Coma is the inability to waken or react to the surrounding environment. The Glasgow Coma Scale is frequently used to measure the depth of coma. Causes of coma include trauma, bleeding, edema, lack of oxygen, poisoning, or hypoglycemia. Prognosis for a patient in a coma depends on the cause of the coma.
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Coma is a state of decreased consciousness whereby a patient cannot react with the
surrounding environment. The patient cannot be easily wakened when outside physical or
auditory stimulation are applied. Patients may have different levels of unconsciousness and unresponsiveness
depending upon how much or how little of the brain is functioning. Patients in
coma do not voluntarily interact with their environment.
The inability to waken differentiates coma from sleep.
What is the Glasgow Coma Scale?
The Glasgow Coma Scale was developed to provide health-caregivers a
simple way of measuring the depth of coma based upon observations of eye
opening, speech, and movement. Patients in the deepest level of coma:
respond with any body movement to pain,
do not have any speech, and
do not open
Those in lighter coma may offer some response to a verbal or painful stimulus, to the point they may
even seem wake, yet meet the criteria of coma because they do not respond to
their environment by initiating voluntary actions.
The Glasgow Coma Scale is used as part of the initial evaluation of a patient, but does not
assist in making the diagnosis as to the cause of coma. Since it "scores" the
level of coma, the Glasgow Coma Scale can be used as a standard method for any health care
professional to assess change in the patient's mental status over time.
The best use of the Glasgow Coma Scale is to allow caregivers of different clinical skills and training to consistently assess a patient over longer periods of time in order to determine whether the patient is improving, deteriorating, or
remaining the same. In the initial care of a comatose patient, chronologically, there may be first responders,
emergency medical technicians (EMTs), paramedics, nurses, emergency physicians, neurologists,
and neurosurgeons, all evaluating the same patient in different places at
different times. The
Glasgow Coma Scale allows a standard assessment that can be shared.
Glasgow Coma Scale
To loud voice
Withdraws from pain
Abnormal flexion posturing
A fully awake patient has a Glasgow Coma Score of 15. A person who is
dead has a Glasgow Coma Scale of 3 (there is no lower score).
Sports and Concussions: What Are the Recommendations?
When it comes to making recommendations, doctors' organizations tend to come
late to the game, calling press conferences to state the obvious. The American Academy of Neurology
that "any athlete who is suspected to have suffered a concussion should be
removed from participation until he or she is evaluated by a physician with
training in the evaluation and management of sports concussions." The Academy's
position also includes an educational component to increase concussion education
for parents, athletes, and coaches; and reminds us that players should not
return to competition until they had recovered from their injury.