Coma, or Sleep of Reason

Coma.  Disconnecting from a respirator.  Photo from www.sciencephoto.com

One day the whole world got a story about how an Italian pensioner committed suicide after losing hope that his wife sometime come out of the coma. The woman woke up a few hours after his death, and the first thing she asked the doctor was "where's my husband." This truly Shakespearean drama was played out in a hospital in Padova (Padua), where an elderly Italian was treated. A woman went into a coma after a severe heart attack and remained in this state for 4 months. Its70-year-old husband devotedly cared for her all the time, but in the end decided that there is no hope to return the wife and took his own life …

The ancient Greek dream

In ancient Greek coma — a "deep sleep." In the modern sense coma — the maximum degree of pathological inhibition of the central nervous system (CNS), characterized by profound loss of consciousness, loss of reflexes, lack of response to external stimuli and disorder regulation of vital body functions.

The essence of the coma is that disrupted the function of the central nervous system as the leading and guiding force, and the body begins the "confusion and vacillation" — violated a clear interaction of organs and systems. This, of course, at the level of the whole organism is reduced ability to self-regulate and maintain a constant internal environment (homeostasis). Coma clinically manifested by loss of consciousness, disturbance of motor, sensory, and other functions, including vital signs.

What, where, when

Coma may occur because of a variety of reasons, which can be grouped into four broad groups:
  • intracranial processes (swelling, inflammation, cardiovascular problems);
  • lack of oxygen (hypoxia) in lesions of the respiratory system, circulatory disorders and other conditions;
  • metabolic disorders (most often associated with hepatic or renal failure, endocrine disorders);
  • various intoxication.
Furthermore, the coma can be primary, when there is a focal disease of the brain, and then develops a cascade of pathological reactions of the organs and systems (for epilepsy, traumatic brain injuries, stroke, tumors and infections of the brain) andsecondary, developing as a result of a variety of chronic diseases and conditions (eg chronic liver failure, diabetes, starvation, etc.).
 

More often than not, according to the emergency services and emergency medical care in Moscow, cause of coma is a stroke — 57.2 percent, the second place went to a drug overdose — 14.5 per cent, followed by hypoglycemic coma — 5.7 percent, craniocerebral trauma — 3.1 percent, diabetic coma and poisoning drugs — by 2.5 percent, alcoholic coma — 1.3 percent; often cause coma pre-hospital not only remained unexplained, but not even suspected — 11.9 percent.

With all the variety of causes of coma, their result is the same disease process. The immediate cause development of a coma — violation education, distribution and transmission of nerve impulses in the brain cells because of violations of tissue respiration, metabolism and energy. Thus coma— Only the result of a chain of pathological processes in the body and aggravate each other states.

In addition, the deeper the coma, so, in turn, the expression of disorders of the respiratory andcardiovascular systems.

With the consequences of disasters

Coma is terrible not only in itself — are no less a threat and its complications. First of all, it conditions associated with damage to the brain: the various disordered breathing until it stops, pulmonary edema, fall, or, conversely, a sharp rise in blood pressure, cardiac arrest. These complications can cause clinical, biological and then death. Other serious complications associated with the violation of regulatory fukntsii CNS — is vomiting with a hit of vomit in the respiratory tract, urinary retention with the possibility of rupture of the bladder and peritonitis.

We will disable or let him live

The patient may be in a coma for a long time. A case when the victim regained consciousness after a car accident 19-year-old residence in "deep sleep." It depends on the state of his brain, and also from the medical monitoring and care. Modern equipment allows us to maintain vital functions indefinitely. Whole the question of expediency.

That's where the issue of euthanasia and intersects the sphere moves in the sphere of health moral and ethical. At times, doctors and relatives of the patient are real war when one side does not see the point in maintaining the vital functions of the body, and the second opposed disconnect the patient from the equipment

Plays a vital role prior condition of the patient and the specific cause of the coma. The elderly patient with chronic liver disease are much less likely to "wake up" than the young man injured in a car accident.

The only "hardware" argument in favor of the trip — it's brain-dead. In international practice, and the Russian legislation brain death is equivalent to death. Russian Ministry of Health approved a special instruction on death, a person on the basis of the diagnosis of brain death, which is very detailed nine clinical signs, the necessary data of laboratory and instrumental studies suggest that brain this person is dead.

However, in practice, is often not the case, as it is written in the laws and documents. Not always with the patient will mess as it is shown in Hollywood movies. Most often, the question about money and the possibility of the facility. And they end quickly enough and not all hospitals have modern medical equipment and medical staff who will take care of comatose patient. Most often, these problems fall down the full weight on the shoulders of relatives.

The author is known for the case when the girl was in an accident, suffered multiple internal injuries, including a ruptured spleen, she lay in a coma for 7 months in one of the major medical institutions in Moscow. The doctors felt state hopeless, like disconnect the patient from life support, but my mother suffered with the battle has defended daughter, she took care of her and pay extra medical personnel. As a result, the girl came out of the coma and almost recovered. However, such cases, most likely can be attributed to "the exception that only prove the rule."

Alexei Vodovozov

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