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A coma is a state of deep and prolonged unconsciousness, from which the patient cannot be roused. It can occur during illness (for example, diabetes, liver or kidney disorder), after a head injury or a stroke, or after poisoning (particularly from drug or alcohol poisoning). A related condition, persistent vegetative state, is a term used to describe the condition of patients with severe brain damage in whom coma has progressed to a state of "wakefulness without awareness".
Initial treatment will depend on the cause of the coma, and will be directed at preventing further damage to the brain. If the patient is having difficulty breathing, he or she may be placed on a respirator. After a head injury, surgery may be required to stop bleeding and/or reduce swelling. If there is an underlying illness, or poisoning, then treatment will be directed at the underlying cause.
If the coma persists, then further treatment will be directed at maintaining the patient's physical condition and preventing complications. For example, this could involve providing adequate nutrition, and preventing infection (e.g. pneumonia, bed sores). Physical therapy may also be given to maintain muscle condition.
Prognosis (outlook for recovery)
Patients awakening from a coma will usually recover consciousness gradually. A coma rarely lasts more than four weeks; however, patients in a persistent vegetative state may remain in that state for months or years.
Recovery from a coma depends, to a considerable extent, on the original cause of the coma, and on the severity of any brain damage. Some patients (e.g. patients in a diabetic coma) will make a complete recovery, while others, particularly those who have suffered a head trauma, may have some physical, intellectual or psychological impairment that will require further treatment.
The most usual cause of death in patients in a persistent vegetative state is pneumonia.
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