Evaluation of the pupils of the eyes and breathing pattern are also important. Blood and urine tests will probably be performed in order to quickly diagnose the presence of toxins (such as high levels of alcohol, drugs, carbon dioxide, or poisons), abnormalities of blood chemistry (such as sodium, potassium, and glucose), liver or kidney failure, low blood oxygen, or infection. CT scans or MRI brain scans may be performed to evaluate the possibility of brain injury due to trauma, stroke, aneurysm, or tumor. Quick, thorough evaluation is necessary, so that the cause of the coma is quickly identified and potentially reversible conditions can be treated immediately.
How Are Stupor and Coma Treated?
Impairment of consciousness is considered amedical emergency. Evaluation and treatment of any abnormalities in respiration or circulation should be attended to immediately. Oxygen is often given, and an intravenous (in the vein) line is placed in case fluids or medications need to be given quickly. The ultimate treatment will depend on the underlying cause of the coma, although basic measure may include elevation of the head of the bed, use of diuretics* or steroid drugs to decrease swelling in the brain, and/or administration of sedative drugs to decrease muscle contractions. Infections may require antimicrobial drugs; chemical abnormalities may respond to the administration of sodium or glucose; dehydration may improve with fluids; narcotic overdose may be treated with Narcan; and antiepileptics may stop seizures. In severe situations, surgery may be necessary to relieve excess pressure on the brain or to remove or repair abnormalities (such as a tumor or bleeding aneurysm).
If the coma persists, it may become necessary to place a tube for feeding, cither through the nose or through an incision in the abdomen into the stomach. Physical therapy may be employed to move the individual through passive range of motion exercises in order to keep joints and muscles as healthy as possible.
What Is the Prognosis of Stupor and Coma?
Prognosis (the prediction of future healing) depends on the underlying condition responsible for the impaired level of consciousness, the patient's original medical condition, the duration of the stupor or coma, how quickly the individual begins to make a recovery, and the degree of structural damage that the brain has suffered. When the impairment is duc to sedative overdose, complete recovery is likely, unless oxygen deprivation has caused brain damage. Prognosis for recovery after impairment due to low blood sugar is very good, if the low blood sugar has been corrected in less than an hour. Head injury may have a good prognosis, although coma lasting more than three months reverses this prognosis. A stroke that prompts a coma lasting less than six hours may have a reasonably good prognosis, although coma lasting more than six hours has a poor prognosis. Heart attack or oxygen deprivation share a poor prognosis.
With treatment, stupor or coma due to toxic exposures (such as drug overdoses) has a higher rate of complete recovery than many other causes of impairment. Only about 15 percent of adults who suffer stupor or coma due to other causes and who remain in a coma for more than just a few hours, return to their previous level of functioning. Children and younger adults may return to their expected level of functioning after as long as two months of impairment of consciousness.
Can Stupor and Coma be Prevented?
Although there is no way to prevent stupor and coma, certain basic measures can decrease the risk, including wearing seatbelts and using appropriate protective head gear (helmets while bike riding); avoiding illicit drugs and excess alcohol; using prescription medications exactly as prescribed; and following standard recommendations for avoiding or treating high blood pressure, diabetes, obesity, high cholesterol, and other medical conditions.
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