the exact diagnosis of "coma". After all, there are other conditions with similar symptoms. For example, the “locked-in syndrome”, when a person cannot respond to external stimuli due to paralysis of the bulbar, facial and chewing muscles, which usually occurs as a result of damage to such a brain structure as the base of the pons. The patient can move only the eyeballs, while being fully conscious.

In turn, such patients are similar to patients with akinetic mutism, who are also conscious and able to follow moving objects with their eyes, but cannot move due to organic lesions (trauma, vascular accidents, tumors) of some parts of the brain. Thus, until now, one of the differences between these diagnoses and coma is considered to be the presence of consciousness. But today, these criteria may be shaken, and below we will explain why.

Exit from a coma and further prognosis

Not all patients, alas, come out of a coma. Sometimes, if this condition drags on and the brain damage is so severe that there is no hope for recovery, doctors, together with the patient's relatives, decide on the issue of disconnecting him from life support systems. Sometimes a person comes out of a coma, but falls into the so-called chronic vegetative state, in which only wakefulness is restored, and all cognitive functions are lost. He sleeps and wakes up, breathes on his own, his heart and other organs function normally, but at the same time he lacks movement, speech and reaction to verbal stimuli. This condition can last for months or even years, but the prognosis is unfavorable - as a rule, as a result, the patient dies from infections or bedsores. The cause of the vegetative state is a massive lesion of the forebrain, often in the complete death of the cerebral cortex. This condition also serves as a reason to turn off the devices.

But there are still chances for patients in a coma. With proper treatment and a favorable prognosis, a person can come out of a coma. The functions of the central nervous system are gradually restored - reflexes, vegetative functions. Interestingly, as a rule, their restoration occurs in the reverse order of oppression. Quite often, the recovery of consciousness occurs through confusion and even delirium, accompanied by discoordinated movements and, less often, convulsions. Even if the ability to think, speak and move returns to a person, it is very important how well they looked after him during a coma, because immobility can lead to muscle atrophy and bedsores, which requires additional treatment.

Unfortunately, in Russia today the level of care provided to patients in a coma and vegetative state is not at the proper level. This is the opinion of Sergei Efremenko, a doctor who has been dealing with such patients for many years, the head of the resuscitation and intensive care unit for neurosurgical patients at the N.V. Sklifosovsky Research Institute for Emergency Medicine. According to him, this level shows, firstly, the moral state of society, and secondly, the level of development of medicine. “Unfortunately, - says Efremenko, - in our country today there is not a single medical institution that is specialized in the treatment of such patients. In the majority of cases, patients in vegetative states are doomed to a painful death, unable to live to see a possible improvement in their condition, while bringing unbearable suffering to their loved ones.

Happy examples of coming out of a coma

It is impossible not to say that history knows many happy examples of a person coming out of a long coma and in some cases even returning him to a normal life. Although most of these cases did not occur in Russia, but abroad.

For example, in 2003, American Terry Wallis woke up after 19 years of being in a coma after being injured in a car accident. In 2005, American firefighter Don Herbert came out of a 10-year coma following his 12-minute stay in a blockage without air. In 2007, Polish citizen Jan Grzebski woke up after 18 years in a coma. He suffered after he got into a train accident. Thanks to the departure of his wife, he got out of this state without muscle atrophy and bedsores and ... learned that now all his four children were married and married, and that he now has 11 grandchildren. And finally, Zhao Guihua, a Chinese woman who had been in a coma for 30 years, woke up in November 2008. Her husband was selflessly next to her bed and, in addition to caring for her, maintained constant verbal contact - told her about recent events and spoke affectionate words of love and support. And, quite possibly, this was precisely what was of key importance - as recent studies have shown, many of these patients retain the ability to hear and be aware of what they hear. And this can radically change the current opinion that a person in a coma is a person who has lost consciousness.

New opportunities for contact with a person in a coma

In general, the problem of coma, no doubt, requires careful study, because the price of a mistake here is too high. Turning off life support systems in accordance with the desire of the patient himself (in countries where euthanasia is allowed, each person can make such a request in advance) or, with the consent of his relatives, can take the life of a person who might soon come to his senses. Moreover, the attitude of most people and the doctors themselves around the world to the possibility of euthanasia is negative.

For example, Dr. Efremenko is deeply convinced that the problem of coma, incurable conditions should not be linked with the problem of euthanasia, since it abhors the moral principles of any doctor and opposes the main message of healing “Non nocere” - “do no harm”. "The probability of error, even if it is one millionth of a percent, can also occur," says the doctor. He recalls that Orthodoxy is the titular religion of our country, and its canons categorically reject both murder and suicide. Only God is in control of our lives, as well as our suffering. However, this also applies to other religions, Efremenko adds.

This complex question is all the more relevant given that recent studies have confirmed that 30% of patients in a coma actually show signs of consciousness. A new brain-computer interface helped determine this, with the help of which scientists were able to look into the previously inaccessible depths of the brain of an immobilized and seemingly detached person from reality.

The study, organized by the German-Belgian Group for the Study of Coma States under the leadership of Professor Stephen Loris, was built using a computer, a special program of which read the results of the encephalograms of two groups - patients in a coma and healthy people from the control group. Encephalograms were obtained when the subjects answered simple questions, where everyone had to choose the correct answer using simple words “yes”, “no”, “forward” and “stop”. The real sensation was that three out of ten people who were in a coma answered most of the questions correctly! This meant that doctors today do not know everything about the nuances of this condition, and that in the future they have a chance, with the help of established contact with such patients, not only to make an accurate diagnosis and calculate the chances of recovery, but also to find out from them what they are. need and are satisfied with the care.

The results of this promising study were presented at the annual conference of the European Neurological Society (ENS) and are highly acclaimed by scientists from around the world.

How do our Russian doctors regard such studies? We finally asked Dr. Efremenko about this. “In the study of coma and vegetative states, science still stands only on the shores of a boundless ocean of knowledge,” he noted. We haven't even wet our feet yet. Only when we get comprehensive and accurate information about coma and vegetative states, we will really be able to make any decisions about the fate of patients.”

IA No. FS77-55373 dated September 17, 2013, issued by the Federal Service for Supervision of Communications, Information Technology and Mass Media (Roskomnadzor). Founder: PRAVDA.Ru LLC

How long can a person be in a coma?

Until he dies, and this, with proper use, can last up to ten years or longer. But usually during this time a person gets cold, bedsores start, sepsis and sun.

There have been cases where people have been in a coma for years. The record term is 42 years. Eduard Obar was in a coma for so many years, who fell into a coma at the age of 16, and all this time she was looked after first by her mother, and then by her sister. She did not regain consciousness and died.

And there is a case when a person, after 19 years of being in a coma, came to himself. I wrote about it in the answer to this question, I will not repeat it. This is also a record.

A person, if he cannot breathe on his own, will be in a coma as long as he is connected to life support devices and until his brain is dead. If he can breathe on his own, can swallow, and is in a more or less stable condition, he will be in a coma until someone cares for him or until he dies from some concomitant disease of an immobile lifestyle, such as pneumonia. . Or until you regain consciousness.

Diagnosis of coma in stroke: how many days does the condition last?

A stroke is a violation of blood circulation in the brain, provoking a loss of consciousness. No doctor will give an exact answer to the question of a coma during a stroke for how many days: a lot depends on the patient’s state of health, on the causes that caused the stroke, on the time when the first medical aid was provided, etc.

Experts distinguish two types of stroke:

ischemic: the formation of a blood clot (blood clot) that caused blockage of blood vessels;
hemorrhagic: rupture of the vessel, causing bleeding in the brain.

A stroke causes a violation of blood circulation, which leads to extensive damage to brain tissue. In half of the cases, cardiac arrest occurs, in other situations, the patient falls into a coma.

The exact reasons why a person is struck by a stroke have not yet been established. The risk of occurrence is increased by high blood pressure, atherosclerosis, intoxication, and blood diseases. Hemorrhagic stroke can occur in a state of strong emotional overexcitation (overstrain). The reason is high blood pressure, which increases the risk of rupture of cerebral vessels.

A stroke can strike a person suddenly (in 10 minutes). In other cases, stroke symptoms may last for several days.

Signs that may precede a stroke:

severe dizziness, headaches;
visual impairment;
weakness;
violation (loss) of speech;
partial memory loss (including inability to think logically);
feeling of numbness or tingling in various parts of the body, paralysis;
pallor;
frequent breathing.

If a person has these symptoms, they should seek help immediately. A coma can occur when a person loses consciousness. More often this happens as a result of hemorrhagic stroke, 90% of cases are fatal. If a person has suffered two strokes in a row, the likelihood that he will come out of a coma is extremely small. The chances of surviving a coma decrease in the elderly.

Coma after a stroke can last from an hour to 10 days. However, a person can be in this state from several months to several years. It is impossible to predict how long this period will last.

Coma is the state of a person who has lost consciousness, as a result of which the functioning of the central nervous and physiological systems has been disrupted.

Doctors distinguish four degrees of coma:

First degree (precoma). The patient has minor brain damage, his consciousness is confused, there is a slow reaction to external stimuli, reflexes are preserved. In this case, the prognosis is encouraging;

Second degree. The patient has a deep sleep, there are no skin reflexes, noisy, intermittent breathing, uncontrolled spontaneous muscle movements, uncontrolled bowel movements (urination, defecation) are observed;

Third degree (atonic form). The patient has a complete loss of consciousness, there is no swallowing reflex (there is a need for tube feeding), blood pressure and body temperature decrease;

Fourth degree (extraordinary form). Most of the patient's brain is not subject to recovery, there are serious disturbances in the brain. There is no breathing (the patient is connected to life support devices), hypothermia is observed. This degree of coma is considered incomparable with life, so the patient has practically no chance of recovery.

When a person is in a coma, the doctor prescribes a life-sustaining treatment. The patient's condition is confirmed by tests. There are a number of factors that determine the chances of coming out of a coma:

site of stroke
causes of stroke
the severity of the coma;
the degree of brain damage;
efficiency of medical care;
the state of the patient's body.

Factors that reduce these chances:

coma after a second stroke;
convulsions for more than two days;
elderly patient (over 70 years old);
dysfunction of the brain stem;
tomography showed serious violations of brain activity.

The longer the coma continues, the more difficult the rehabilitation period will be.

If a person has a massive stroke, death can occur on the 3rd day after the onset of a severe coma due to cerebral edema or damage to the nerve centers.

The coma is reversible. Even in the most difficult stages, the patient has a chance to recover. If a person is conscious and can already move his fingers, the doctor puts an encouraging prognosis.

In a patient who has undergone a coma, in the first place, swallowing and skin reflexes are restored. Then there are improvements in muscle activity: the person can move their fingers and toes. Lastly, consciousness and speech are restored.

After a coma, brain cells are damaged, some of them cannot be restored. If a person has suffered a first-degree coma, this does not mean that he will be able to fully recover: full recovery is observed only in 10% of cases. If the patient succeeds in regaining consciousness after a third-degree coma, he may experience numerous physical and mental abnormalities. Most patients after coming out of a coma cannot continue a normal life: they remain disabled. The patient's memory is impaired. There is a danger of thinking inadequately. After such a period, a person can change a lot: to relatives, he may seem like a stranger.

If a patient manages to regain consciousness after experiencing a coma after a stroke, it will take him a long time to restore brain activity. The patient is given a tomography to find out exactly which areas of the brain have been affected by a stroke. After that, doctors refer him to inpatient treatment, followed by rehabilitation in a special institution.

The rehabilitation period lasts several weeks, sometimes several months. The prognosis depends on each individual situation. After discharge from the hospital, the patient will have to work on himself for a long time in order to fully recover. Many patients learn to eat, go to the toilet, and talk again.

Doctors' diagnosis is not always correct when the patient is unconscious. It is impossible to say how long a person will stay in a coma, how long he will need to recover, if he survived this condition. Sometimes doctors make an unfavorable diagnosis, and the patient, on the contrary, comes out of a coma and recovers quickly. This is due to the fact that the state of coma has not yet been fully studied. Therefore, even at the most difficult stages, the patient has a chance for rehabilitation.

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Life without consciousness. How long can a coma last?

The girl woke up after 7 years of coma. Is there a chance to return to a full life in such patients?

In 2009, 17-year-old Daniela Kovacevic from Serbia suffered blood poisoning during childbirth. She fell into a coma, and her recovery from a coma after 7 years, doctors do not call it anything other than a miracle. After active therapy, the girl can move around (so far with the help of outsiders), hold a pen in her hands. And those who are on duty near the bedside of the sick, who are in a coma, have a hope that the same miracle can happen to their loved ones.

General is not with us yet

More than 3 years ago, Maria Konchalovsky, the daughter of director Andron Konchalovsky, was in a coma. In October 2013, the Konchalovsky family had a serious accident in France. The director and his wife, Yulia Vysotskaya, escaped with minor bruises thanks to deployed airbags. And the girl, who was not wearing a seat belt, received a severe head injury. Doctors saved the child's life, but warned that the recovery would be long. Alas, their prediction came true. The girl's rehabilitation continues.

For 21 years, the rehabilitation of Colonel-General Anatoly Romanov, commander of the united group of federal troops in Chechnya, has continued. On October 6, 1995, his car was blown up in a tunnel in Grozny. Romanov was collected literally piece by piece. Thanks to the efforts of doctors, after 18 days, the general opened his eyes and began to respond to light, movement and touch. But the patient is still not aware of what is happening around him. What methods were not used by doctors to “break through” into his mind. For 14 years, the general was treated at the Burdenko hospital. Then he was transferred to the Moscow region hospital of internal troops. But while this strong and courageous man, as the doctors say, is in a state of minimal consciousness.

Life with a clean slate

Until now, only one case is known when the patient managed to return to a full life after a long coma. On June 12, 1984, Terry Wallace from Arkansas, after drinking heavily, went for a ride with a friend. The car went off the cliff. A friend died, Wallace fell into a coma. A month later, he went into a vegetative state, in which he remained for almost 20 years. In 2003, he suddenly uttered two words: "Pepsi-Cola" and "mom." After conducting an MRI study, scientists discovered that the incredible happened: the brain repaired itself, growing new structures to replace the affected ones. For 20 years of immobility, all the muscles atrophied in Wallace and he lost the simplest self-care skills. He also did not remember anything about the accident or the events of the past years. In fact, he had to start life from scratch. However, the example of this man still inspires hope in those who continue the struggle for the return of their loved ones to normal life.

Mikhail Piradov, Academician of the Russian Academy of Sciences, Director of the Scientific Center for Neurology:

From the point of view of pathophysiology, any coma ends no later than 4 weeks after its onset (if the patient has not died). There are options for getting out of a coma: a transition to consciousness, a vegetative state (the patient opens his eyes, breathes on his own, the sleep-wake cycle is restored, consciousness is absent), a state of minimal consciousness. The vegetative state is considered permanent if it lasts (according to various criteria) from 3-6 months to a year. In my long practice, I have not seen a single patient who would come out of a vegetative state without loss. The prognosis for each individual patient depends on many factors, the main of which are the nature and nature of the injuries received. The most favorable prognosis is usually for patients with metabolic (eg, diabetic) coma. If resuscitation care was provided competently and in a timely manner, such patients come out of a coma fairly quickly and often without any loss. However, there have always been, are and will be patients with severe brain damage, which is very difficult to help even with the highest level of resuscitation and rehabilitation. The worst prognosis is in coma due to vascular origin (after a stroke).

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How long can a person be in a coma?

Until they are declared brain dead. The more severe the damage to the brain, the more severe and deeper the coma and, accordingly, the less chance of getting out of it.

If during the day the pupil does not react to a beam of light, then the chances are minimal.

And if the pressure dropped below 80 and there was no reaction of the muscles, then the brain died ..

Until he dies, and this, with proper use, can last up to ten years or longer. But usually during this time a person gets cold, bedsores start, sepsis and that's it.

There have been cases where people have been in a coma for years. The record term is 42 years. So many years was in the coma of Edward O'Bar, who fell into a coma at the age of 16, and all this time she was cared for first by her mother, and then by her sister. She did not regain consciousness and died.

And there is a case when a person after 19 years of being in a coma came to his senses. I wrote about it in the answer to this question, I will not repeat it. This is also a record.

A person, if he cannot breathe on his own, will be in a coma as long as he is connected to life support devices and until his brain is dead. If he can breathe on his own, can swallow, and is in a more or less stable state, he will be in a coma until someone cares for him or until he dies from some concomitant disease of an immobile lifestyle, such as pneumonia. . Or until he regains consciousness.

Irreversible processes in the brain, if I'm not mistaken, begin in 1-3 hours. That is, the longer a person stays in a coma, the stronger the brain dies. It is the brain that is responsible for consciousness, and the spinal cord for the unconscious. In other words, after a long time in a coma, the body loses the organ responsible for consciousness. As a result, only the shell remains - physically the arms and legs. will live, but it will no longer be a man.

Usually they fall into a coma due to a serious illness or from injuries received, especially the brain. I know that you can stay in a coma from several days to several years. People who are in a coma rarely survive or become disabled for life, but it all depends on doctors and proper care.

It is simply impossible to determine how long a person can lie in a coma. A person can be in this state for several days, or several months and years. Even after being in a coma for several years, people can recover and return to normal life.

A person can be in a coma for a long time, it all depends on the severity of the disease or injury, from several hours, days, months and up to ten years, until he comes to his senses or dies. One American after a car accident was in a coma for 19 years, and a resident of China - 30 years.

A person can be in a coma for a very long time. There have been cases for ten or more years. In general, a coma is scary. A person dies only when the brain dies. I had 2 friends in a coma, none of them came out of this state.

The duration of a person's stay in a coma depends on many different factors. From the reasons that caused the coma, the intensity of treatment, care and others. As a rule, this period can be from several weeks, months and even years.

You can stay in a coma for a very long time. There is a case when, as a girl, an American woman fell into a coma and died without waking up after 42 years of half-dead hibernation. And there were incidents when after a year people woke up and continued to live.

It is very scary when a loved one is in a coma.

A person can lie in a coma from several days to several months, and even years.

The duration of being in a coma depends on several different factors.

A person can be in a coma for a completely different amount of time from 3 days to several years.

In 2009, a 17-year-old Daniela Kovacevic from Serbia during childbirth, blood poisoning occurred. She fell into a coma, and her recovery from a coma after 7 years, doctors do not call it anything other than a miracle. After active therapy, the girl can move around (so far with the help of outsiders), hold a pen in her hands. And those who are on duty near the bedside of the sick, who are in a coma, have a hope that the same miracle can happen to their loved ones.

General is not with us yet

More than 3 years ago, she was in a coma Maria Konchalovsky, daughter of director Andron Konchalovsky. In October 2013, the Konchalovsky family had a serious accident in France. The director and his wife, Yulia Vysotskaya, escaped with minor bruises thanks to deployed airbags. And the girl, who was not wearing a seat belt, received a severe head injury. Doctors saved the child's life, but warned that the recovery would be long. Alas, their prediction came true. The girl's rehabilitation continues.

21 years of rehabilitation Colonel General Anatoly Romanov, commander of the combined grouping of federal troops in Chechnya. On October 6, 1995, his car was blown up in a tunnel in Grozny. Romanov was collected literally piece by piece. Thanks to the efforts of doctors, after 18 days, the general opened his eyes and began to respond to light, movement and touch. But the patient is still not aware of what is happening around him. What methods were not used by doctors to “break through” into his mind. For 14 years, the general was treated at the Burdenko hospital. Then he was transferred to the Moscow region hospital of internal troops. But while this strong and courageous man, as the doctors say, is in a state of minimal consciousness.

Sharon Stone suffered an intracerebral hemorrhage, due to which she was in a coma for 9 days. Stevie Wonder, American blind soul singer, got into a serious car accident and was in a coma for 4 days, after the exit he partially lost his sense of smell. In 2013, he received a severe head injury seven-time Formula 1 champion Michael Schumacher. He remained unconscious for more than six months. Then there was progress in his condition, but rehabilitation continues to this day.

Life with a clean slate

Until now, only one case is known when the patient managed to return to a full life after a long coma. June 12, 1984 Terry Wallace from Arkansas, pretty drunk, went with a friend to ride. The car went off the cliff. A friend died, Wallace fell into a coma. A month later, he went into a vegetative state, in which he remained for almost 20 years. In 2003, he suddenly uttered two words: "Pepsi-Cola" and "mom." After conducting an MRI study, scientists discovered that the incredible happened: the brain repaired itself, growing new structures to replace the affected ones. For 20 years of immobility, all the muscles atrophied in Wallace and he lost the simplest self-care skills. He also did not remember anything about the accident or the events of the past years. In fact, he had to start life from scratch. However, the example of this man still inspires hope in those who continue the struggle for the return of their loved ones to normal life.

Mikhail Piradov, Academician of the Russian Academy of Sciences, Director of the Scientific Center for Neurology:

Every day, new patients enter hospitals in different cities. Sometimes the patient has to make a choice in favor of this or that treatment, or refuse it altogether, but what about the one who is in a coma?

What is a coma and why can people enter this state?

Coma is a severe coma in which man is in a deep sleep. Depending on what degree of coma the patient has, various functions of the body can be slowed down, brain activity is turned off, metabolism is completely stopped or significantly slowed down, the functioning of the nervous system.

The cause of whom can be: stroke, brain injury, meningitis, epilepsy, encephalitis, hypothermia or overheating of the body.

Are there coma qualifications?

Coma is conditionally divided into 5 degrees of severity, namely:

1 degree - precoma. Those who have been affected by this gradually begin to experience general lethargy, a drop in reaction, a feeling of drowsiness, lack of sleep, and confusion in consciousness. Rarely, but still it happens that everything happens the other way around, in excessive excitement. Reflexes at this stage are preserved, while the work of all internal organs is already inhibited. Sometimes precoma is called nothing more than a state before a coma, and is not referred to as a coma at all.
Grade 2 - initial level of severity. They begin to slow down reactions to external stimuli. A person still retains the ability to swallow liquid food and water, he can move his limbs, but only slightly.
Grade 3 - medium severity. The patient is already entering a state of deep sleep, contact with him becomes impossible. Only sometimes movements of the limbs can be observed, but rarely they are realized. The skin already has low sensitivity, a person walks under himself.
4 degree - high level of severity. There is a lack of pain, consciousness, tendon reflexes, no reaction to light. Reduced not only body temperature but also the pressure with breathing.
5degree - severe coma. Violation of consciousness becomes deep, reflexes are absent. There is a cessation of breathing and the patient is transferred to the artificial respiration apparatus.

By what signs to recognize whom?

Only specialists can recognize who. For these purposes, they conduct the following studies:

The level of alcohol in the blood is determined to exclude alcohol intoxication, in which consciousness can be turned off for a while.
Determine the presence of drugs in the blood to exclude drug syncope.
Conduct an electrocardiogram.

These are only general studies, special ones can be prescribed by doctors if necessary.

How long can a person stay in a coma?

It is worth saying that doctors often, after several years, advise relatives to make a decision to disconnect a person from devices that support his life. Forecasts are becoming unfavorable, and life support is not cheap, so many agree to this step. But do not forget that a person is still alive, he just cannot live without special help. The longest recorded time a person spent in a coma 37 years.

How does a person feel when in a coma?

Someone claims to have met with deceased relatives, all this happens in patients in a state of sleep, in which, as you know, anything can happen.

How can a person be brought out of a coma?

How do they get out of it?

The exit from the coma is gradual. At first, a person can wake up for a couple of minutes, look around and fall back into a dream. An hour or two will pass, and he will wake up again, and this happens several times.

Coming out of a coma, a person will need a lot of time to adapt. Everything around him seems strange, if he spent more than a year in this state, he needs time to realize that so much time has passed. You should not expect that a person will immediately get on his feet and begin to live as before. Speech will not be restored immediately.

At this moment, a person will need the help of loved ones more than ever, everything around him will be alien to him, and he, as if a child, will begin to learn to walk and talk again.

Are there any consequences?

Directly to the consequences can be attributed, up to amnesia. There may be lethargy, absent-mindedness, aggressiveness. Do not be afraid, all this is recoverable, you just need time and patience. A person may have lost everyday skills, so he will need to be taught everything again. It is easy to understand what consequences await those who have spent more than five years in a coma, during this time much has changed around and then a person needs to be introduced to everything around.