medical report terminology for coma patient

Symptoms

Synonym (s): coma aberration A state of deep, often prolonged unconsciousness, usually the result of injury, disease, or poison, in which an individual is incapable of sensing or responding to external stimuli and internal needs. The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company.

Causes

The assessment of patients in coma is a medical emergency. The cause should be identified and, where possible, corrected and the brain provided with appropriate protection to reduce further damage.

Prevention

Patient Care. Assessment of the patient in a coma includes an evaluation of vital signs, determination of level of consciousness, neuromuscular responses, and reaction of the pupils to light. In most hospitals a standard form is used to measure and record the patient's responses to stimuli in objective terms.

Complications

The advent of cardiopulmonary resuscitation during the 1960s, together with the advances in intensive care medicine, created the need for techniques to identify prognosis early in the course of coma.

What is the medical term for coma?

What is the assessment of a patient in coma?

What is included in patient care in a coma?

What is the history of the diagnosis of coma?

How would you describe a comatose patient?

The signs and symptoms of a coma commonly include: Closed eyes. Depressed brainstem reflexes, such as pupils not responding to light. No responses of limbs, except for reflex movements. No response to painful stimuli, except for reflex movements.

What is the medical term for coma?

A coma, sometimes also called persistent vegetative state, is a profound or deep state of unconsciousness. Persistent vegetative state is not brain-death. An individual in a state of coma is alive but unable to move or respond to his or her environment.

How do you document level of consciousness?

The tool we use to assess the level of consciousness is the Glasgow Coma Scale (GCS). This tool is used at the bedside in conjunction with other clinical observations and it allows us to have a baseline and ongoing measurement of the level of consciousness (LOC) for our patients.

What does GCS 7t mean?

Certain scores on the Glasgow Coma Scale have significance. Patients with a Glasgow Coma Scale score of 7 or less are considered comatose. Patients with a Glasgow Coma Scale score of 8 or less are considered to have suffered a severe head injury.

What does STM mean in medical terms?

short-term memoryAbbreviation for short-term memory.

What are the different levels of unconsciousness?

Unconsciousness is when a person is not aware of what is going on and is not able to respond normally to things that happen to and around him or her. Fainting is a brief form of unconsciousness. Coma is a deep, prolonged state of unconsciousness. General anesthesia is a controlled period of unconsciousness.

What are 4 levels of consciousness?

It is my observation that individuals and organizations move into and out of the four states of consciousness: unconscious unreality, conscious unreality, unconscious reality, and conscious reality. At differing points in time we live, move, and have our being in one of these levels of awareness.

What are the 5 levels of consciousness nursing?

Often, an altered level of consciousness can deteriorate rapidly from one stage to the next, so it requires timely diagnosis and prompt treatment.Confusion. ... Delirium. ... Lethargy and Somnolence. ... Obtundation. ... Stupor. ... Coma.

What is alert and oriented x4 mean?

A&Ox4 (also AAOx4 – awake,alert and oriented) refers to someone who is alert and oriented to person,place, time and event. Does the person being evaluated understand who they are, where they are, approximate date or part of the day, and what is happening?

What does GCS 10 mean?

Severe, GCS 3 to 8. Moderate, GCS 9 to 12. Mild, GCS 13 to 15.

What does GCS 15 mean?

The GCS is the summation of scores for eye, verbal, and motor responses. The minimum score is a 3 which indicates deep coma or a brain-dead state. The maximum is 15 which indicates a fully awake patient (the original maximum was 14, but the score has since been modified).

What does GCS 9 mean?

Head Injury Classification: Severe Head Injury----GCS score of 8 or less Moderate Head Injury----GCS score of 9 to 12 Mild Head Injury----GCS score of 13 to 15 (Adapted from: Advanced Trauma Life Support: Course for Physicians, American College of Surgeons, 1993).

What is a coma?

Share on Pinterest. A coma is a state of deep unconsciousness. A person who is experiencing a coma cannot be awakened, and they do not react to the surrounding environment. They do not respond to pain, light, or sound in the usual way, and they do not make voluntary actions. Although they do not wake up, their body follows normal sleep patterns. ...

What are the symptoms of a coma?

Symptoms. During a coma, a person cannot communicate, so diagnosis is through the outward signs. These include: closed eyes. limbs that do not respond or voluntarily move, except for reflex movements. lack of response to painful stimuli, except for reflex movements.

How long does a coma last?

Levels of consciousness and responsiveness will depend on how much of the brain is functioning. A coma often lasts for a few days or weeks. Rarely, it can last for several years. If a person enters a coma, this is a medical emergency. Rapid action may be needed to preserve life and brain function.

Why is coma different from sleep?

Coma is different from sleep because the person is unable to wake up. It is not the same as brain death. The person is alive, but they cannot respond in the normal way to their environment.

What happens to a person in a coma?

Without treatment, their ability to think clearly will gradually decrease. Finally, they will lose consciousness.

What does a 6 mean?

A score of 6 means the person can obey commands. A score of 8 or less overall indicates a coma. If the score is from 9 to 12, the condition is moderate. If the score is 13 or more, the impairment to consciousness is minor.

How to determine if you have carbon monoxide poisoning?

These will be taken to determine: 1 blood count 2 signs of carbon monoxide poisoning 3 presence and levels of legal or illegal drugs or other substances 4 levels of electrolytes 5 glucose levels 6 liver function

What is a coma in medical terms?

A coma is a medical emergency. Doctors will first check the affected person's airway and help maintain breathing and circulation. Doctors might give breathing assistance, intravenous medications and other supportive care. Treatment varies, depending on the cause of the coma.

How to know if you are in a coma?

Speaking loudly or pressing on the angle of the jaw or nail bed while watching for signs of arousal, such as vocal noises, eyes opening or movement. Testing reflexive eye movements to help determine the cause of the coma and the location of brain damage.

How does a coma test work?

This measures the electrical activity inside the brain through small electrodes attached to the scalp. Doctors send a low electrical current through the electrodes, which record the brain's electrical impulses. This test can determine if seizures might be the cause of a coma.

What is the best test to diagnose brain injury?

Imaging tests help doctors pinpoint areas of brain injury. Tests might include: CT scan. This uses a series of X-rays to create a detailed image of the brain. A CT scan can show a brain hemorrhage, tumors, strokes and other conditions. This test is often used to diagnose and determine the cause of a coma. MRI.

Why do doctors need to rely on physical clues?

Because people in a coma can't express themselves , doctors must rely on physical clues and information provided by families and friends. Be prepared to provide information about the affected person, including: Details about how the affected person lost consciousness, including whether it occurred suddenly or over time.

What to check for in a coma exam?

The exam is likely to include: Checking the affected person's movements and reflexes, response to painful stimuli, and pupil size. Observing breathing patterns to help diagnose the cause of the coma. Checking the skin for signs of bruises due to trauma.

What to do if you are in a coma?

If you are with a person who develops signs and symptoms of a coma, call 911 or your local emergency number immediately . When you arrive at the hospital, emergency room staff will need as much information as possible from family and friends about what happened to the affected person before the coma.

What is a coma in psychology?

A coma is a prolonged state of unconsciousness. During a coma, a person is unresponsive to their environment. The person is alive and looks like they are sleeping. However, unlike in a deep sleep, the person cannot be awakened by any stimulation, including pain.

What is a temporary coma?

Medically induced: This type of temporary coma, or deep state of unconsciousness, is used to protect the brain from swelling after an injury. The patient receives a controlled dose of an anesthetic, which causes lack of feeling or awareness. Doctors then closely watch the person’s vitals.

Why do people go into a coma?

More than 50% of comas are related to head trauma or disturbances in the brain 's circulatory system. Problems that can lead to coma include: Anoxic brain injury. This is a brain condition caused by total lack of oxygen to the brain. Lack of oxygen for a few minutes causes cell death to brain tissues.

What are the different types of comas?

Types of coma can include: 1 Toxic-metabolic encephalopathy. This is an acute condition of brain dysfunction with symptoms of confusion and/or delirium. The condition is usually reversible. The causes of toxic-metabolic encephalopathy are varied. They include systemic illness, infection, organ failure, and other conditions. 2 Persistent vegetative state. This is a state of severe unconsciousness. The person is unaware of their surroundings and incapable of voluntary movement. With a persistent vegetative state, someone may progress to wakefulness but with no higher brain function. With persistent vegetative state, there is breathing, circulation, and sleep -wake cycles. 3 Medically induced: This type of temporary coma, or deep state of unconsciousness, is used to protect the brain from swelling after an injury. The patient receives a controlled dose of an anesthetic, which causes lack of feeling or awareness. Doctors then closely watch the person’s vitals. This happens only in hospital intensive care units.

What causes a coma in the brain?

High blood pressure, cerebral aneurysms, and tumors are non-traumatic causes of bleeding in the brain. Stroke: When there is no blood flow to a major part of the brain stem or loss of blood accompanied with swelling, coma can occur. Blood sugar: In people with diabetes, coma can occur when blood sugar levels stay very high.

What is the prognosis for a coma?

What's the Prognosis for a Coma? The prognosis for a coma varies with each situation. The chances of a person's recovery depend on the cause of the coma, whether the problem can be corrected, and the duration of the coma. If the problem can be resolved, the person can often return to their original level of functioning.

How long does it take to wake up from a coma?

As we would expect, the longer a person is in a coma, the worse the prognosis. Even so, many patients can wake up after many weeks in a coma. However, they may have significant disabilities.

What is the treatment for a coma patient?

Upon admittance to an emergency department, coma patients will usually be placed in an Intensive Care Unit (ICU) immediately, where maintenance of the patient's respiration and circulation become a first priority. Stability of their respiration and circulation is sustained through the use of intubation, ventilation, administration of intravenous fluids or blood and other supportive care as needed.

How long does a coma last?

Comas can last from several days to, in particularly extreme cases, years. After this time, some patients gradually come out of the coma, some progress to a vegetative state, and others die. Some patients who have entered a vegetative state go on to regain a degree of awareness and in some cases, may remain in vegetative state for years or even decades (the longest recorded period being 42 years).

What is a coma man?

A coma is a deep state of prolonged unconsciousness in which a person cannot be awakened, fails to respond normally to painful stimuli, light, or sound, lacks a normal wake-sleep cycle and does not initiate voluntary actions.

What are the reactions of a coma?

Common reactions, such as desperation, anger, frustration, and denial are possible. The focus of the patient care should be on creating an amicable relationship with the family members or dependents of a comatose patient as well as creating a rapport with the medical staff. Although there is heavy importance of a primary care taker, secondary care takers can play a supporting role to temporarily relieve the primary care taker's burden of tasks.

What causes a coma in the brain?

Causes. Many types of problems can cause a coma. Forty percent of comatose states result from drug poisoning. Certain drug use under certain conditions can damage or weaken the synaptic functioning in the ascending reticular activating system ( ARAS) and keep the system from properly functioning to arouse the brain.

What is the purpose of EEG in a coma?

Imaging basically encompasses computed tomography (CAT or CT) scan of the brain, or MRI for example, and is performed to identify specific causes of the coma, such as hemorrhage in the brain or herniation of the brain structures. Special tests such as an EEG can also show a lot about the activity level of the cortex such as semantic processing, presence of seizures, and are important available tools not only for the assessment of the cortical activity but also for predicting the likelihood of the patient's awakening. The autonomous responses such as the skin conductance response may also provide further insight on the patient's emotional processing.

Where did the term "coma" come from?

The term 'coma', from the Greek κῶμα koma, meaning deep sleep, had already been used in the Hippocratic corpus ( Epidemica) and later by Galen (second century AD). Subsequently, it was hardly used in the known literature up to the middle of the 17th century. The term is found again in Thomas Willis ' (1621–1675) influential De anima brutorum (1672), where lethargy (pathological sleep), 'coma' (heavy sleeping), carus (deprivation of the senses) and apoplexy (into which carus could turn and which he localized in the white matter) are mentioned. The term carus is also derived from Greek, where it can be found in the roots of several words meaning soporific or sleepy. It can still be found in the root of the term 'carotid'. Thomas Sydenham (1624–89) mentioned the term 'coma' in several cases of fever (Sydenham, 1685).

What is a coma in medicine?

Coma is a medical emergency, and attention must first be directed to maintaining the patient's respiration and circulation, using intubation aand ventilation, administration of intravenous fluids or blood as needed, and other supportive care. If head trama has not been excluded, the neck should be stablized in the event of fracture. It is obviously extremely important for a physician to determine quickly the cause of a coma, so that potentially reversible conditions are treated immediately. For example, an infection may be treated with antibiotics; a brain tumor may be removed; and brain swelling from an injury can be reduced with certain medications. Various metabolic disorders can be addressed by supplying the individual

What does coma mean in medical terms?

Coma, from the Greek word "koma," meaning deep sleep, is a state of extreme unresponsiveness, in which an individual exhibits no voluntary movement or behavior. Furthermore, in a deep coma, even painful stimuli (actions which, when performed on a healthy individual, result in reactions) are unable to affect any response, and normal reflexes may be lost.

How long do you stay in a coma after drug poisoning?

Leaving out those people whose coma followed drug poisoning, only about 15% of patients who remain in a coma for more than just a few hours make a good recovery. Those adult patients who remain in a coma for greater than four weeks have almost no chance of eventually regaining their previous level of functioning.

What vitamins are given to a patient in a coma?

Because of their low incidence of side effects and potential for prompt reversal of coma in certain conditions, glucose, the B-vitamin thiamine, and Narcan (to counteract any narcotic-type drugs) are routinely given.

What is the spectrum of coma?

Coma lies on a spectrum with other alterations in consciousness. The level of consciousness required by, for example, someone reading this passage lies at one extreme end of the spectrum, while complete brain death lies at the other end of the spectrum. In between are such states as obtundation, drowsiness, and stupor.

What are the conditions that cause a person to go into a coma?

The four brain conditions that result in coma. (Illustration by Hans & Cassady.) with the correct amount of oxygen, glucose, or sodium; by treating the underlying disease in liver disease, asthma, or diabetes; and by halting seizures with medication.

What are the causes of coma?

There are many metabolic causes of coma, including: A decrease in the delivery to the brain of substances necessary for appropriate brain functioning, such as oxygen, glucose (sugar), and sodium. The presence of certain substances that disrupt the functioning of neurons.

Is the Glasgow Coma Scale accurate?

While the Glasgow Coma Scale is a great diagnostic tool there are multiple limitations that can alter the score and not provide an accurate picture of the patient’s brain injury. These include:

Does Glasgow coma scale measure brain injury?

Another significant limitation of the Glasgow Coma Scale, as it was originally developed, is that it does not accurately measure traumatic brain injury in children under 5 years of age. The aptly-named ‘Pediatric Glasgow Coma Scale (PGCS)’ includes modifications for this patient population.

What is cognitive impairment?

The Diagnostic and Statistical Manual of Mental Disorders (DSM IV) officially defines delirium as a disturbance of consciousness with inattention accompanied by a change in cognition or perceptual disturbance that develops over a short period of time (hours to days) and fluctuates over time.

What is delirium in critical care?

Background: Delirium (acute brain dysfunction) is a potentially life threatening disturbance in brain function that frequently occurs in critically ill patients. While this area of brain dysfunction in critical care is rapidly advancing, striking limitations in use of terminology related to delirium internationally are hindering cross-talk and collaborative research. In the English literature, synonyms of delirium such as the Intensive Care Unit syndrome, acute brain dysfunction, acute brain failure, psychosis, confusion, and encephalopathy are widely used. This often leads to scientific ‘‘confusion’’ regarding published data and methodology within studies, which is further exacerbated by organizational, cultural and language barriers.

What is the assessment of a patient in a coma?

The assessment of patients in coma is a medical emergency. The cause should be identified and, where possible, corrected and the brain provided with appropriate protection to reduce further damage. It then becomes important to identify those patients for whom the prognosis is hopeless and in whom the institution or persistence ...

What imaging techniques are used to determine if a patient is in a coma?

Imaging techniques, including computed tomography, magnetic resonance imaging, and single photon emission computed tomography, together with methods of measuring blood flow are of proven use in determining the diagnosis of coma and in identifying brain stem death; however, their value in prediction is no better than clinical signs. Even the use of cerebral metabolic rate for oxygen appears only to allow correct prediction of outcome in approximately 82% of patients, 14 though magnetic resonance spectroscopy may provide further and better information in the future.

What are the problems with coma prognosis?

There are recognised difficulties in interpreting the outcome of studies of coma prognosis 10 15: the lack of prospective studies, failure to state confidence intervals , and the inevitable confounding factor that many patients included in the studies will die of non-neurological disease. There are two other problems which are impossible to eliminate and cause difficulty in evaluation; the self fulfilling nature of poor prognoses and the problem of the persistent vegetative state. The fact that a poor prognosis given by a researcher to an individual patient may be self fulfilling seems unavoidable. Even if the researcher involved in collecting the data prospectively is not actively involved in the care of the patient there will be a tendency for the future care of that patient to reflect the impressions and opinions of those responsible for management. Ideally prognostic studies should only be performed on patients who will all receive maximal life support for as long as possible, but this is inconsistent with the humane and sensitive management of patients and their relatives. The problem relating to the persistent vegetative state arises because in some studies no distinction has been made between a persistent vegetative state and death, and in others the vegetative state is combined with severe disability as a “non-acceptable outcome”.

What are the five EEG abnormalities in a coma?

Five grades of EEG abnormality in coma are internationally accepted: alpha rhythm, dominant theta, diffuse dominant delta, burst suppression, and isoelectric. 9 At 48 hours these grades provide prediction with an accuracy of about 88% and to date it seems that the evaluation of compressed spectral arrays with a “brain monitor” is unlikely to improve upon that provided by clinical assessment or standard EEG.

Why is prolonged survival important in a coma?

The prolonged survival of patients in coma usually indicates the development of a vegetative state and the avoidance of the persistent vegetative state is frequently given as an important reason for the use of predictors in coma.

What are the two problems that are impossible to eliminate and cause difficulty in evaluation?

There are two other problems which are impossible to eliminate and cause difficulty in evaluation; the self fulfilling nature of poor prognoses and the problem of the persistent vegetative state. The fact that a poor prognosis given by a researcher to an individual patient may be self fulfilling seems unavoidable.

Why do people with drug overdoses appear comatose?

Patients with drug overdose coma frequently appear deeply comatose with depressed brain stem reflexes because of the effects of the drugs upon the brain stem, yet may show disproportionately high levels of motor activity. In general, metabolic causes of coma have a better prognosis than anoxic–ischaemic causes.

Overview

Etymology

Signs and symptoms

Causes

Pathophysiology

Diagnosis

• A coma is a medical emergency. Doctors will first check the affected person's airway and help maintain breathing and circulation. Doctors might give breathing assistance, intravenous medications and other supportive care. Treatment varies, depending on the cause of the coma. A procedure or medications to relieve pressure on the brain due to brain s...

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Treatment

Prognosis

A coma is a deep state of prolonged unconsciousness in which a person cannot be awakened, fails to respond normally to painful stimuli, light, or sound, lacks a normal wake-sleep cycle and does not initiate voluntary actions. Coma patients exhibit a complete absence of wakefulness and are unable to consciously feel, speak or move. Comas can be derived by natural causes, or can be medically induced.
Clinically, a coma can be defined as the inability consistently to follow a one-step command. It can also be defin…