Materiały źródłowe

• #1 Coma – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/coma/diagnosis-treatment/drc-20371103

  A coma is a medical emergency. Healthcare professionals typically first check the affected person’s airway and help maintain breathing and circulation. A person in a coma might need breathing assistance, medicines through a vein and other supportive care. […] Treatment depends on the cause of the coma. A procedure or medicines to relieve pressure on the brain due to brain swelling might be needed. Emergency responders might give glucose or antibiotics through a vein in the arm. These may be given even before blood test results return in cases of very low blood sugar or an infection affecting the brain. […] If the coma is the result of a medicine or an illegal drug overdose, healthcare professionals typically give medicines to treat the condition. If the coma is due to seizures, medicines can control seizures. Other treatments might focus on medicines or therapies to address an underlying disease, such as diabetes or liver disease. […] Sometimes the cause of a coma can be completely reversed, and the affected person regains function. Recovery usually occurs gradually. A person with severe brain damage might have permanent disabilities or never regain consciousness.

• #2 Coma – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/coma/symptoms-causes/syc-20371099

  Coma is a medical emergency. Quick action is needed to preserve life and brain function. […] Healthcare professionals typically order a series of blood tests and a brain scan to try to learn what’s causing the coma so that proper treatment can begin. […] A coma doesn’t usually last longer than several weeks. People who are unconscious for a longer time might transition to a lasting vegetative state, known as a persistent vegetative state, or brain death. […] A coma is a medical emergency. Seek immediate medical care for the person in a coma. […] Although many people gradually recover from a coma, others enter a persistent vegetative state or die. Some people who recover from a coma end up with major or minor disabilities.

• #3 Coma – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/coma/diagnosis-treatment/drc-20371103

  A coma is a medical emergency. Healthcare professionals typically first check the affected person’s airway and help maintain breathing and circulation. A person in a coma might need breathing assistance, medicines through a vein and other supportive care. […] Treatment depends on the cause of the coma. A procedure or medicines to relieve pressure on the brain due to brain swelling might be needed. Emergency responders might give glucose or antibiotics through a vein in the arm. These may be given even before blood test results return in cases of very low blood sugar or an infection affecting the brain. […] If the coma is the result of a medicine or an illegal drug overdose, healthcare professionals typically give medicines to treat the condition. If the coma is due to seizures, medicines can control seizures. Other treatments might focus on medicines or therapies to address an underlying disease, such as diabetes or liver disease. […] Sometimes the cause of a coma can be completely reversed, and the affected person regains function. Recovery usually occurs gradually. A person with severe brain damage might have permanent disabilities or never regain consciousness.

• #4 Coma: Types, Causes, Treatments, Prognosis, and More

  https://www.healthline.com/health/neurological-health/coma

  The first priority of coma treatment is to minimize brain damage and to support the functions of the body. […] If the cause of the coma is known, medications for treating the underlying condition will be administered, as in the case of a drug overdose or a brain infection. […] Sometimes, surgery may be required to reduce swelling in the brain. […] Once a person who is in a coma is stabilized, doctors will work to prevent infections, bedsores, and contractures of the muscles. The medical team will also make sure to provide the person with balanced nutrition during the coma.

• #5 Coma | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/coma

  A coma is a medical emergency. […] Treatment of coma depends on the cause and severity, but may include: […] Intravenous administration of glucose in the case of hypoglycaemia […] Intravenous administration of naloxone in the case of a heroin overdose […] Surgery in the case of haemorrhage, for example, subdural haematoma (a blood clot between the brain and its covering) […] Antibiotics in the case of infection. […] Proper diagnosis can sometimes take hours or even days. In the meantime, the person is given immediate intensive care, including: […] An intravenous line (IV or drip) to provide fluids and drugs […] An oxygen mask […] Urinary bladder catheterisation […] Constant monitoring of their vital signs including pulse, breathing and blood pressure […] Intravenous glucose […] Pumping of the stomach, if it is thought the person ate or drank something poisonous […] Administration of a narcotic antidote, if a drug overdose is suspected […] A respirator, if the person is unable to breathe by themselves.

• #6 Coma: Types, Causes, Treatments, Prognosis

  https://www.webmd.com/brain/coma-types-causes-treatments-prognosis

  A coma is a medical emergency. Early treatment may limit the amount of damage to the brain and rest of the body. Call 9-1-1 for emergency help if you find someone in a coma or someone who is losing consciousness. […] Emergency medical technicians or paramedics will evaluate how well the person is breathing and provide assistance if needed. They can start an IV to provide fluids and give certain types of medications, such as glucose if the person’s blood glucose level is too low, anti-seizure medications, or naloxone (Narcan) if they suspect an opioid overdose. […] After the person arrives at the hospital, treatment continues as the staff does tests to determine the cause. Prompt medical attention is vital to treat potentially reversible conditions. For example, if there is an infection that’s affecting the brain, antibiotics may be needed. Surgery may also be necessary to relieve the pressure on the brain due to swelling or to remove a tumor.

• #7 Coma | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/coma

  A coma is a medical emergency. […] Treatment of coma depends on the cause and severity, but may include: […] Intravenous administration of glucose in the case of hypoglycaemia […] Intravenous administration of naloxone in the case of a heroin overdose […] Surgery in the case of haemorrhage, for example, subdural haematoma (a blood clot between the brain and its covering) […] Antibiotics in the case of infection. […] Proper diagnosis can sometimes take hours or even days. In the meantime, the person is given immediate intensive care, including: […] An intravenous line (IV or drip) to provide fluids and drugs […] An oxygen mask […] Urinary bladder catheterisation […] Constant monitoring of their vital signs including pulse, breathing and blood pressure […] Intravenous glucose […] Pumping of the stomach, if it is thought the person ate or drank something poisonous […] Administration of a narcotic antidote, if a drug overdose is suspected […] A respirator, if the person is unable to breathe by themselves.

• #8 Coma – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430722/

  The first goal of the clinician is to stabilize the comatose patient and diagnose and treat any reversible causes of coma such as hypoglycemia. Further evaluation follows that will identify a likely cause of coma or do the initial critical sorting into structural or nonstructural causes of coma. […] Determination of the serum glucose by the point of care testing or empiric administration of glucose is recommended for all patients with altered mental status. Naloxone should be considered in patients with elements of the narcotic toxidrome such as slowed respiratory rate, small pupils, or altered mental status. If a readily reversible of coma is not discovered, further evaluation is indicated. Simplistically, the treatment of a coma is treatment of conditions that lead to coma. Liberal neuroimaging is encouraged if history, physical, and stat laboratory results do not determine a treatment path.

• #9 Overview of Coma and Impaired Consciousness – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/coma-and-impaired-consciousness/overview-of-coma-and-impaired-consciousness

  Immediate stabilization and specific management of the cause are essential in the treatment of coma. […] For long-term coma, adjunctive treatment includes passive range-of-motion exercises, enteral feedings, and measures to prevent pressure ulcers. […] Patients with impaired consciousness are admitted to the ICU so that respiratory and neurologic status can be monitored. […] If trauma is involved, the neck is immobilized until CT is done to rule out damage to the cervical spine. Some patients in a stupor or coma after head trauma benefit from treatment with medications that can improve nerve cell function (eg, amantadine). Such treatment leads to improvement in neurologic responsiveness for as long as the medication is continued. […] If opioid overdose is suspected, naloxone 0.4 to 2 mg IV is given and repeated as necessary.

• #10 Coma – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/coma/diagnosis-treatment/drc-20371103

  A coma is a medical emergency. Healthcare professionals typically first check the affected person’s airway and help maintain breathing and circulation. A person in a coma might need breathing assistance, medicines through a vein and other supportive care. […] Treatment depends on the cause of the coma. A procedure or medicines to relieve pressure on the brain due to brain swelling might be needed. Emergency responders might give glucose or antibiotics through a vein in the arm. These may be given even before blood test results return in cases of very low blood sugar or an infection affecting the brain. […] If the coma is the result of a medicine or an illegal drug overdose, healthcare professionals typically give medicines to treat the condition. If the coma is due to seizures, medicines can control seizures. Other treatments might focus on medicines or therapies to address an underlying disease, such as diabetes or liver disease. […] Sometimes the cause of a coma can be completely reversed, and the affected person regains function. Recovery usually occurs gradually. A person with severe brain damage might have permanent disabilities or never regain consciousness.

• #11 Coma: What It Is, Causes, Diagnosis, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/6007-coma-persistent-vegetative-state

  A coma is a medical emergency. If youre with someone whos unconscious and unresponsive, call 911 (or your local emergency services number) immediately. Many causes of coma need immediate medical care, and any delay could lead to dangerous complications or death. […] The treatment for a coma depends greatly on the underlying cause. Because comas can happen for so many reasons, there are many possible treatments. What works for one cause may not work for another (or might make another condition worse). […] There are certain treatments that providers or caregivers may start before knowing what caused a coma. These treatments usually relate to known medical conditions, or they may relate to evidence around a person that indicates a possible cause of coma. These treatments may help stabilize a person, keeping the coma from worsening, or even reverse the coma entirely. Examples include: Glucose or insulin. These can help raise or lower blood sugar levels. Glucose can rapidly reverse a coma when given in time. […] Because there are so many different treatments for coma, there are also many possible complications and side effects of the treatments. Your healthcare provider is the best person to explain what side effects or complications are possible or likely, and what you can do about these.

• #12 Coma: Causes, diagnosis, treatment, and outlook

  https://www.medicalnewstoday.com/articles/173655

  A coma can result from complications of conditions such as diabetes or an infection, or from a traumatic incident involving a blow to the head or a lack of oxygen. […] Doctors sometimes induce a coma to protect a person from pain and complications during the healing process. […] Sometimes, a doctor will induce a coma using medications. For example, they might do this to protect the person from intense pain during a healing process or to preserve higher brain function following a form of brain trauma. […] A coma is usually a serious medical emergency. Healthcare professionals will start by ensuring the immediate survival of the individual. They will secure their breathing and circulation to maximize the amount of oxygen that reaches the brain. […] As a 2021 review explains, further treatment will then depend on the underlying cause of the coma.

• #13 Coma: Causes, diagnosis, treatment, and outlook

  https://www.medicalnewstoday.com/articles/173655

  The treatment options may include administering glucose, even before the results of blood tests are available, in case the person is in diabetic shock or has a brain infection. […] In some cases, doctors may need to relieve pressure within the individual’s skull by draining the excess CSF or prescribing medication that reduces brain swelling, such as mannitol and hypertonic saline.

• #14 Coma | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/19750

  Coma represents brain failure. It may be caused by neuronal dysfunction from many causes including structural or nonstructural processes affecting the central nervous system. […] The first goal of the clinician is to stabilize the comatose patient and diagnose and treat any reversible causes of coma such as hypoglycemia. […] Determination of the serum glucose by the point of care testing or empiric administration of glucose is recommended for all patients with altered mental status. Naloxone should be considered in patients with elements of the narcotic toxidrome such as slowed respiratory rate, small pupils, or altered mental status. If a readily reversible of coma is not discovered, further evaluation is indicated. […] Simplistically, the treatment of a coma is treatment of conditions that lead to coma. Liberal neuroimaging is encouraged if history, physical, and stat laboratory results do not determine a treatment path.

• #15 Diabetic coma | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/diabetic-coma

  The 3 types of diabetic coma include diabetic ketoacidosis coma, hyperosmolar coma and hypoglycaemic coma. […] Diabetic coma is a medical emergency and needs prompt medical treatment. […] Treatment options for diabetic coma include: ketoacidotic coma intravenous fluids, insulin and administration of potassium, hyperosmolar coma intravenous fluids, insulin, potassium and sodium given as soon as possible, hypoglycaemic coma an injection of glucagon (if available) to reverse the effects of insulin or administration of intravenous glucose.

• #16 Diabetes-Related Coma: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/16628-diabetic-coma

  The treatment for a diabetes-related coma depends on the cause. But all cases need treatment in a hospital. […] Treatment for a diabetes-related coma due to DKA or HHS includes: IV fluids, Insulin, Other treatments. […] Treatment for diabetes-related coma due to severe low blood sugar includes: Emergency glucagon. […] Its crucial to know the early warning signs of DKA, HHS and low blood sugar to prevent a diabetes-related coma. […] Yes, its possible to survive a diabetes-related coma if you get treatment for the underlying cause. But some people have permanent brain damage. If you dont get proper treatment in time, you can die. […] The length of a diabetes-related coma depends largely on how quickly you receive proper treatment. The only possible way to end this kind of coma is to return to healthy blood glucose and insulin levels, which only happens with treatment by medical professionals.

• #17 Vegetative State and Minimally Conscious State – Neurologic Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/neurologic-disorders/coma-and-impaired-consciousness/vegetative-state-and-minimally-conscious-state

  Treatment is mainly supportive. […] Supportive care is the mainstay of treatment for patients in a vegetative state or minimally conscious state; it should include the following: Preventing systemic complications due to immobilization (eg, pneumonia, urinary tract infection, thromboembolic disease), Providing good nutrition, Preventing pressure ulcers, Providing physical therapy to prevent limb contractures. […] Vegetative state has no specific treatment. […] Most patients in a minimally conscious state do not respond to specific treatments. However, in some cases, treatment with zolpidem, apomorphine, or amantadine can lead to improvement in neurologic responsiveness for as long as the medication is continued. […] A growing number of studies are evaluating the effects of providing music interventions during disorders of consciousness. Some studies show that music therapy may lead to positive behavioral effects and return to normal physiologic responses. Results should be interpreted with caution because research in this area has thus far been limited.

• #18 Methylphenidate in the treatment of coma – PubMed

  https://pubmed.ncbi.nlm.nih.gov/9152268/

  While there is significant morbidity and mortality involving patients in semicomatose and comatose states, the care of such patients has traditionally been limited to supportive measures. […] We report two cases of patients treated with methylphenidate hydrochloride: the first, a patient in a semicomatose state resulting from traumatic brain injury, and the second, a patient in a comatose state secondary to a subdural hematoma that occurred after a fall. […] Treatment with methylphenidate may provide neurostimulations by augmenting the activity of injured neuronal tissue within the reticular activating system, and by amplifying the net effect of the reduced number of viable neurons. […] Methylphenidate is a low-cost, potentially efficacious intervention for reducing the duration of comas, for preventing life-threatening and costly complications of prolonged unconsciousness, and for promoting early ambulation and recovery. […] Further research using more rigorous research designs to ascertain the effectiveness of methylphenidate in the treatment of patients in semicomatose and comatose states is needed.

• #19 Methylphenidate in the treatment of coma – PubMed

  https://pubmed.ncbi.nlm.nih.gov/9152268/

  While there is significant morbidity and mortality involving patients in semicomatose and comatose states, the care of such patients has traditionally been limited to supportive measures. […] We report two cases of patients treated with methylphenidate hydrochloride: the first, a patient in a semicomatose state resulting from traumatic brain injury, and the second, a patient in a comatose state secondary to a subdural hematoma that occurred after a fall. […] Treatment with methylphenidate may provide neurostimulations by augmenting the activity of injured neuronal tissue within the reticular activating system, and by amplifying the net effect of the reduced number of viable neurons. […] Methylphenidate is a low-cost, potentially efficacious intervention for reducing the duration of comas, for preventing life-threatening and costly complications of prolonged unconsciousness, and for promoting early ambulation and recovery. […] Further research using more rigorous research designs to ascertain the effectiveness of methylphenidate in the treatment of patients in semicomatose and comatose states is needed.

• #20 Induced coma – Wikipedia

  https://en.wikipedia.org/wiki/Induced_coma

  An induced coma also known as a medically induced coma (MIC), barbiturate-induced coma, or drug-induced coma is a temporary coma (a deep state of unconsciousness) brought on by a controlled dose of an anesthetic drug, often a barbiturate such as pentobarbital or thiopental. Other intravenous anesthetic drugs such as midazolam or propofol may be used. […] Drug-induced comas are used to protect the brain during major neurosurgery, as a last line of treatment in certain cases of status epilepticus that have not responded to other treatments, and in refractory intracranial hypertension following traumatic brain injury. […] Considering the high risks of medically induced comas, protocols such as the ABCDEF Bundle and PADIS guidelines have been developed to guide ICU teams to avoid unnecessary sedation and comas. ICU teams that master these protocols to keep patients as awake and mobile as possible are called „Awake and Walking ICUs”. These are teams that only implement medically induced comas when the possible benefits of sedation outweigh the high risks during specific cases.

• #21 Coma: Types, Causes, Treatment, Recovery, and Outlook

  https://www.verywellhealth.com/coma-8644695

  A coma is a state of deep unconsciousness in which a person is unresponsive for a prolonged time. […] In some situations, a medically induced coma may help prevent brain damage, improving the chances of survival and reducing the likelihood of long-term disability. […] A coma is a state of unconsciousness caused by altered brain function and can also be medically induced in certain situations as a method of protecting the brain. […] Treatment depends on how long a person has been in a coma, the cause, and the likelihood of recovery. […] Often, particularly when there is a high chance of recovery, the person is cared for in the intensive care unit, where close medical monitoring and quick medication adjustments are possible. […] Corticosteroids or diuretics (water pills) can reduce brain swelling. Additionally, support for breathing, blood pressure, and heart function is usually necessary to maintain survival and prevent further brain injury.

• #22 MEDICALLY INDUCED COMA: WHAT IT IS, HOW IT WORKS, WHO BENEFITS, AND RECOVERY OUTCOMES | Mya Care

  https://myacare.com/blog/medically-induced-coma-what-it-is-how-it-works-who-benefits-and-recovery-outcomes

  A medically induced coma is a reversible state of deep unresponsiveness that is brought about by sedative administration in an attempt to protect the brain from traumatic damage. […] A medically induced coma is often only used as a last, life-saving resort in the emergency ward of the hospital. A coma is medically induced to protect brain function in cases of traumatic injury. […] In severe cases of status epilepticus, the doctor may resort to treating a patient with a medically induced coma. In this instance, it can help to reduce seizure duration and promote a quicker resolution of the condition, as indicated by shorter hospital stays and time spent in ICU. […] The drugs used to induce a medical coma typically work by suppressing the networks used to generate consciousness, allowing the brain to rest and regenerate more efficiently.

• #23 Induced Coma – Bolton NHS FT

  https://www.boltonft.nhs.uk/induced-coma/

  The term induced coma is commonly used to describe the state of sedation that some patients on critical care are temporarily placed into, most commonly in order to facilitate therapies like going onto a ventilator. […] Patients are only kept in an induced coma for as long as is required, which can range from a matter of hours to several weeks. […] An induced coma is not a specific treatment for any illness it is merely a requirement for being able to offer a patient ventilation, which is itself only a form of breathing support to give the body time to recover from whatever insult it has sustained. […] Like with any therapy, there are risks associated with being placed into an induced coma, but these are outweighed by the intended benefits.

• #24 Induced coma – Wikipedia

  https://en.wikipedia.org/wiki/Induced_coma

  An induced coma also known as a medically induced coma (MIC), barbiturate-induced coma, or drug-induced coma is a temporary coma (a deep state of unconsciousness) brought on by a controlled dose of an anesthetic drug, often a barbiturate such as pentobarbital or thiopental. Other intravenous anesthetic drugs such as midazolam or propofol may be used. […] Drug-induced comas are used to protect the brain during major neurosurgery, as a last line of treatment in certain cases of status epilepticus that have not responded to other treatments, and in refractory intracranial hypertension following traumatic brain injury. […] Considering the high risks of medically induced comas, protocols such as the ABCDEF Bundle and PADIS guidelines have been developed to guide ICU teams to avoid unnecessary sedation and comas. ICU teams that master these protocols to keep patients as awake and mobile as possible are called „Awake and Walking ICUs”. These are teams that only implement medically induced comas when the possible benefits of sedation outweigh the high risks during specific cases.

• #25 MEDICALLY INDUCED COMA: WHAT IT IS, HOW IT WORKS, WHO BENEFITS, AND RECOVERY OUTCOMES | Mya Care

  https://myacare.com/blog/medically-induced-coma-what-it-is-how-it-works-who-benefits-and-recovery-outcomes

  Recovery from a coma depends on the areas of the brain that are affected and how well the brain manages to prevent secondary injury as a result of prolonged faulty brain energy metabolism. […] Medical experts are trained to monitor the patient throughout the entire process to minimize the risk of complications. Keeping the patient at a cooler temperature is known to minimize potential brain damage and maximize recovery. […] A medically induced coma renders a person reversibly unconscious on anesthetic sedatives in an attempt to minimize damage, trauma, and pain. It is mostly used as a last resort in ICU and emergency wards to treat patients with traumatic brain injury, prolonged seizures, or after cardiac arrest.

• #26 Induced coma – Wikipedia

  https://en.wikipedia.org/wiki/Induced_coma

  Survivors of prolonged medically induced comas are at high risk of suffering from post-ICU syndrome and may require extended physical, cognitive, and psychological rehabilitation. […] Some studies have found that barbiturate-induced coma can reduce intracranial hypertension but does not necessarily prevent brain damage. Furthermore, the reduction in intracranial hypertension may not be sustained. Some randomized trials have failed to demonstrate any survival or morbidity benefit of induced coma in diverse conditions such as neurosurgical operations, head trauma, intracranial aneurysm rupture, intracranial hemorrhage, ischemic stroke, and status epilepticus. If the patient survives, cognitive impairment may also follow recovery from the coma. Due to these risks, barbiturate-induced coma should be reserved for cases of refractory intracranial pressure elevation.

• #27 Induced coma – Wikipedia

  https://en.wikipedia.org/wiki/Induced_coma

  An induced coma also known as a medically induced coma (MIC), barbiturate-induced coma, or drug-induced coma is a temporary coma (a deep state of unconsciousness) brought on by a controlled dose of an anesthetic drug, often a barbiturate such as pentobarbital or thiopental. Other intravenous anesthetic drugs such as midazolam or propofol may be used. […] Drug-induced comas are used to protect the brain during major neurosurgery, as a last line of treatment in certain cases of status epilepticus that have not responded to other treatments, and in refractory intracranial hypertension following traumatic brain injury. […] Considering the high risks of medically induced comas, protocols such as the ABCDEF Bundle and PADIS guidelines have been developed to guide ICU teams to avoid unnecessary sedation and comas. ICU teams that master these protocols to keep patients as awake and mobile as possible are called „Awake and Walking ICUs”. These are teams that only implement medically induced comas when the possible benefits of sedation outweigh the high risks during specific cases.

• #28 Coma | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/coma/

  A patient may be placed into a coma while in the intensive care unit (ICU) as part of their treatment. This might be called an induced coma. […] In the short term, a person in a coma will normally be looked after in an ICU. Their treatment will include: supporting their bodily functions (like breathing) and treating the underlying cause of the coma. […] In the longer term, healthcare staff will give supportive treatment on a hospital ward. This can involve: providing nutrition (things like vitamins, protein and water that everyone needs to survive), trying to prevent infections, preventing bedsores by moving the person, gently exercising their joints to stop them becoming tight. […] If someone is in a coma for a long time, they may have a tracheostomy put in to keep their airway open. This allows them to receive better mouth care (for example, toothbrushing) and means they can be moved to a long-term ward for supportive care.

• #29 Coma: Types, Causes, Treatments, Prognosis

  https://www.webmd.com/brain/coma-types-causes-treatments-prognosis

  Certain drugs may also help relieve the swelling. […] Supportive care for someone in a coma is meant to keep them as comfortable as possible and to prevent complications. These support measures include: […] Nutrition. Although the person is in a coma, they still need good nutrition and adequate fluids. This means they will likely need a feeding or gastric tube that will supply the liquid nutrition directly to the stomach. […] Skin care. Because the person can’t move on their own, they are at a high risk of pressure injuries (bed sores). […] Bowel and bladder. Someone in a coma has no control over their bowel or bladder. […] Muscle and joint contractures. Limiting muscles from contracting, causing joints to turn in, is an important part of care. Regular „range of motion” exercises are simple exercises that guide the limbs through natural motions. Splints may also help the joints from contracting.

• #30 Coma Signs, Types, Causes, Prevention & Treatment

  https://www.emedicinehealth.com/coma/article_em.htm

  What Is the Treatment for a Coma? At the outset of a coma, it is important to diagnose and treat the underlying cause. Depending on the severity of the coma, the patient may require life-saving resuscitative measures. Once medically stable, treatments can be used to correct the underlying problem that is causing the coma. […] For patients in a prolonged coma, or persistent vegetative state, the focus is on preventing infections, providing nutrition, and maintaining the patient’s physical health. This includes proper nutrition and prevention of infections such as pneumonia (a common cause of death in those in a long-term coma) and bedsores. Sometimes, physical therapy is administered to prevent bone, joint, or muscle deformities. […] In general, a coma is temporary, rarely lasting more than two to four weeks. After emerging from a coma, the prognosis is varied and typically depends upon the cause of the coma and the severity of the brain injury. […] For those who do recover, recovery is usually gradual. Many patients can recover fully. Some require lifelong physical and occupational therapy, while others may recover only basic functions.

• #31 Brain Injury Overview | Centre for Neuro Skills

  https://www.neuroskills.com/brain-injury/brain-injury-overview/coma/

  A coma is a profound or deep state of unconsciousness. The affected individual is alive but is not able to react or respond to life around him/her. Coma may occur as an expected progression or complication of an underlying illness, or as a result of an event such as head trauma. […] Once the patient is out of immediate danger, although still in coma or vegetative state, the medical care team will concentrate on preventing infections and maintaining the patient’s physical state as much as possible. Such maintenance includes preventing pneumonia and bed sores and providing balanced nutrition. Physical therapy may also be used to prevent contractures (permanent muscular contractions) and orthopedic deformities that would limit recovery for the patients who emerge from coma. […] The outcome for coma and vegetative state depends on the cause and on the location, severity, and extent of neurological damage: outcomes range from recovery to death. People may emerge from a coma with a combination of physical, intellectual, and psychological difficulties that need special attention. Recovery usually occurs gradually, with patients acquiring more and more ability to respond. Some patients never progress beyond very basic responses, but many recover full awareness. Patients recovering from coma require close medical supervision. A coma rarely lasts more than 2 to 4 weeks. Some patients may regain a degree of awareness after vegetative state. Others may remain in a vegetative state for years or even decades. The most common cause of death for a person in a vegetative state is infection such as pneumonia. […] The NINDS supports research on neurological conditions such as coma and persistent vegetative state. This research is aimed at finding ways to prevent, treat, and cure these conditions.

• #32

  https://carexperts-homenursing.com/coma-patient-physiotherapy-treatment/

  Physiotherapy emerges as a vital component of careits role extends beyond preserving physical functions to ignite the spark of consciousness potentially. […] Physiotherapy aims to prevent the complications of prolonged immobility in coma patients. These goals include maintaining muscle mass and joint range of motion, preventing contractures and bedsores, and providing sensory stimulation that may encourage a return to consciousness. […] Before beginning any physiotherapy, a comprehensive assessment is critical. […] Physiotherapy for coma patients typically includes passive range-of-motion exercises to keep joints flexible and muscles from shortening and atrophying. […] The primary challenge in treating coma patients is the uncertainty of their perception and the subtlety of their responses.

• #33

  https://carexperts-homenursing.com/coma-patient-physiotherapy-treatment/

  Physiotherapy plays a critical role in maintaining the physical health of coma patients by preventing muscle atrophy and joint stiffness, reducing the risk of pressure sores, and providing sensory stimulation that may aid in regaining consciousness. […] Techniques include passive range of motion exercises, positioning and repositioning schedules, use of tilt tables to aid in vertical positioning, and multi-sensory stimulation, such as tactile, auditory, and visual stimuli. […] Physiotherapy is tailored to each individuals needs and condition. […] Progress is measured through physical responses, changes in muscle tone, joint mobility, and any signs of increased responsiveness or arousal. […] Advances include using technology such as robotic-assisted devices, virtual reality for sensory stimulation, and research into more effective stimulation techniques to encourage responsiveness. […] Yes, once a patient regains consciousness, physiotherapy continues to be vital in aiding their rehabilitation, helping to restore strength, mobility, and function as part of the recovery process.

• #34 Physical Therapy For Coma Victims – Advance Physical Therapy in Wantagh, New York

  https://advance-pt.com/physical-therapy-for-coma-victims/

  If your loved one has recently suffered from an event that has put them in a coma, dont hesitate to contact Advance Physical Therapy in Wantagh, NY once they have regained consciousness to begin their journey to recovery. […] When a person emerges out of a coma, physical therapy is an instrumental segment on the road to recovery. […] Physical therapy is a crucial way for individuals who have gone through a coma to improve their motor skills and stimulate brain function. […] Physical therapy has long been overlooked for the role it plays in rehabilitating individuals who have experienced a life-altering brain injury and other disorders of consciousness (DOC). […] Once conscious (blinking, breathing, and other small signals) the best way to stimulate motor improvement is to pursue physical therapy.

• #35 Physical Therapy For Coma Victims – Advance Physical Therapy in Wantagh, New York

  https://advance-pt.com/physical-therapy-for-coma-victims/

  Physical therapy is strongly recommended to begin almost immediately once the patient is showing minimal signs of consciousness. […] Engaging in this type of rehabilitation has manifested diminishing time of hospital stay, length of recovery, and the chance of contracting infections such as bronchitis, thrombosis, and pneumonia. […] The good news is the damage that a brain injury brings upon somebody can be overcome and restored with physical treatment.

• #36 What is a Coma? Duration, Recovery, and Brain Damage Risk

  https://brainfoundation.org.au/disorders/coma/

  Coma is a state of unconsciousness in which the person doesnt respond their environment. Treatment will vary a lot depending on the cause of the coma, and your stage of recovery. […] Initial treatment will depend on the cause of the coma and will be directed at preventing further damage to the brain. […] Once stable and no longer in immediate danger then further treatment will be directed at maintaining the patients physical condition and preventing complications. […] While not empirically validated, families have reported benefits from arousal regimes, such as those implemented by Dr Ted Freeman (eg Coma Arousal Therapy). The therapy involves family members taking the patient through a regimen of controlled auditory, visual and physical stimulation for up to six hours a day, every day.

• #37

  https://journals.lww.com/neur/fulltext/2017/65020/description_of_coma_and_coma_arousal_therapy_in.5.aspx

  The description of coma and coma arousal therapy in Caraka Sahit is described in stra 24, verses 4253. It describes the definition of coma, differential diagnosis of coma from other disorders of consciousness, signs of coma, etiology of coma, coma arousal therapy, and emergence from coma. The similarities and differences of these aspects of coma from the perspective of its interpretation in modern medicine are discussed in this article. […] Coma is one of the dreaded neurological symptoms. It is defined as a state of unresponsiveness in which the patient lies with eyes closed and cannot be aroused to respond appropriately to stimuli, even with vigorous stimulation. […] The therapies described to arouse a person from coma are classified as physical and chemical (medicinal). The physical therapies mentioned are ajana (antimomy) application of collyrium, avapa nasya nasal drops of juice extracts of herbs to produce sneezing, and dhma smoke. Other physical therapies mentioned are needles and hot applications on the skin, painful stimuli on the nail bed, plucking of the hair, biting with teeth, and rubbing of hairy fruits, the tmagupt (velvet bean), on the skin to provoke itching. The Sahit mentions that various types of strong alcoholic drinks mixed with other drugs of pungent taste should be carefully put in the mouth frequently. The physician should further administer the juice of mtulug (sweet lime citrus decumana/citrus limon), mahauadha (ginger), asafoetida, and black pepper until the patient regains consciousness.

• #38 MED.00011 Sensory Stimulation for Brain-Injured Individuals in Coma or Vegetative State

  https://www.anthem.com/dam/medpolicies/abcbs/active/policies/mp_pw_a049947.html

  This document addresses sensory stimulation for brain-injured individuals in a coma or vegetative state. Sensory stimulation is intended to enhance the rehabilitative potential of brain-injured individuals. Protocols may involve stimulation of any or all of the following senses: visual, auditory, olfactory, gustatory, cutaneous and kinesthetic. […] Sensory stimulation (also known as: coma stimulation sessions, coma arousal therapy, multisensory stimulation programs and coma care) for brain injured individuals in a coma or vegetative state is considered investigational and not medically necessary. […] It has been proposed that comatose individuals treated with intense and repeated stimulation following very precise protocols could awaken earlier from coma and return to a higher level of functioning.

• #39 MED.00011 Sensory Stimulation for Brain-Injured Individuals in Coma or Vegetative State

  https://www.anthem.com/dam/medpolicies/abcbs/active/policies/mp_pw_a049947.html

  The authors concluded that sensory stimulation, transcranial magnetic stimulation, and transcranial direct current stimulation can significantly improve outcomes for individuals with DOC, with sensory stimulation showing the greatest effect. […] The effect of sensory stimulation on the DOC state of coma and/or vegetative state alone was not reported on in this review, thus minimally conscious states, which are outside the scope of this policy, were included in the analysis. […] The intensity of multisensory stimulation programs varies. Programs range from one or two cycles of stimulation daily (approximately 1 hour each), to hourly stimulation cycles, lasting approximately 15-20 minutes, for 12-14 hours per day, 6 days a week. […] A stimulus is considered successful if the individual grimaces or moves.

• #40 MED.00011 Sensory Stimulation for Brain-Injured Individuals in Coma or Vegetative State

  https://www.anthem.com/dam/medpolicies/abcbs/active/policies/mp_pw_a049947.html

  The authors concluded that sensory stimulation, transcranial magnetic stimulation, and transcranial direct current stimulation can significantly improve outcomes for individuals with DOC, with sensory stimulation showing the greatest effect. […] The effect of sensory stimulation on the DOC state of coma and/or vegetative state alone was not reported on in this review, thus minimally conscious states, which are outside the scope of this policy, were included in the analysis. […] The intensity of multisensory stimulation programs varies. Programs range from one or two cycles of stimulation daily (approximately 1 hour each), to hourly stimulation cycles, lasting approximately 15-20 minutes, for 12-14 hours per day, 6 days a week. […] A stimulus is considered successful if the individual grimaces or moves.

• #41 COMA AROUSAL THERAPY – Neuro-Rehab Program

  https://www.sarvodayahospital.com/blog/coma-arousal-therapy-neuro-rehab-program

  People who survive Accidental Brain Injuries often land in the state of altered sensorium (loss of consciousness) commonly referred to as coma. […] Recovering from a severe brain injury requires the right treatment, at right time and a lot of rest to rebuild neural connections lost or damaged from trauma or illness. At the same time, the consistent and appropriate practice of multi-sensory stimulation to help the patient return from a coma state can be an integral step in the recovery process. […] The practice of coma stimulation/coma arousal therapy has increased in the past few years and helped many patients recover from traumatic brain injuries sooner. […] The ideal time to initiate coma stimulation is once the patient is medically stable and has been transferred to an inpatient facility. Sensory stimulation intends to raise the level of consciousness and promote the recovery of the patient.

• #42 COMA AROUSAL THERAPY – Neuro-Rehab Program

  https://www.sarvodayahospital.com/blog/coma-arousal-therapy-neuro-rehab-program

  Coma stimulation therapy should be initiated as soon as the patient is medically stable. Initiating multisensory stimulation during an acute hospital stay may result in increased functional abilities, (sitting, reaching out for objects, etc.) while delay in rehabilitation program may result in the missed window of opportunity that cannot be regained.

• #43 COMA AROUSAL THERAPY – Neuro-Rehab Program

  https://www.sarvodayahospital.com/blog/coma-arousal-therapy-neuro-rehab-program

  Coma stimulation therapy should be initiated as soon as the patient is medically stable. Initiating multisensory stimulation during an acute hospital stay may result in increased functional abilities, (sitting, reaching out for objects, etc.) while delay in rehabilitation program may result in the missed window of opportunity that cannot be regained.

• #44 Innovative treatment methods for coma patients

  https://kliniken-schmieder.com/news/coma-patients/

  With the Brain Stimulation Center (BSC) at the clinic site in Allensbach, Kliniken Schmieder created an innovative treatment offer for patients in coma or with disorders of consciousness, like Minimally Conscious State (MSC) or Unresponsive Wakefulness Syndrome. […] The non-invasive brain stimulation helps to increase the activity of the nerve cells in the brain. Depending on the type of disease as well as the needs of the patient, it can be done pharmacological or non-pharmacological with transcranial Direct Current Stimulation (tDCS) and Transcranial Magnetic Stimulation (TMS). […] Besides an interdisciplinary rehabilitation treatment, patients in the Brain Stimulation Center receive intensive cognitive training, to support the recovery of the brain functions. To ensure that the treatment is state-of-the-art and based on the latest scientific findings, Kliniken Schmieder work together with external specialists like the Coma Science Group.

• #45

  https://journals.lww.com/neur/fulltext/2017/65020/description_of_coma_and_coma_arousal_therapy_in.5.aspx

  In modern medicine, the persistence of coma, particularly in hypoxia and traumatic brain injury, has lead researchers to find treatment for arousal from coma. The modern medical treatment for coma arousal can also be divided into the physical and chemical (pharmacological) forms. The physical modalities used for coma arousal are sensory stimulation, music therapy, median nerve electrical stimulation, dorsal column stimulation, transcranial magnetic stimulation, and hyperbaric oxygen. The pharmacological therapy for coma arousal mainly includes dopaminergic drugs such as amantadine, bromocriptine, and levodopa/carbidopa. However, other drugs such as GABAergic medications, methylphenidate, antidepressants, and antiepileptics have also been tried. All of these therapies have a variable level of evidence to support their use in clinical practice, and in the recent future, the awakening drugs does not seem to be a real possibility in the realm of clinical medicine.

• #46 Scientists jump-start two people’s brains after coma | UCLA

  https://newsroom.ucla.edu/releases/ucla-scientists-jump-start-brains-after-coma

  In 2016, a team led by UCLAs Martin Monti reported that a 25-year-old man recovering from a coma had made remarkable progress following a treatment to jump-start his brain using ultrasound. […] Now, Monti and colleagues report that two more patients with severe brain injuries both had been in what scientists call a long-term minimally conscious state have made impressive progress thanks to the same technique. […] The paper notes that of three people who received the treatment, one a 58-year-old man who had been in a car accident five-and-a-half years prior to treatment and was minimally conscious did not benefit. However, the other two did. […] Importantly, Monti said, these behaviors are diagnostic markers of emergence from a disorder of consciousness. […] Both patients showed the ability to understand speech.

• #47 Scientists jump-start two people’s brains after coma | UCLA

  https://newsroom.ucla.edu/releases/ucla-scientists-jump-start-brains-after-coma

  This is what we hoped for, but it is stunning to see it with your own eyes. Seeing two of our three patients who had been in a chronic condition improve very significantly within days of the treatment is an extremely promising result. […] The scientists used a technique called low-intensity focused ultrasound, which uses sonic stimulation to excite the neurons in the thalamus, an egg-shaped structure that serves as the brains central hub for processing. […] Monti hopes to eventually translate the technology into an inexpensive, portable device so the treatment could be delivered not only at state-of-the-art medical centers, but also at patients homes, to help wake up patients from a minimally conscious or vegetative state. […] While the scientists are excited by the results, they emphasize that the technique is still experimental and likely will not be available to the public for at least a few years. For now, there is little that can be done to help patients recover from a severe brain injury that results in either a chronic vegetative state or a minimally conscious state, Monti said.

• #48 Permanent Coma Patient Re-Learned to Speak via Coordination Dynamics Therapy

  http://www.fortunejournals.com/articles/permanent-coma-patient-relearned-to-speak-via-coordination-dynamics-therapy.html

  Permanent Coma Patient Re-Learned to Speak via Coordination Dynamics Therapy. Following an extreme severe brain injury in a car accident, a 22-year-old male patient lost approximate 50% of the brain and switched into the permanent coma state. One year after the accident coordination dynamics therapy (CDT) was started with 20 hours per week. Following 3 years of CDT he started to reach slowly the minimally consciousness state. Following 5 years of CDT, he was fully out-of-coma. Some movement functions re-appeared and he became able to communicate with the surrounding. Following 5.5 years of CDT he could move better and say the word ‘ma’ instead of mama. It was hoped that he could re-learn a few words. Through 5.7 years of intensive CDT, he rather suddenly became able to speak again. He could precisely repeat every word in English or Greek (mother tongue), but he was not able to have a conversation. The cognitive functions were still missing. Following 6 years of CDT the patient Manolis became able to exercise a bit on the special CDT device by himself. His higher mental functions, including memory, improved and he became able to communicate via speech. Because of the speeding up of the repair, when the patient was fully out-of-coma, more brain repair seems possible through further intensive CDT. It is discussed with respect to repair in spinal cord injury and cerebral palsy why such tremendous brain repair was possible.

• #49 Permanent coma patient re-learned to speak via coordination dynamics therapy

  https://www.oatext.com/permanent-coma-patient-re-learned-to-speak-via-coordination-dynamics-therapy.php

  Following an extreme severe brain injury in a car accident, a 22-year-old male patient lost approximate 50% of the brain and switched into the permanent coma state. One year after the accident coordination dynamics therapy (CDT) was stated with 20 hours per week. Following 3 years of CDT he started to reach slowly the minimally consciousness state. Following 5 years of CDT, he was fully out-of-coma. […] CDT is an efficient movement-based-learning treatment to repair the human brain and can also be applied to coma patients. […] The CDT of the coma patient consisted mainly of the exercising on the special CDT device for improving mainly the impaired phase and frequency coordination […] Following 3 to 5 years of CDT with 20 hours therapy per week, Manolis came via the minimally consciousness state out-of-coma.

• #50 Permanent Coma Patient Re-Learned to Speak via Coordination Dynamics Therapy

  http://www.fortunejournals.com/articles/permanent-coma-patient-relearned-to-speak-via-coordination-dynamics-therapy.html

  CDT is an efficient movement-based-learning treatment to repair the human brain and can also be applied to coma patients. The movement-based learning therapy of the coma patient consisted mainly of exercising passively on a special CDT device for improving mainly the impaired phase and frequency coordination and sky-walking to train the walking and the upright position for counter-acting an orthostasis syndrome. Additional conventional physiotherapy and speech therapy were administered to the patient. When the patient was fully out-of-coma, additional movements were trained as playing with a ball or activating old-learned movements like playing violin. When the speech was repaired, all kinds of communication were trained. […] It has been shown that CDT can improve or repair central nervous system (CNS) functioning after stroke, traumatic brain injury, spinal cord injury, cerebellar injury, cerebral palsy, hypoxic brain injury, in Parkinson’s disease, spina bifida (myelomeningocele) and scoliosis. Speech had been induced and improved in a patient with severe cerebral palsy and urinary bladder functions were repaired in patients with spinal cord injury. In patients with cancer, especially breast cancer, cancer growth inhibition could be achieved via CDT. The cardio-vascular performance was repaired in a patient with a very severe brain injury (Manolis) during the first years of CDT. It seems therefore that CDT can improve CNS functioning in every case, even in the extreme case, and since the nervous system is involved in nearly all body functions, CDT can improve/repair human health in general.

• #51 Permanent Coma Patient Re-Learned to Speak via Coordination Dynamics Therapy

  http://www.fortunejournals.com/articles/permanent-coma-patient-relearned-to-speak-via-coordination-dynamics-therapy.html

  CDT is an efficient movement-based-learning treatment to repair the human brain and can also be applied to coma patients. The movement-based learning therapy of the coma patient consisted mainly of exercising passively on a special CDT device for improving mainly the impaired phase and frequency coordination and sky-walking to train the walking and the upright position for counter-acting an orthostasis syndrome. Additional conventional physiotherapy and speech therapy were administered to the patient. When the patient was fully out-of-coma, additional movements were trained as playing with a ball or activating old-learned movements like playing violin. When the speech was repaired, all kinds of communication were trained. […] It has been shown that CDT can improve or repair central nervous system (CNS) functioning after stroke, traumatic brain injury, spinal cord injury, cerebellar injury, cerebral palsy, hypoxic brain injury, in Parkinson’s disease, spina bifida (myelomeningocele) and scoliosis. Speech had been induced and improved in a patient with severe cerebral palsy and urinary bladder functions were repaired in patients with spinal cord injury. In patients with cancer, especially breast cancer, cancer growth inhibition could be achieved via CDT. The cardio-vascular performance was repaired in a patient with a very severe brain injury (Manolis) during the first years of CDT. It seems therefore that CDT can improve CNS functioning in every case, even in the extreme case, and since the nervous system is involved in nearly all body functions, CDT can improve/repair human health in general.

• #52 Permanent Coma Patient Re-Learned to Speak via Coordination Dynamics Therapy

  http://www.fortunejournals.com/articles/permanent-coma-patient-relearned-to-speak-via-coordination-dynamics-therapy.html

  Permanent Coma Patient Re-Learned to Speak via Coordination Dynamics Therapy. Following an extreme severe brain injury in a car accident, a 22-year-old male patient lost approximate 50% of the brain and switched into the permanent coma state. One year after the accident coordination dynamics therapy (CDT) was started with 20 hours per week. Following 3 years of CDT he started to reach slowly the minimally consciousness state. Following 5 years of CDT, he was fully out-of-coma. Some movement functions re-appeared and he became able to communicate with the surrounding. Following 5.5 years of CDT he could move better and say the word ‘ma’ instead of mama. It was hoped that he could re-learn a few words. Through 5.7 years of intensive CDT, he rather suddenly became able to speak again. He could precisely repeat every word in English or Greek (mother tongue), but he was not able to have a conversation. The cognitive functions were still missing. Following 6 years of CDT the patient Manolis became able to exercise a bit on the special CDT device by himself. His higher mental functions, including memory, improved and he became able to communicate via speech. Because of the speeding up of the repair, when the patient was fully out-of-coma, more brain repair seems possible through further intensive CDT. It is discussed with respect to repair in spinal cord injury and cerebral palsy why such tremendous brain repair was possible.

• #53 Permanent coma patient re-learned to speak via coordination dynamics therapy

  https://www.oatext.com/permanent-coma-patient-re-learned-to-speak-via-coordination-dynamics-therapy.php

  Following an extreme severe brain injury in a car accident, a 22-year-old male patient lost approximate 50% of the brain and switched into the permanent coma state. One year after the accident coordination dynamics therapy (CDT) was stated with 20 hours per week. Following 3 years of CDT he started to reach slowly the minimally consciousness state. Following 5 years of CDT, he was fully out-of-coma. […] CDT is an efficient movement-based-learning treatment to repair the human brain and can also be applied to coma patients. […] The CDT of the coma patient consisted mainly of the exercising on the special CDT device for improving mainly the impaired phase and frequency coordination […] Following 3 to 5 years of CDT with 20 hours therapy per week, Manolis came via the minimally consciousness state out-of-coma.

• #54 Permanent Coma Patient Re-Learned to Speak via Coordination Dynamics Therapy

  http://www.fortunejournals.com/articles/permanent-coma-patient-relearned-to-speak-via-coordination-dynamics-therapy.html

  Permanent Coma Patient Re-Learned to Speak via Coordination Dynamics Therapy. Following an extreme severe brain injury in a car accident, a 22-year-old male patient lost approximate 50% of the brain and switched into the permanent coma state. One year after the accident coordination dynamics therapy (CDT) was started with 20 hours per week. Following 3 years of CDT he started to reach slowly the minimally consciousness state. Following 5 years of CDT, he was fully out-of-coma. Some movement functions re-appeared and he became able to communicate with the surrounding. Following 5.5 years of CDT he could move better and say the word ‘ma’ instead of mama. It was hoped that he could re-learn a few words. Through 5.7 years of intensive CDT, he rather suddenly became able to speak again. He could precisely repeat every word in English or Greek (mother tongue), but he was not able to have a conversation. The cognitive functions were still missing. Following 6 years of CDT the patient Manolis became able to exercise a bit on the special CDT device by himself. His higher mental functions, including memory, improved and he became able to communicate via speech. Because of the speeding up of the repair, when the patient was fully out-of-coma, more brain repair seems possible through further intensive CDT. It is discussed with respect to repair in spinal cord injury and cerebral palsy why such tremendous brain repair was possible.

• #55 Permanent Coma Patient Re-Learned to Speak via Coordination Dynamics Therapy

  http://www.fortunejournals.com/articles/permanent-coma-patient-relearned-to-speak-via-coordination-dynamics-therapy.html

  Actually, two important steps were achieved in this formerly permanent coma patient. The first step was to get him fully out-of-coma and the second to make him speak and communicate again. A third step would be to reach the meaningful life state. The very big therapy effort was to get him fully out of the coma through approximately 5-years of CDT. The speech, including memory and improvement of cognitive functions, were achieved with less effort, namely with approximately one year of CDT. […] Such tremendous repair achieved via CDT, especially in the permanent coma case, seems only possible if the epigenetic regulation for repair had been substantially activated by movement-based learning. CDT had induced the stimulation of those pathways that regulate neural network repair. Epigenetic mechanisms, stimulated by physiologic network activation, are likely key players within signaling networks, as DNA methylation, chromatin remodeling and small non-coding RNAs superfamily and are required for the fine-tuning and coordination of gene expression during neural network repair by learning. The complexity of the epigenetic regulation is tremendous.

• #56 Permanent coma patient re-learned to speak via coordination dynamics therapy

  https://www.oatext.com/permanent-coma-patient-re-learned-to-speak-via-coordination-dynamics-therapy.php

  The big therapy effort was to get him fully out of the permanent coma through approximately 5-years CDT. The speech was achieved with less effort, namely with approximately 1-year CDT. […] It has been shown that CDT can also improve or repair central nervous system (CNS) functioning after stroke, traumatic brain injury, spinal cord injury, cerebellar injury, cerebral palsy, hypoxic brain injury, in Parkinsons disease, spina bifida and scoliosis. […] Such tremendous repair achieved via CDT, especially in the permanent coma case, seems only possible if the epigenetic regulation for repair had been substantially activated by movement-based learning.

• #57

  https://journals.lww.com/neur/fulltext/2017/65020/description_of_coma_and_coma_arousal_therapy_in.5.aspx

  The verses 5153 describe treatments for patients emerging from coma. It mentions that, after the patient regains consciousness, he should be given a light diet. Thereafter, his consciousness should be maintained by various psychological and physical devices, and his mind should be diverted from the etiological factors that were responsible for the unconsciousness. He should be made to remember some surprising events, hear pleasing songs, and music. He should be exposed to a joyous environment of agreeable talk, narration of stories and reminiscences, and music and songs of an enchanting landscape. […] In modern medicine, it has been shown that patients in a minimally conscious state activate higher-order cortical areas. Though there are no strong evidence-based recommendations for coma arousal, uncontrolled studies indicate that some rehabilitative procedures can promote the recovery of consciousness, especially in patients in a minimally conscious state.

• #58 What is a Coma? Duration, Recovery, and Brain Damage Risk

  https://brainfoundation.org.au/disorders/coma/

  Coma is a state of unconsciousness in which the person doesnt respond their environment. Treatment will vary a lot depending on the cause of the coma, and your stage of recovery. […] Initial treatment will depend on the cause of the coma and will be directed at preventing further damage to the brain. […] Once stable and no longer in immediate danger then further treatment will be directed at maintaining the patients physical condition and preventing complications. […] While not empirically validated, families have reported benefits from arousal regimes, such as those implemented by Dr Ted Freeman (eg Coma Arousal Therapy). The therapy involves family members taking the patient through a regimen of controlled auditory, visual and physical stimulation for up to six hours a day, every day.

• #59 Coma | healthdirect

  https://www.healthdirect.gov.au/coma

  A coma is a medical emergency and the person in the coma needs urgent treatment in hospital. If someone is unconscious or not responding to you, call triple-zero (000) and ask for an ambulance immediately. […] Someone in a coma needs intensive care in hospital. They may need help with breathing. They will be fed through a tube and they will receive blood and fluids through a drip inserted into their vein. […] Sometimes doctors put a person into a medically induced coma with medicines. This helps their brain to keep functioning after an injury and saves the patient from feeling extreme pain. […] Although it has not been scientifically proven, families of people who have been in a coma say that talking to them, playing their favourite music and stimulating them can help them to wake up.

• #60 Coma | healthdirect

  https://www.healthdirect.gov.au/coma

  A coma is a medical emergency and the person in the coma needs urgent treatment in hospital. If someone is unconscious or not responding to you, call triple-zero (000) and ask for an ambulance immediately. […] Someone in a coma needs intensive care in hospital. They may need help with breathing. They will be fed through a tube and they will receive blood and fluids through a drip inserted into their vein. […] Sometimes doctors put a person into a medically induced coma with medicines. This helps their brain to keep functioning after an injury and saves the patient from feeling extreme pain. […] Although it has not been scientifically proven, families of people who have been in a coma say that talking to them, playing their favourite music and stimulating them can help them to wake up.

• #61

  https://journals.lww.com/neur/fulltext/2017/65020/description_of_coma_and_coma_arousal_therapy_in.5.aspx

  The verses 5153 describe treatments for patients emerging from coma. It mentions that, after the patient regains consciousness, he should be given a light diet. Thereafter, his consciousness should be maintained by various psychological and physical devices, and his mind should be diverted from the etiological factors that were responsible for the unconsciousness. He should be made to remember some surprising events, hear pleasing songs, and music. He should be exposed to a joyous environment of agreeable talk, narration of stories and reminiscences, and music and songs of an enchanting landscape. […] In modern medicine, it has been shown that patients in a minimally conscious state activate higher-order cortical areas. Though there are no strong evidence-based recommendations for coma arousal, uncontrolled studies indicate that some rehabilitative procedures can promote the recovery of consciousness, especially in patients in a minimally conscious state.

• #62 Coma | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/coma/

  Some people will make a full recovery and be completely unaffected by the coma. Others will have disabilities caused by the damage to their brain. They may need physiotherapy, occupational therapy, psychological assessment, and support while theyre recovering. They may also need care for the rest of their lives.

• #63 Coma | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/coma/

  Some people will make a full recovery and be completely unaffected by the coma. Others will have disabilities caused by the damage to their brain. They may need physiotherapy, occupational therapy, psychological assessment, and support while theyre recovering. They may also need care for the rest of their lives.

• #64 Awakening Hope

  https://www.curingcoma.org/

  In 2019 the Neurocritical Care Society launched Curing Coma as its signature clinical, scientific, and public health effort. Curing Coma is the first global public health initiative to tackle the unifying concept of coma as a treatable medical entity. The goal of Curing Coma is to develop and implement coma treatment strategies that improve human lives. […] The Innovative Treatments in Disorders of Consciousness (ITDC) program provided two $400,000 grants to researchers at Brigham and Womens Hospital and Baylor College of Medicine to spur cutting-edge research and improve treatment options for people with traumatic brain injuries (TBIs) who experience disorders of consciousness like coma. […] The grants are the first to be awarded by Spauldings recently launched Innovative Treatments in Disorders of Consciousness (ITDC) program, in collaboration with the Curing Coma Campaign of the Neurocritical Care Society.

• #65 Top Coma Experts Develop Three-Part Plan to Improve Patient Outcomes | UVA Today

  https://news.virginia.edu/content/top-coma-experts-develop-three-part-plan-improve-patient-outcomes

  Leading coma experts have created an ambitious plan to help doctors better care for comatose patients and answer that most awful question: Will my loved one wake up? […] The three-part plan outlines key steps physicians and researchers should take in the coming years to improve patient care and deepen our understanding of coma and other conditions that reduce consciousness. […] This research endeavor aims to help patients and families dealing with the consequences of brain damage gain clarity about the current chances for improvement and maintain hope that, in the future, there will be treatments to help recover consciousness. […] The plans first recommendation is to better classify and understand different types of coma and their causes. […] The council also urges the development of better indicators of patient prognosis.

• #66 Awakening Hope

  https://www.curingcoma.org/

  In 2019 the Neurocritical Care Society launched Curing Coma as its signature clinical, scientific, and public health effort. Curing Coma is the first global public health initiative to tackle the unifying concept of coma as a treatable medical entity. The goal of Curing Coma is to develop and implement coma treatment strategies that improve human lives. […] The Innovative Treatments in Disorders of Consciousness (ITDC) program provided two $400,000 grants to researchers at Brigham and Womens Hospital and Baylor College of Medicine to spur cutting-edge research and improve treatment options for people with traumatic brain injuries (TBIs) who experience disorders of consciousness like coma. […] The grants are the first to be awarded by Spauldings recently launched Innovative Treatments in Disorders of Consciousness (ITDC) program, in collaboration with the Curing Coma Campaign of the Neurocritical Care Society.

• #67 A cure for coma? | Hub

  https://hub.jhu.edu/2022/07/25/researchers-aim-to-better-understand-comas-and-recovery/

  Terry Wallis had been unable to respond to the world since 1984, when the truck he was riding in veered off an Arkansas bridge and crashed, tires up, into the creek bed below. […] A coma can be caused by traumatic brain injury (TBI), stroke, cardiac event, and complications from other illnesses, including COVID-19. Comas can also be induced intentionally to give the brain time to heal until swelling and pressure which can cut off blood flow to the brain can recede. […] But what if coma were considered, like diseases, something that could be treated? Launched in 2019 by the Neurocritical Care Society, the Curing Coma Campaign is the first to address coma as a treatable medical issue, bringing together researchers from Johns Hopkins and around the globe to better understand the condition and improve outcomes for those like Wallis, who died this spring at 57.

• #68 A cure for coma? | Hub

  https://hub.jhu.edu/2022/07/25/researchers-aim-to-better-understand-comas-and-recovery/

  The campaign aims to convey that individuals who have experienced coma can indeed recover, while its researchers work to develop new strategies for diagnosis and treatment. […] The Curing Coma effort also wants to explore biomarkers, such as molecular and cellular markers shown under brain scans, that can indicate neurological health. These tools help health care providers make earlier diagnoses and understand both the current level of a person’s consciousness and how they might be responding to interventions, such as medications or noninvasive brain stimulations, two approaches that are under study. […] Adults, too, can recover after coma and other disorders of consciousness. […] Being able to better forecast coma outcomes and ease people into consciousness sooner could result not only in better outcomes but also in lower costs. […] The Curing Coma Campaign aims to help coma patients and their families find the answers that are within reach.

• #69 Top Coma Experts Develop Three-Part Plan to Improve Patient Outcomes | UVA Today

  https://news.virginia.edu/content/top-coma-experts-develop-three-part-plan-improve-patient-outcomes

  Leading coma experts have created an ambitious plan to help doctors better care for comatose patients and answer that most awful question: Will my loved one wake up? […] The three-part plan outlines key steps physicians and researchers should take in the coming years to improve patient care and deepen our understanding of coma and other conditions that reduce consciousness. […] This research endeavor aims to help patients and families dealing with the consequences of brain damage gain clarity about the current chances for improvement and maintain hope that, in the future, there will be treatments to help recover consciousness. […] The plans first recommendation is to better classify and understand different types of coma and their causes. […] The council also urges the development of better indicators of patient prognosis.

• #70 Top Coma Experts Develop Three-Part Plan to Improve Patient Outcomes | UVA Today

  https://news.virginia.edu/content/top-coma-experts-develop-three-part-plan-improve-patient-outcomes

  Finally, the council urges clinical trials of new therapies to promote recovery of consciousness for intensive-care patients who are in comas or suffering from other forms of reduced consciousness. […] We envision that a principled, mechanistic approach to predicting and measuring responses to new therapies in the ICU could allow clinicians to provide targeted treatments that are personalized to each patient, ensuring that each patient is given the best possible chance to recover consciousness in the ICU and beyond. […] With this initiative, we hope to be able to treat patients in a coma the way we treat patients with strokes and heart attacks. […] In the future, having impaired consciousness from brain injury wont be the lifelong medical condition it is now.

• #71 Top Coma Experts Develop Three-Part Plan to Improve Patient Outcomes | UVA Today

  https://news.virginia.edu/content/top-coma-experts-develop-three-part-plan-improve-patient-outcomes

  Leading coma experts have created an ambitious plan to help doctors better care for comatose patients and answer that most awful question: Will my loved one wake up? […] The three-part plan outlines key steps physicians and researchers should take in the coming years to improve patient care and deepen our understanding of coma and other conditions that reduce consciousness. […] This research endeavor aims to help patients and families dealing with the consequences of brain damage gain clarity about the current chances for improvement and maintain hope that, in the future, there will be treatments to help recover consciousness. […] The plans first recommendation is to better classify and understand different types of coma and their causes. […] The council also urges the development of better indicators of patient prognosis.

• #72 Prognosis and Therapy after Cardiac Arrest-Induced Coma | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/prognosis-and-therapy-after-cardiac-arrest-induced-coma/2009-08

  The role of a neurologist in these circumstances is to provide as much prognostic information as possible to help guide the decisions of both the family and the medical team. […] After the Levy Criteria were published, physicians could deliver more accurate prognostic information to families of patients with cerebral ischemia after cardiac arrest, but until recently there was little that could be done therapeutically for these patients besides treating underlying pathologies, maintaining respiration and circulation, and providing other supportive care. […] In 2002, however, two studies were published, showing that patients who were made mildly hypothermic (to a temperature between 32 degrees and 34 degrees Celsius) for 12 to 24 hours following resuscitation after arrest due to ventricular fibrillation had significantly better long-term neurologic outcomes than patients who were kept normothermic.

• #73 Prognosis and Therapy after Cardiac Arrest-Induced Coma | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/prognosis-and-therapy-after-cardiac-arrest-induced-coma/2009-08

  Therapeutic hypothermia can provide real benefit to some patients and represents the first proven therapy to prevent brain damage after cardiac arrest. […] Research in the field of post-anoxic interventions is ongoing and in the near future we hope to be able to offer these patients scientifically proven therapies, in addition to our best prognostic efforts.

• #74 Prognosis and Therapy after Cardiac Arrest-Induced Coma | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/prognosis-and-therapy-after-cardiac-arrest-induced-coma/2009-08

  Therapeutic hypothermia can provide real benefit to some patients and represents the first proven therapy to prevent brain damage after cardiac arrest. […] Research in the field of post-anoxic interventions is ongoing and in the near future we hope to be able to offer these patients scientifically proven therapies, in addition to our best prognostic efforts.

• #75 Coma – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/coma/symptoms-causes/syc-20371099

  Coma is a medical emergency. Quick action is needed to preserve life and brain function. […] Healthcare professionals typically order a series of blood tests and a brain scan to try to learn what’s causing the coma so that proper treatment can begin. […] A coma doesn’t usually last longer than several weeks. People who are unconscious for a longer time might transition to a lasting vegetative state, known as a persistent vegetative state, or brain death. […] A coma is a medical emergency. Seek immediate medical care for the person in a coma. […] Although many people gradually recover from a coma, others enter a persistent vegetative state or die. Some people who recover from a coma end up with major or minor disabilities.

• #76 Coma: Types, Causes, Treatment, Recovery, and Outlook

  https://www.verywellhealth.com/coma-8644695

  After recovery from a coma, rehabilitation can help to strengthen breathing muscles and build muscle strength and control. Many coma survivors will also need speech and swallow therapy. […] Many people can recover from a coma. If your loved one is in a medically induced coma, they are more likely to have a full recovery because the coma-inducing medication can be reversed when they become medically stable. […] Recovery from a coma depends on many factors individual to the person and the cause of the coma. […] Waking up from a coma is usually a gradual process. […] If your loved one is waking up from a coma, remain patient and anticipate a slow recovery. […] A head injury is the most clear-cut risk factor for a coma. […] Additionally, health conditions that can lead to rapid alterations in metabolism can also cause a coma.

• #77 Coma – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/coma/symptoms-causes/syc-20371099

  Coma is a medical emergency. Quick action is needed to preserve life and brain function. […] Healthcare professionals typically order a series of blood tests and a brain scan to try to learn what’s causing the coma so that proper treatment can begin. […] A coma doesn’t usually last longer than several weeks. People who are unconscious for a longer time might transition to a lasting vegetative state, known as a persistent vegetative state, or brain death. […] A coma is a medical emergency. Seek immediate medical care for the person in a coma. […] Although many people gradually recover from a coma, others enter a persistent vegetative state or die. Some people who recover from a coma end up with major or minor disabilities.

• #78 Coma and reduced awareness states | Headway

  https://www.headway.org.uk/about-brain-injury/individuals/effects-of-brain-injury/coma-and-reduced-awareness-states/

  Whether it lasts for a few seconds or a few weeks, the usual immediate effect of brain injury is a loss of consciousness. Coma can be defined as a state of depressed consciousness where a person is unresponsive to the outside world. […] Recovery from coma is a gradual process, starting with the person’s eyes opening, then responding to pain, and then responding to speech. People do not just wake up from a coma, and say, 'Where am I?’ as is sometimes portrayed in films. The length of coma is one of the most accurate predictors of the severity of long-term symptoms. The longer the coma, the greater the likelihood of residual symptoms, particularly physical disabilities, although this is only a guide and some people can make good recoveries after an extended period in a coma. […] Post-traumatic amnesia (PTA) is the time after a period of unconsciousness when the injured person is conscious and awake, but is behaving or talking in a bizarre or uncharacteristic manner.

• #79 Coma: Types, Causes, Treatment, Recovery, and Outlook

  https://www.verywellhealth.com/coma-8644695

  After recovery from a coma, rehabilitation can help to strengthen breathing muscles and build muscle strength and control. Many coma survivors will also need speech and swallow therapy. […] Many people can recover from a coma. If your loved one is in a medically induced coma, they are more likely to have a full recovery because the coma-inducing medication can be reversed when they become medically stable. […] Recovery from a coma depends on many factors individual to the person and the cause of the coma. […] Waking up from a coma is usually a gradual process. […] If your loved one is waking up from a coma, remain patient and anticipate a slow recovery. […] A head injury is the most clear-cut risk factor for a coma. […] Additionally, health conditions that can lead to rapid alterations in metabolism can also cause a coma.

• #80 Coma and reduced awareness states | Headway

  https://www.headway.org.uk/about-brain-injury/individuals/effects-of-brain-injury/coma-and-reduced-awareness-states/

  Whether it lasts for a few seconds or a few weeks, the usual immediate effect of brain injury is a loss of consciousness. Coma can be defined as a state of depressed consciousness where a person is unresponsive to the outside world. […] Recovery from coma is a gradual process, starting with the person’s eyes opening, then responding to pain, and then responding to speech. People do not just wake up from a coma, and say, 'Where am I?’ as is sometimes portrayed in films. The length of coma is one of the most accurate predictors of the severity of long-term symptoms. The longer the coma, the greater the likelihood of residual symptoms, particularly physical disabilities, although this is only a guide and some people can make good recoveries after an extended period in a coma. […] Post-traumatic amnesia (PTA) is the time after a period of unconsciousness when the injured person is conscious and awake, but is behaving or talking in a bizarre or uncharacteristic manner.

• #81 Coma: Types, Causes, Treatment, Recovery, and Outlook

  https://www.verywellhealth.com/coma-8644695

  After recovery from a coma, rehabilitation can help to strengthen breathing muscles and build muscle strength and control. Many coma survivors will also need speech and swallow therapy. […] Many people can recover from a coma. If your loved one is in a medically induced coma, they are more likely to have a full recovery because the coma-inducing medication can be reversed when they become medically stable. […] Recovery from a coma depends on many factors individual to the person and the cause of the coma. […] Waking up from a coma is usually a gradual process. […] If your loved one is waking up from a coma, remain patient and anticipate a slow recovery. […] A head injury is the most clear-cut risk factor for a coma. […] Additionally, health conditions that can lead to rapid alterations in metabolism can also cause a coma.

• #82 Recovering from a Coma: Steps and Challenges

  https://lonestarneurology.net/blog/coma-recovery/

  A coma is a terrible condition. It is life-threatening for many people and puts relatives under severe stress. And what a joy it is when a person finally recovers from a coma. […] Recovery from a coma requires taking steps to regain consciousness, relearning skills, and understanding how the persons body was affected by this traumatic event. […] Recovery from a coma is a long and often complex process. Brain damage can range from mild to severe. Thus, it is difficult for us to predict recovery time as well as the severity of the effects. […] It usually takes several months for people to come out of a coma. During this time, they regain consciousness and respond to what is happening. After another short period, the person can fully recover their cognitive abilities. […] The body may also need physical rehabilitation therapy. It will restore the strength and reflexes lost during this time. […] Recovery from a coma can sometimes be discouraging. But with proper care and support, patients can make significant progress. And very soon, patients will be able to return to everyday life. […] With proper care and support, full recovery from a coma is possible.

• #83 Recovering from a Coma: Steps and Challenges

  https://lonestarneurology.net/blog/coma-recovery/

  A coma is a terrible condition. It is life-threatening for many people and puts relatives under severe stress. And what a joy it is when a person finally recovers from a coma. […] Recovery from a coma requires taking steps to regain consciousness, relearning skills, and understanding how the persons body was affected by this traumatic event. […] Recovery from a coma is a long and often complex process. Brain damage can range from mild to severe. Thus, it is difficult for us to predict recovery time as well as the severity of the effects. […] It usually takes several months for people to come out of a coma. During this time, they regain consciousness and respond to what is happening. After another short period, the person can fully recover their cognitive abilities. […] The body may also need physical rehabilitation therapy. It will restore the strength and reflexes lost during this time. […] Recovery from a coma can sometimes be discouraging. But with proper care and support, patients can make significant progress. And very soon, patients will be able to return to everyday life. […] With proper care and support, full recovery from a coma is possible.

• #84 Recovering from a Coma: Steps and Challenges

  https://lonestarneurology.net/blog/coma-recovery/

  A coma is a terrible condition. It is life-threatening for many people and puts relatives under severe stress. And what a joy it is when a person finally recovers from a coma. […] Recovery from a coma requires taking steps to regain consciousness, relearning skills, and understanding how the persons body was affected by this traumatic event. […] Recovery from a coma is a long and often complex process. Brain damage can range from mild to severe. Thus, it is difficult for us to predict recovery time as well as the severity of the effects. […] It usually takes several months for people to come out of a coma. During this time, they regain consciousness and respond to what is happening. After another short period, the person can fully recover their cognitive abilities. […] The body may also need physical rehabilitation therapy. It will restore the strength and reflexes lost during this time. […] Recovery from a coma can sometimes be discouraging. But with proper care and support, patients can make significant progress. And very soon, patients will be able to return to everyday life. […] With proper care and support, full recovery from a coma is possible.

• #85 Diabetic coma | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/diabetic-coma

  The 3 types of diabetic coma include diabetic ketoacidosis coma, hyperosmolar coma and hypoglycaemic coma. […] Diabetic coma is a medical emergency and needs prompt medical treatment. […] Treatment options for diabetic coma include: ketoacidotic coma intravenous fluids, insulin and administration of potassium, hyperosmolar coma intravenous fluids, insulin, potassium and sodium given as soon as possible, hypoglycaemic coma an injection of glucagon (if available) to reverse the effects of insulin or administration of intravenous glucose.

• #86 Diabetes-Related Coma: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/16628-diabetic-coma

  A diabetes-related coma is a life-threatening complication that can result from very high blood sugar (hyperglycemia) or very low blood sugar (hypoglycemia). A person in a diabetes-related coma needs immediate medical attention. Call 911 or your local emergency number. […] If you dont get treatment for HHS in time, it can lead to a coma. […] If you dont get treatment for DKA in time, it can lead to a coma. […] Prolonged severe hypoglycemia thats not treated in time can lead to a coma. […] Three diabetes complications can lead to a coma if you dont get proper treatment for them in time, including: Hyperosmolar hyperglycemic state (HHS), Diabetes-related ketoacidosis (DKA), Severe low blood sugar (hypoglycemia). […] HHS and DKA can both cause severe dehydration, which can trigger a coma. As your brain needs glucose to function, a severe lack of glucose from low blood sugar can cause your brain to shut down and go into a coma.

• #87 Diabetes-Related Coma: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/16628-diabetic-coma

  The treatment for a diabetes-related coma depends on the cause. But all cases need treatment in a hospital. […] Treatment for a diabetes-related coma due to DKA or HHS includes: IV fluids, Insulin, Other treatments. […] Treatment for diabetes-related coma due to severe low blood sugar includes: Emergency glucagon. […] Its crucial to know the early warning signs of DKA, HHS and low blood sugar to prevent a diabetes-related coma. […] Yes, its possible to survive a diabetes-related coma if you get treatment for the underlying cause. But some people have permanent brain damage. If you dont get proper treatment in time, you can die. […] The length of a diabetes-related coma depends largely on how quickly you receive proper treatment. The only possible way to end this kind of coma is to return to healthy blood glucose and insulin levels, which only happens with treatment by medical professionals.

• #88 Myxedema coma – UpToDate

  https://www.uptodate.com/contents/myxedema-coma

  Myxedema coma is defined as severe hypothyroidism leading to decreased mental status, hypothermia, and other symptoms related to slowing of function in multiple organs. It is a medical emergency with a high mortality rate. Fortunately, it is now a rare presentation of hypothyroidism, likely due to earlier diagnosis as a result of the widespread availability of thyroid-stimulating hormone (TSH) assays. […] Early recognition and therapy of myxedema coma are essential. Treatment should be initiated on the basis of clinical suspicion without waiting for laboratory results. Important clues to the possible presence of myxedema coma in a poorly responsive patient are the presence of a thyroidectomy scar or a history of radioiodine therapy or hypothyroidism. A history obtained from family members often reveals antecedent symptoms of thyroid dysfunction followed by progressive lethargy, stupor, and coma. […] The clinical presentation, diagnosis, and treatment of myxedema coma will be reviewed here.

• #89 Myxedema Coma or Crisis Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/123577-treatment

  Myxedema coma is a life-threatening condition; therefore, patients with this disorder should be managed in an intensive care unit (ICU). If the diagnosis is considered likely, immediate and aggressive administration of multiple interventions is necessary to lower the high mortality rate. Initial priorities include the following. […] Supportive care includes the following: Cardiac monitoring in an ICU is advised. Correction of hypothermia with passive rewarming using blankets – Active external rewarming is not recommended as it can cause vasodilatation and worsen hypotension; temperature is usually determined using a rectal probe to assess the true core temperature and monitor rewarming. Mechanical ventilation – If indicated by the clinical status and levels of respiratory acidosis, hypercapnia, and hypoxia. Intravenous (IV) fluids with normal saline and glucose – Usually needed given that patients are generally hypovolemic; however, these should be carefully administered as some patients may have volume overload and concomitant congestive heart failure; hypertonic saline should be considered in cases of severely hyponatremic patients; if hypotension does not respond to IV fluids, vasopressors can be considered. Correction of hypoglycemia with IV dextrose. Empiric administration of antibiotics should be considered until appropriate cultures are proven negative.

• #90 Myxedema Coma or Crisis Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/123577-treatment

  Myxedema coma is a life-threatening condition; therefore, patients with this disorder should be managed in an intensive care unit (ICU). If the diagnosis is considered likely, immediate and aggressive administration of multiple interventions is necessary to lower the high mortality rate. Initial priorities include the following. […] Supportive care includes the following: Cardiac monitoring in an ICU is advised. Correction of hypothermia with passive rewarming using blankets – Active external rewarming is not recommended as it can cause vasodilatation and worsen hypotension; temperature is usually determined using a rectal probe to assess the true core temperature and monitor rewarming. Mechanical ventilation – If indicated by the clinical status and levels of respiratory acidosis, hypercapnia, and hypoxia. Intravenous (IV) fluids with normal saline and glucose – Usually needed given that patients are generally hypovolemic; however, these should be carefully administered as some patients may have volume overload and concomitant congestive heart failure; hypertonic saline should be considered in cases of severely hyponatremic patients; if hypotension does not respond to IV fluids, vasopressors can be considered. Correction of hypoglycemia with IV dextrose. Empiric administration of antibiotics should be considered until appropriate cultures are proven negative.

• #91 Myxedema Coma or Crisis Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/123577-treatment

  Because of the rarity of myxedema coma, randomized trials comparing different treatment modalities are not available. There is no agreement on the type of thyroid hormone preparation to prescribe (levothyroxine [T4] alone, liothyronine [T3] alone, or T4 and T3 combined), or on the dose, frequency, and route of administration. […] Because gastrointestinal absorption may be compromised, IV thyroid therapy is initially advised. T3 has a quicker onset of action and greater biologic activity than T4. In addition, the conversion of T4 to T3 is usually impaired in hypothyroidism and in the setting of severe systemic illness. […] We suggest the administration of both T4 and T3 in the treatment of myxedema coma. An IV T4 loading dose of 4 mcg/kg (200-400 mcg) is followed by a daily IV dose of 50-100 mcg; the daily dose can be switched to the oral route when the patient can take medications by mouth. T3 is given intravenously at the same time, at an initial dose of 5-20 mcg, followed by 2.5 to 10 mcg every 8-12 hours, with lower doses prescribed for older patients and those with cardiovascular disease.

• #92 Myxedema Coma or Crisis Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/123577-treatment

  Because of the rarity of myxedema coma, randomized trials comparing different treatment modalities are not available. There is no agreement on the type of thyroid hormone preparation to prescribe (levothyroxine [T4] alone, liothyronine [T3] alone, or T4 and T3 combined), or on the dose, frequency, and route of administration. […] Because gastrointestinal absorption may be compromised, IV thyroid therapy is initially advised. T3 has a quicker onset of action and greater biologic activity than T4. In addition, the conversion of T4 to T3 is usually impaired in hypothyroidism and in the setting of severe systemic illness. […] We suggest the administration of both T4 and T3 in the treatment of myxedema coma. An IV T4 loading dose of 4 mcg/kg (200-400 mcg) is followed by a daily IV dose of 50-100 mcg; the daily dose can be switched to the oral route when the patient can take medications by mouth. T3 is given intravenously at the same time, at an initial dose of 5-20 mcg, followed by 2.5 to 10 mcg every 8-12 hours, with lower doses prescribed for older patients and those with cardiovascular disease.

• #93 Insulin shock therapy – Wikipedia

  https://en.wikipedia.org/wiki/Insulin_shock_therapy

  Insulin shock therapy or insulin coma therapy was a form of psychiatric treatment in which patients were repeatedly injected with large doses of insulin in order to produce daily comas over several weeks. […] Insulin coma therapy was a labour-intensive treatment that required trained staff and a special unit. […] The daily insulin dose was gradually increased to 100-150 units until comas were produced, at which point the dose would be levelled out. […] A few psychiatrists (including Sakel) claimed success rates for insulin coma therapy of over 80% in the treatment of schizophrenia. […] The hypoglycemia that resulted from insulin coma therapy made patients extremely restless, sweaty, and liable to further convulsions and „after-shocks”. […] Insulin coma therapy was used in most hospitals in the US and the UK during the 1940s and 1950s. […] By the 1970s, insulin shock therapy had mostly fallen out of use in the United States, though was still practiced in some hospitals. […] Recent articles about insulin coma treatment have attempted to explain why it was given such uncritical acceptance.

• #94 Insulin shock therapy | Description, Uses, Effects, & Decline | Britannica

  https://www.britannica.com/science/insulin-shock-therapy

  insulin shock therapy, form of psychiatric treatment in which patients were given increasingly large doses of insulin in order to induce hypoglycemia (low blood glucose) and coma. Insulin shock therapy was based on the notion that hypoglycemia-induced coma could basically jolt patients out of their psychoses. […] The idea for insulin shock therapy was conceived in the 1920s by Polish psychiatrist Manfred Sakel, who accidentally administered too much insulin to a patient with a morphine addiction, triggering convulsions and coma in the patient. […] Sakel began testing his theory in patients with schizophrenia in the late 1920s, administering the drug in doses high enough to not only induce unconsciousness but also sometimes trigger convulsions, which he considered to be beneficial in certain cases.

• #95 Insulin shock therapy – Wikipedia

  https://en.wikipedia.org/wiki/Insulin_shock_therapy

  Insulin shock therapy or insulin coma therapy was a form of psychiatric treatment in which patients were repeatedly injected with large doses of insulin in order to produce daily comas over several weeks. […] Insulin coma therapy was a labour-intensive treatment that required trained staff and a special unit. […] The daily insulin dose was gradually increased to 100-150 units until comas were produced, at which point the dose would be levelled out. […] A few psychiatrists (including Sakel) claimed success rates for insulin coma therapy of over 80% in the treatment of schizophrenia. […] The hypoglycemia that resulted from insulin coma therapy made patients extremely restless, sweaty, and liable to further convulsions and „after-shocks”. […] Insulin coma therapy was used in most hospitals in the US and the UK during the 1940s and 1950s. […] By the 1970s, insulin shock therapy had mostly fallen out of use in the United States, though was still practiced in some hospitals. […] Recent articles about insulin coma treatment have attempted to explain why it was given such uncritical acceptance.

• #96 Insulin shock therapy – Wikipedia

  https://en.wikipedia.org/wiki/Insulin_shock_therapy

  Insulin shock therapy or insulin coma therapy was a form of psychiatric treatment in which patients were repeatedly injected with large doses of insulin in order to produce daily comas over several weeks. […] Insulin coma therapy was a labour-intensive treatment that required trained staff and a special unit. […] The daily insulin dose was gradually increased to 100-150 units until comas were produced, at which point the dose would be levelled out. […] A few psychiatrists (including Sakel) claimed success rates for insulin coma therapy of over 80% in the treatment of schizophrenia. […] The hypoglycemia that resulted from insulin coma therapy made patients extremely restless, sweaty, and liable to further convulsions and „after-shocks”. […] Insulin coma therapy was used in most hospitals in the US and the UK during the 1940s and 1950s. […] By the 1970s, insulin shock therapy had mostly fallen out of use in the United States, though was still practiced in some hospitals. […] Recent articles about insulin coma treatment have attempted to explain why it was given such uncritical acceptance.

• #97 Insulin shock therapy | Description, Uses, Effects, & Decline | Britannica

  https://www.britannica.com/science/insulin-shock-therapy

  Despite a lack of scientific evidence to support the effectiveness or safety of insulin shock therapy, the treatment quickly became popular and was adopted by psychiatrists in countries worldwide, including Canada, China, Korea, the United Kingdom, and the United States. […] Patients experienced various effects during and after insulin shock therapy. Immediately following injection, patients exhibited a range of symptoms, including pallor, sweating, and restlessness, followed by deep sleep and finally coma. […] Treatment also sometimes resulted in death; estimates of the fatality rate of insulin shock therapy vary from 1 to nearly 5 percent. […] Insulin shock therapy was considered by its proponents to be highly effective in the treatment of schizophrenia; however, in many cases schizophrenic patients were selected for therapy because they were considered to be so ill that any change in their mental stateincluding changes that today are considered hallmarks of brain damagecould be claimed as an improvement. By the 1950s, however, insulin shock therapy was rapidly falling out of use.

• #98

  https://link.springer.com/article/10.1007/s12028-021-01425-8

  Although coma is commonly encountered in critical care, worldwide variability exists in diagnosis and management practices. […] The primary objective of the Coma Epidemiology, Evaluation, and Therapy (COME TOGETHER) survey was to assess international variability of defining coma clinical features and etiology and to identify current practices for diagnosis, management, and prognosis of comatose patients across underlying disease and mechanisms of coma. […] The most common clinical assessment tools used for coma included the GCS (94%) and neurological examination (78%). […] Sixty-six percent of respondents routinely performed sedation interruption, in the absence of contraindications, for clinical coma assessments in the intensive care unit. […] The leading determinants for prognostication included etiology of coma, neurological examination findings, and neuroimaging.

• #99

  https://link.springer.com/article/10.1007/s12028-021-01425-8

  There is wide heterogeneity among health care professionals regarding the clinical definition of coma and limited routine use of advanced coma assessment techniques in acute care settings. […] Coma management practices vary across sites, and mechanisms for coordinated and sustained follow-up after acute treatment are inconsistent. […] There is an urgent need for the development of evidence-based guidelines and a collaborative, coordinated approach to advance both the science and the practice of coma management globally.

• #100

  https://link.springer.com/article/10.1007/s12028-021-01425-8

  There is wide heterogeneity among health care professionals regarding the clinical definition of coma and limited routine use of advanced coma assessment techniques in acute care settings. […] Coma management practices vary across sites, and mechanisms for coordinated and sustained follow-up after acute treatment are inconsistent. […] There is an urgent need for the development of evidence-based guidelines and a collaborative, coordinated approach to advance both the science and the practice of coma management globally.

• #101

  https://link.springer.com/article/10.1007/s12028-021-01425-8

  There is wide heterogeneity among health care professionals regarding the clinical definition of coma and limited routine use of advanced coma assessment techniques in acute care settings. […] Coma management practices vary across sites, and mechanisms for coordinated and sustained follow-up after acute treatment are inconsistent. […] There is an urgent need for the development of evidence-based guidelines and a collaborative, coordinated approach to advance both the science and the practice of coma management globally.

• #102 Top Coma Experts Develop Three-Part Plan to Improve Patient Outcomes | UVA Today

  https://news.virginia.edu/content/top-coma-experts-develop-three-part-plan-improve-patient-outcomes

  Finally, the council urges clinical trials of new therapies to promote recovery of consciousness for intensive-care patients who are in comas or suffering from other forms of reduced consciousness. […] We envision that a principled, mechanistic approach to predicting and measuring responses to new therapies in the ICU could allow clinicians to provide targeted treatments that are personalized to each patient, ensuring that each patient is given the best possible chance to recover consciousness in the ICU and beyond. […] With this initiative, we hope to be able to treat patients in a coma the way we treat patients with strokes and heart attacks. […] In the future, having impaired consciousness from brain injury wont be the lifelong medical condition it is now.

• #103 Recovering from a Coma: Steps and Challenges

  https://lonestarneurology.net/blog/coma-recovery/

  A coma is a terrible condition. It is life-threatening for many people and puts relatives under severe stress. And what a joy it is when a person finally recovers from a coma. […] Recovery from a coma requires taking steps to regain consciousness, relearning skills, and understanding how the persons body was affected by this traumatic event. […] Recovery from a coma is a long and often complex process. Brain damage can range from mild to severe. Thus, it is difficult for us to predict recovery time as well as the severity of the effects. […] It usually takes several months for people to come out of a coma. During this time, they regain consciousness and respond to what is happening. After another short period, the person can fully recover their cognitive abilities. […] The body may also need physical rehabilitation therapy. It will restore the strength and reflexes lost during this time. […] Recovery from a coma can sometimes be discouraging. But with proper care and support, patients can make significant progress. And very soon, patients will be able to return to everyday life. […] With proper care and support, full recovery from a coma is possible.

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