|Brainstem and Cerebrum|
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- Severe head injury—most often a result of car accidents, violence, or falls.
- Brain illness such as:
- Lack of oxygen to the brain which may be due to:
Severe general illness such as:
- Severe bodily infections
- Severe acute liver or kidney failure
- High carbon dioxide levels
- Carbon monoxide poisoning
- Toxicity from poisons, medication, alcohol , or drugs
- Abnormal hormone levels, such as from the thyroid or adrenal gland
- Abnormal blood chemistries, such as sodium or calcium
- Very low or very high levels of blood sugar
- Very low or very high body temperatures
- Severe nutrient deficiency
- Liver failure
- Kidney failure
- Inherited metabolic diseases
- Severe illness
- Liver, kidney, or cardiovascular disease
- Tendency to have blood clots
- Exposure to poisonous substances (such as carbon dioxide)
- Cancer and chemotherapy
- Age: 5 years or younger, 15-24 years old, and 75 years or older
- Sex: male
- Traveling in a vehicle at a high rate of speed or at night
- Lack of sleep
- A previous head injury
No response to stimulus, such as:
Spontaneous body movements, such as:
- Eyes opening and closing
- Irregular breathing
- Blood tests—to check blood glucose levels, organ function and screen for infection and toxic substances
- Urine test—to test for the presence of drugs
Imaging tests, such as:
- Neck x-rays —in cases where head and neck trauma may have occurred, a test that uses radiation to take pictures of structures inside the body
- MRI scan —a test that uses magnetic and radio waves to make pictures of the inside of the body, in this case the brain
- CT scan —a type of x-ray that uses a computer to make pictures of the inside of the head
- SPECT or Xenon—enhanced CT scan to test for blood flow and metabolic activity within the brain
- Electroencephalogram (EEG) —a test that records the brain's activity by measuring electrical currents through the brain
- Spinal tap (lumbar puncture) —removal of a small amount of cerebrospinal fluid to check for pressure, blood, and infection
- Evoked potentials—a test for brain wave activity after stimulation of the sensory nerves (including the auditory nerves) of the body
- 15-13—mild brain injury
- 12-9—moderate brain injury
- 8 or less—a severe brain injury
- Monitoring of vital signs
- Oxygen therapy
- Delivering fluids directly into the blood through an IV
- Ventilator to help support breathing
- Glucose delivered through IV—in case low blood sugar is causing the coma
- Naloxone—if a narcotics overdose is suspected
- Thiamine (vitamin B1) may be given with glucose if alcoholism or malnutrition is suspected
- Wear a seatbelt . Make sure infants and small children are securely fastened in a child safety seat.
- Children aged 12 years and under should ride in the back seat of a vehicle.
- Wear an appropriate helmet while biking, rollerblading, playing contact sports, skiing, snowboarding, and riding a motorcycle.
- Wear athletic mouth guards while playing sports.
- Do not abuse alcohol or drugs .
- If you have diabetes, see your doctor regularly and take appropriate steps to regulate your blood sugar levels.
- If you are ill or take medicine, see your doctor regularly for check-ups.
Brain Injury Association of America http://www.biausa.org
Coma Recovery Association, Inc. http://www.comarecovery.org
Brain Injury Association of Canada http://biac-aclc.ca/
Ontario Brain Injury Association http://www.obia.ca/index.php
Berger, JR. Stupor and coma. In: Bradley WG, et al, eds. Neurology in Clinical Practice . 5th ed. Philadelphia, PA: Butterworth Heinemann Elsevier; 2008.
Braunwald E. Harrison's Principles of Internal Medicine . 15th ed. New York, NY: McGraw-Hill; 2001.
Coma. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 20, 2012. Accessed August 31, 2012.
Hall JB, Schmidt GA, Wood L. Principles of Critical Care . 3rd ed. New York, NY: McGraw-Hill; 2005: chap 67.
- Reviewer: Rimas Lukas, MD
- Review Date: 12/2013 -
- Update Date: 01/13/2014 -