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Coma may be defined as "a
prolonged unconsciousness caused by disease, injury, or poison" (Gage Canadian
Dictionary, 1983). It is commonly known as a state similar to sleep, but
in which the person cannot be aroused and does not respond to any type of
People in coma may still be able
to hear and to understand what others are saying around them. For
this reason, it is important to be aware of what is being said in their
presence. It is recommended that friends, family, and staff refrain from
speaking negatively about the patient or his progress. It is also
recommended that staff be encouraged to speak to the person and explain what
they are doing to him or her. For example, before conducting any type of
test, explain that a test will be done, what it is, what they have to do in
order to take the test, and why it is important.
There are several levels of coma
defined by the patient's increasing awareness to his surroundings. Professionals
measure levels of coma by the Glasgow Coma Scale or the Rancho Los Amigos levels of
cognitive functioning. Generally, there are four possible awareness states when
coming out of coma.
The Comatose and Unresponsive State
In this state, the
patient makes no response to stimuli. He has no facial expressions and
there is no movement of any kind.
2. The Comatose but Responsive
In this state, the patient makes a response when his
senses are stimulates (that is, sight, hearing, touch, smell, and taste).
His breathing rate may increase, his heart rate may increase, he may make
facial expressions, or he may have some movement of his body.
3. The Conscious but
This is also known as the "locked in"
state. The patient may be able to see, hear, touch, taste, and/or smell
but is unable to respond.
4. The Conscious and Responsive
The patient has emerged from his coma in this state and
can respond to simple commands.
Coming out of
When coming out of coma, a
patient may make incomprehensible noises and/or move one or both arms or legs in
a random, uncoordinated, and repetitive movement. They may often try to
pull any tubes out, have facial expressions, groan, cry, or shout. They
may also try to move and may resist people doing anything to them.
One belief in terms of why a patient may make
such noises or movements is that he is attempting to express himself. He
may be expressing that he is trying to get better, that he doesn't like what has
happened, or that he doesn't like what people are doing to him. He may
also be expressing that he wants out of the situation he is in.
(1987). The Catastrophe of Coma: A Way Back. Queensland, Austrailia: David
Ivan, L.P. & Bruce, D.A. (1982). Coma: Physiopathology,
Diagnosis and Management. Springfield: Charles C. Thomas.
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