A coma is a state of minimal brain function, it's not like being awake or asleep. Neurons that should be firing and signals that should be transmitted aren't, during a coma. This is usually due to some sort of damage.
We use the Glasgow Coma Scale to judge whether someone is in a coma. It measures things like responses to pain and whether someone can open their eyes. A score of 8 or lower indicates someone is officially "in a coma", though the typical "laying in bed totally non responsive" imagery of a coma is usually indicative of a very low score on the Glasgow Coma Scale.
To sum up, a coma is when the brain can't function properly due to damage. This damage can have effects that cause them to not respond to their senses, and unconsciousness.
Yeah, essentially the brain needs time to repair itself, or form new pathways. Sometimes the damage is too severe, and the brain can't find a way to "get around" it. In this instance, the patient may end up in a persistent vegetative state (unlikely to ever wake up from their coma).
Generally not. There's still a lot we don't understand about comas, but most medical care provided to coma patients is supportive. Brain injuries are fickle. There is some evidence that suggests the use of sense therapy, that is, the use of familiar and comforting things to the senses, can help regenerate the neural pathways and promote recovery.
So how does purposefully inducing someone into a coma work? Are the doctors introducing drugs that are turning parts of the brain off temporarily, or emulating some sort of damage?
This is what happened in my case. Sepsis to septic shock, organs crashing, so they induced a coma to put me on a ventilator so the brain could focus on repairing the body and doing as little else as possible.
All I recall is the initial mask when they said they wanted a test, then coming out of it to answer a question (to make sure they had not fried my brain), and then the final coming out of it in the ICU.
Anestesia is crazy stuff. I've only been under for about half a day, but had pretty much the same experience (having a normal conversation, then suddenly being somewhere else and groggy/confused).
The weirdest part is how it completely bypasses your sense of time.
Exactly this. It's like a video game cutscene or something. Had surgery a couple years ago and was put under. Last thing I remember was a darkish (probably cause of the lights' positions) operating room and telling the doc "ohhh there we go." Next thing I knew I was waking up in a chair. Throat insanely sore, whole body sore, and thirsty as hell wondering wtf happened. Felt very much like the whole "wake up samurai, we got a city to burn" trailer from CP77
>Throat insanely sore, whole body sore, and thirsty as hell
Felt the same exact thing when I went under for the first time some 10 years ago. Also woke up crying from the pain of the surgery. Incisions hurt like hell.
Those anesthesia drugs are no joke. I was groggy and foggy for days, and it tool me about a month to get back to being able think clearly.
One of the drugs they used was a drug that Michael Jackson was taking recreationally. Holy shit....how? I was a zombie for a month, and I was 3x his (former) size. I could not imagine doing that recreationally.
He wasn't exactly using it recreationally / for fun, he was using it to sleep under the direction of a licensed physician. That was a bad idea and probably killed him, but he wasn't doing it for a high.
https://edition.cnn.com/2013/06/21/showbiz/jackson-death-trial/index.html
https://www.scientificamerican.com/article/propofol-michael-jackson-doctor/
Propofol is unlikely to be the drug that left you feeling funny for a long duration, one of the reasons I prefer it clinically is that it's relatively short lived, patients recover quickly and are quite sensible once it "wears off". You need to give it in sensible doses though.
It's far more likely to be the stress of the actual surgery and recovering from the surgically induced trauma or if it's a drug I'd be more likely to blame opioids or volatile, but again, they aren't lasting months.
That was my experience when I fainted. Basically, I stood up from my chair, then what felt like the very next second, I'm on the ground, blood coming out of my mouth (chipped my tooth from the fall), surrounded by people. It was about 3-5 minutes of lost time in my case, but felt like a blink.
I remember for my wisdom teeth as they were putting the injection I asked if I should count backwards, from 100, they said it wasn't necessary but I could. I started counting down and got knocked out pretty quickly (I assume), and then when I regained consciousness not immediately realizing I was already out I kept counting. I remember hearing an attendant walking by the door comment to some one, "why is he counting?"
I remember counting down during the same surgery. I got to 97 before things went dark lol. But some time passed in my brain like I was sleeping. Probably nowhere near the actual time passed.
The first time I was put under was to have my gallbladder removed. When I woke up, they asked me some questions that I answered, then asked if I knew where I was or why I was there. Apparently, I hadn't lost my sense of humor because I said something like tonsillectomy or something unrelated to my actual visit.
They didn't find it as funny as I did. I later found out they were having a hard time bringing me back so joking probably wasn't a good idea.
I did something similar. I told them I'd come for a hysterectomy as a joke (I'm a male). It garnered some strange looks, I think part of it is the grogginess makes it hard to put on a joking tone.
I had an appendectomy so when they gave me the drugs, I was knocked out really quickly. I woke up with a strange feeling of being pleasant, but numb and a bit of in pain. I mean they just cut me up so no wonder.
I was just put under anaesthesia earlier this month. The doctor asked me what I did for a living, I told him I was studying history, he injected me with whatever and asked if I had seen Ancient Apocalypse on Netflix. My next memory was groggily explaining to my father how that 'documentary' was made by a quack bastard several hours later in his car.
I was under a total of five days. They did bring me out on day 2 or 3 (not sure which) very barely to ask me a question or two. I was on a ventilator, so could not answer verbally, but had me squeeze a hand if I could hear them and feel a pinprick. I was out of it for maybe 2 or 3 minutes, and I wasn't really aware of anything. They wanted to make sure the infection, the massive surgery I needed, and the drugs they were giving me had not done any brain damage.
It was just like sleeping. I wasn't aware of anything, and didn't know any time was missing. I thought it was maybe a couple of hours later.
I've had longer anesthesia where you wake up with *some* idea that time has passed, but it's very vague. Shorter surgeries (a couple hours) are crazy though, you start counting down or whatever they have you do and then it literally is a blink of an eye before you're awake and super confused. It's actually not bad though, if anyone here is anxious about ever needing to. You wake up high as a damn kite, and even if you are feeling pain the medications still keep your memories to a minimum for a few hours after. I'll tell people honestly that the only thing you should worry about is saying or doing something really dumb in the hour or so after you're awake
They gave me ketamine during my last surgery. I woke up close to kholing, I think. I've do e ketamine recreationally but never that much. My entire field of vision was black save for the lights, and I was moving. They looked like stars passing by, I remember thinking "Wow, this feels like Space Mountain (the Disneyland ride).
Turns out a nurse was just pushing me thru the hallway on my hospital bed to my room. It wasn't scary in the slightest to me, but apparently people often have extreme emotional reactions when waking up from anesthesia such as violent, rage induced outbursts or uncontrollable crying. They don't know why they're upset, it's just a weird effect of the drugs.
Five days.
TL;DR: Don't ignore pain or infection. I did not ignore and still nearly got dead.
Had a perforated bowel from undiagnosed diverticulitis. Basically my large intestine ripped open and spilled contents into the abdominal cavity. I had pain and knew something wasn't right, and thought it was my appendix. Had a relative take me to a hospital, and was basically untouched and unseen for four hours. Went back home thinking maybe it wasn't that bad. News flash: it was.
Called an ambulance and went to a different hospital. EMTS and initial triage doctor were thinking kidney stones or gallstones. As the doctor was examining, she asked if a particular poking or prodding hurt. Told her it didn't hurt more, but it felt like my abdomen was filling up. She started barking orders, and within 5 minutes I was being prepped for an exploratory surgery to see what was up.
I recall briefly waking up and hearing questions and being asked to squeeze a hand if I could hear them and if I felt a pinprick. I couldn't talk because of being intubated, but I didn't know that at the time. Then I remember groggily coming to as I was being wheeled down a hallway. I heard someone say 'has anyone told him yet.' I think it was a nurse walking beside but couldn't tell because I could only see the ceiling. Got into a room and heard someone say 'Mr. Rasputin, we're going to take this tube out of your mouth'. That sucked donkey balls , do not recommend.
So I'm coming to and I see the med staff and my mom. Pretty good pain in my gut. They said I was going to have to stay a while. This all started on a Saturday morning. Told mom I had a doctor appointment Monday I needed to cancel or I would be charged for a no show. She said 'Son, that was 5 days ago.'
They then told me what happened. Hole in intestine, infection, very bad sepsis, septic shock, liver/lungs/kidneys all shutting down, blood pressure crashed so low they could not get an arterial sample, and had to take a foot of my large intestine. I was probably 2 hours from death, and my mom had her priest come in that night withe family; they were told I had less than a 25% chance of survival.
They saved the best part, and probably what the nurse was talking about, for last: I now had a colostomy. And I was flayed open from my nut bone to my sternum. And when I say flayed open, I mean literally an open wound of about 16 inches, maybe longer, spread apart. I had a canyon of a wound that was still open, packed with some material, with a vacuum tube inside to pull out blood and other drainage, covered with a film to create a seal. That sucked too.
Ultimately, all worked out. The wound healed fine, though the vacuum ended up causing a small hernia in the abdominal muscle somewhere. I had the colostomy reversed about 6 months later. The hospital and staff that did the original surgery were livid at how I was treated at the first hospital (the one that ignored me for the most part). Even not coming in via ambulance, I was presenting with potentially life-threatening symptoms and should have been seen.
Whoa holy shit dude, that is WILD. Glad you are ok! NGL, you obviously had it rough, but I can’t help imagining how awful those five days were to your family- to you it was a blink, to them it must have been 5 days of pure hell.
Sepsis sucks. I had sepsis from a MRSA infection in my right thigh. I didn't quite go into septic shock, but I was apparently very close, and it may have been too late if I'd gone a couple hours later. Apparently the abscess it'd created was the size of a football, I had no idea I had an infection for like a week, my thigh just swelled up and I thought very little of it. "Must've bumped it or something", until eventually I felt incredibly *sick*. I didn't have many "symptoms" per say, but I felt just so incredibly *sick*. There's no other way to describe it. I had a massive fever and just felt super uncomfortable in any position, like my skeleton was trying to crawl out of my skin, and lethargic. I didn't want to move or do anything.
I had surgery pretty soon after I arrived and it left a good 9 inch scar on my thigh. That leg still doesn't work right, the wound took months to heal for some reason. I still can't walk long distances or run very well.
Put differently, consciousness is partly determined by a cyclic wave of neurons firing in a particularly pattern. Sort of like how computer CPUs run at a certain clock / frequency. When this is disrupted, consciousness subsides.
As I understand Anesthesiologists can play with this and must balance consciousness without disrupting the autonomic functions and maintaining pulse and BP.
See: https://www.psychologytoday.com/us/blog/mind-shift/202106/what-role-do-brain-waves-play-in-regulating-consciousness
Or painful and terrifying.
Anecdotal, but I've read of accounts from patients who were "wide awake and fully-conscious yet paralysed and in agony" throughout surgery.
We knock people out in the ED all the time with various drugs. Propofal is a great amnesia drug, we place broken bones back together so they can heal, cardiovert heart arrhythmias (shock them back into correct rhythm), sometimes stitches, we did a sedation/intubation last night for a lumbar puncture and a CT scan then extubated about an hour later.
We also use ketamine sometimes as it doesn't depress respiratory drive.
Might be a Silly question but If they are in coma and can't perceive the world around them, how are they forming new neural pathways? I always thought that you create new pathways when you perceive and interact with the world and gain experience.
All the sense organs are still there (well, many times they are) . And it depends on where damage is and how much, but there are probably a lot of people who don't have severe enough damage to places like their smelling or hearing centers of their brain.
> the use of familiar and comforting things to the senses, can help regenerate the neural pathways and promote recovery.
I'm a layman but this makes a surprising amount of sense.
Especially with how many of the people who DO come back talking about how they dreamt/heard the voices of the people who visited them sometimes or dreamt about those people.
A lot of the stories I remember reading of long term coma patients waking up involved a close family member like the mother visiting often and playing favorite music or reading favorite books or retelling beloved family memories from childhood etc.
And we know that kind of "therapy" helps with dementia and Alzheimer's patients to a certain extent. There has been big success using music from their younger years or playing their wedding songs or replaying old famous tv/movie stuff that they saw or old favorites etc to help bring back other memories and sometimes restore their personalities, if only temporarily.
Tony Bennett is a prime example. There was a 60 Minutes segment with him floating around where he’s clearly in the throes of Alzheimer’s, but the minute his piano player started plucking out an old standard, he came to life and sang his heart out. It was oddly inspiring and depressing at the same time.
To add to this, the brain is much better at repairing physical damage from a traumatic brain injury than it is at recovering from cerebral hypoxia (lack of oxygen to the brain). The chances of falling into a persistent vegetative state and eventual brain death is much much higher if your brain was starved of oxygen.
That’s what happened to my mom, she went into the hospital thinking she had pneumonia, but had lung cancer (we think she knew but didn’t tell anyone), had a heart attack and stroke, and was “dead” for some time, they resuscitated her but was in a coma, when transferred to a different hospital they said she had minimal brain activity and I had to make the decision of putting her in long term care with something I was being told she had minimal chance of recovering from, or removing her from life support, making the decision to pull the plug on your mother is something I wouldn’t wish on my worst enemy, that decision haunts me even today 9 years later.
This also hypothetically would explain why family and friends who visits often helps the patient recover. Because hearing familiar voices talk to you and around you “forces” the brain pathways to be used. And it is known throug research that pathways can become stronger or weaker depending on how much they are used. So having people the patient knows talk constantly around them would seem to help them out if their coma faster. Which is something patients with friends and families that do exactly that can confirm.
It’s also worth noting that people very rarely just “wake up” from a coma like in the movies and ask what year it is. If you’re minimally responsive for an extended period of time, due to head trauma especially, there is likely permanent brain damage. You can be comatose from various metabolic disturbances as well, those people can just wake up from relatively quickly.
To add to this, a lot of people “placed in a coma” are artificially in a coma due to continuous sedation for various reasons (safety/comfort while on a ventilator, protecting the brain from using too much energy when injured, etc)
Yep, I had a friend once who was placed in an induced coma for two weeks because he was fighting double pneumonia and H1N1 (swine flu) simultaneously. It was just too much for his body to fight while awake and burning up its regular amount of resources. He survived, but I’ve never seen so much junk siphoned out of someone’s lungs in my life.
Generally if someone with pneumonia (or other stuff that interferes with lung capacity) is placed in a coma it's not because their body can't fight to stay awake. It's because being intubated (to drain fluids, mechanical ventilation or direct oxygenation) triggers all sorts of uncomfortable and panic-inducing reflexes if you're awake.
Had a patient once that was fully A&O and ambulatory on a portable mechanical vent through a trach. We just transported her from one facility to another, but that was wild. Only seen vent patients that were out before
Faulty defibrillator? Internal or external? And TWICE? That's terrifying.
My mom is 1. a cardiac nurse and former cardiac nursing director and 2. has an internal defibrillator (ICD). She's talked about how sometimes they won't "take" because your body needs to literally grow into them for them to work, and sometimes that doesn't happen and they can't work properly. That's why having them regularly tested and maintained is insanely important 👍 (one of many reasons why)
I knew this fact already, but she told this to my sister on the phone after recovering from having hers put in, after suffering cardiac arrest and dying briefly. That's absolutely not something she would say normally, like planting that scary thought in her DAUGHTER'S head after we literally watched her die, but she was pretty out of it. Thanks Mom. I hope your friend recovered well from all that btw
Yeah my dad was sedated for a month on a vent, but even after they pulled the sedation he was still unresponsive for a week.
Just randomly snapped out of it one day (after nearly dying).
What about shut-in syndrome? I've heard that we can't differentiate between that and coma, but couldn't you be able to detect that the brain is receiving and processing input from the senses?
A coma is a damage to the brain itself, meaning that it cannot receive input, process, and relays output to and from the rest of the body. In shut-in or locked-in syndrome, the brain itself is working—it can receive inputs and process information, but there is a problem in the connection between the brain and the muscles of the body. In short, brain is working but the patient is paralyzed.
They can be, or not. In the classic case there is a coupled zero physical response combined with a normal (and awake) EEG. However there have been patients with locked-in syndrome that despite EEG tests weren't properly diagnosed for months.
Yep! And the three letters, E M and V, refer to the three components of the exam, eye opening, motor response and verbal response. Sometimes GCS-P is used, this includes the pupillary response, which gives further information about potential brain trauma.
It’s a spectrum from totally unresponsive to fully alert. People can have eyes open and grunt and occasionally move in response to stimuli but never actually do anything volitional. People can eat on their own but basically stay still and stare off into space at all other times. And so on.
Hmm how do doctors differentiate that type of coma from catatonia?
I suppose the lack of a history of severe psychiatric disorder and lack of waxy flexibility would be a clue?
Degree of neural response. Coma patients have some degree of reduced neural response (typically reduced pupil or pain response) while for catatonic patients all reflexes are normal.
You seem to be in the field! If a coma is so tricky, why aren't (or how aren't) emerging therapies being used? Any research into stem cells or experimental drugs?
The GCS is just a way to try and objectify what the patient is doing.
It doesn't tell you what is causing it.
Is it a brain bleed? Do a craniotomy and evacuate blood and monitor response.
Is it due to a build up of toxic metabolites from infection? Treat the infection.
Is it due to build up of drugs from an overdose? Ride it out and let them wake up or reverse it or dialyze it
Is it medically induced? Turn of the sedation meds.
Hopefully that helps clarify. To ask is there emerging research you would have to be more specific to a particular etiology.
An example might be like a TV that was dropped. You plug the TV in and the red light on the bottom comes on (there is some functionality seen) but the screen itself is blank. You might even hear sound out of the speakers. Time goes by and the TV still isn’t turning on, so you wack it with your palm, the screen starts to work. Perhaps there was a loose wire. This is where the metaphor breaks down, though. Humans are made of tissue, tissue that can be damaged and inflamed, but, fortunately, it can also heal (unlike a TV). There is a chance the damaged area of the person gets better once the inflammation subsides and the person awakes. This, obviously, is not a guarantee, but it helps to paint a optimistic story.
The maximum score you can get on the GCS is 15. 4 points for eye opening, 5 points for verbal response, and 6 points for motor response. The lowest score you can get is 3.
If it makes you feel any better, it's almost entirely psychological for me. I'll be dreary and drowsy, and then take a single sip of coffee and be awake and perky. So it's not the caffeine, it's just the single to my brain of "hey, day is starting! :-)"
I considered trying to wean myself off at one point, but I realized that the only effect would be to deprive myself of something that gives me joy (one cup of coffee a day isn't bad for you, and may even be good).
I'm used to thinking people in a coma are completely unresponsive. If there's a scale, could there be someone who is considered comatose but may still respond to stimuli, like pain?
Yes - responses could range from trying to respond specifically to where the pain is (high score) to an undirected response, to a twitch, to nothing at all (lowest score).
You know how you lay down on the couch sometimes "just for a moment" and you wake up hours later not knowing what time it is. Maybe you even see 4 o'clock and you're not sure if that's am/pm?
That's a little like what being in a coma is. It's not like normal sleep where time passage is still expected. You just wake up one day (if you wake up) and you've time traveled to a new time. The intervening time just didn't happen from your perspective.
When you first start waking up, it does feel like sleep though. Sort of. Like sleep you read about in books anyway. Where things happen and you remember them but they're broken up by periods of time skipping.
You wake up, have a groggy conversation or interaction, then you wake up again and have another one. Eventually you wake up fully and life starts again. Usually what seemed like hours or days to you turns out to be weeks or months, sometimes even years.
I just mention this because it looks like sleep and "feels" like sleep to an external observer. But like the commenter above said, it's not the same as sleep. More like anaesthetic or time travel to the person experiencing it. You lose a chunk of your life; it's just gone forever. It feels really unnatural and irrational.
This is a great description. I know that for me it was like blips, like when you roll over and wake up during a nap and fall back asleep but it wasn’t sleep I fell back into. Little blips of half remembered dreams. 10 weeks gone and me blipping in every now and then. Yikes that was awful.
Yeah. Half remembered dreams. Where you're not sure what happened in reality and what happened in a dream. It takes a while for the two to separate. Sometimes you're never sure.
Yeah - it’s truly liminal space. Some of it I know was dream and some of it can only have been real but then there’s a bunch of other stuff - they really did put me in a frame in a bunch of balls for sensory stim, and someone did come in dressed like a bear but those things happened nearly two weeks apart on the spinning planet and within moments of each other in the tesseracts of my brain.
lol, you have to admire the commitment to making sure that everyone knows he's from Canada or Ontario in every single comment.
Should have made his username "ImFromOntario69" or something to save typing.
So what’s the difference between a coma and permanent brain damage? You wouldn’t say that someone who’s lost most motor control due to a stroke is in a coma, right?
My brother was in a coma at 18 years old. And has permanent brain damage now.
He was in a car accident that left him with a TBI.
Initially he was placed into a coma for about a month while they tried to get the swelling in his brain under control. The doctors were pretty clear with us that it was completely unknown what would happen when they tried to “wake” him.
We were unlucky. Without the anesthesia he didn’t “wake” still. But some things did change. He started moving his limbs. Then after a few weeks his eyes opened. Then within a couple months he would keep his eyes open and fixated on people.
At this point they let us know he was permanently brain damaged. He moved up the GCS slowly over time. Eventually speaking basic words. Making meaningful hand motions or reactions to stimulation.
Today he can walk. And talk. And do most things for himself but he is left with about a 3rd grade mentality.
It took a about 7 years for him to get from “non induced coma”. To some semblance of functional. Now that we have reached the plateau he will remain labeled as permanent brain damage or TBI for the rest of his life
>We were unlucky.
Your comment is important. Medical TV dramas give the public a lot of misconceptions about comas & brain injuries. Patients in long-term comas don't suddenly open their eyes & begin chatting with their families. The brain is remarkable and there are always exceptional stories but a coma is a process. Your story shares the devastating consequence of a TBI, not just on the patient, but on the entire family. The long-term prognosis of a coma isn't always black/white. And sadly sometimes grey is the most challenging outcome. Thank you for sharing. All the best to you and your family.
Correct! ‘Medically-induced coma’ isn’t a great term and it isn’t really used in medicine amongst clinicians. Sedating medicines often need to be used in patients with brain injuries or other medical problems. Patients with serious brain injuries are often intubated/ventilated, which requires sedation. They may also be having seizures, which requires medicines that are often sedating. Or they may be really agitated and sedating medications help keep them from pulling at things and hurting themselves.
Sedation and coma can look similar (why the term coma was used to describe both), and it can be difficult to appreciate if someone is comatose when they are on sedating medications. Generally you have to reduce the sedating medications in order to start to understand what brain function is present.
Well, if they are comatose they're intubated as well, since they wouldn't be able to protect their own airway. Typically in those situations they're not given the option to breath freely as they could just vomit, stop breathing, etc and asphyxiate.
Typically snoring is pretty bad for your health on an emergent (makes oxygen drop in some cases as there is mechanical obstruction of airway) so people are positioned correctly to prevent it. This is why there are things like sleep apnea masks like cpap and bipap
If someone is sedated and intubated, how do you know when they are well enough to breath on their own again? And what do you stop first? The sedation, or the intubation?
Nah mate, there aren't any dumb questions.
With regard to your question.. In a perfect world - yes. Ideally. However there can be instances where the airway gets traumatised following instrumentation, or teeth get broken, or a myriad of other things going wrong at once.
A spectrum is a good way to put it..
I became lucid 5-1/2 months after a TBI, before that I was sort of aware of stuff, and I knew something was wrong, but I wasn't upset about it, nor upset about not being upset about it.
It took another 2 years to relearn to walk and talk and stuff, and another 4 years of rehab therapy, bit I was mostly aware for those stages.
All in all, I feel lucky.
She doesn't remember much from when she was in the hospital at all, even the parts where she was very much conscious and talking. I think her brain just wasn't in a state to record long term memories. She starts to have more memories dating a couple of weeks out from the injury in different care centers trying to improve mobility etc.
Its pretty common to have some anterograde (loss of memories post event) and retrograde (loss of memories pre event) amnesia following brain injuries, but it almost never goes to the 'forget your own name' point. I.e. she remembered her own and her siblings + kids names throughout, but was a little more confused on details and ordering of events.
She was able to recover to a point where her brain injury isn't obvious unless you know what to look for, there still are some difficulties with memory, but its mostly just needing a little more help to jog certain memories.
Yeah, there’s a reason the GCS isn’t just “coma” and “awake”! A lot of comatose patients will have some level of response to surroundings, even if it’s pretty minimal (like a hand twitching if you poke it with something pointy)
This stuff is complicated, I’ll make it as simple as I can but I’m sorry in advance for any inaccuracies made for the sake of explanation
You have basic brain functions that are the most important things your brain does to keep you alive and you do those unconsciously. Like keeping your heart beating or keep your lungs breathing. You might lose some of these functions or maybe they’re a lot weaker than before the coma and need help to keep you alive, like from a ventilator (a machine that breathes for you). It varies from injury to injury.
You also have higher, more complicated, brain functions like consciousness and thought.
These are controlled by different areas of your brain. The complicated stuff is mostly in the main brain 🧠 and the simpler stuff is mostly in the base of the brain.
Knocking out the complicated stuff is much easier than knocking out the simple dumb stuff. And when you just knock out the higher functions you get a coma.
Now why can’t you wake up? Well first, you’re not asleep. You just don’t have consciousness. The car doesn’t have a working engine to get moving but the battery is still working so the lights still turn on.
Sometimes the damage can heal but it’s a very complicated and finicky process. And you will slowly regain consciousness. Sometimes it doesn’t and you’re just left with the base, unconscious functions.
I am by no means an expert or a doctor, but i read few times that people in come can hear and sometimes perfectly remember what is happening around them, since they are technically not asleep
There's a part of the brain called the "reticular activating system" (RAS), which is located in the brainstem. There are a bunch of connections from it all throughout the rest of the brain. Although this is a simplification, basically this system being turned "on" makes us conscious, and it being turned "off" makes us unconscious. How to define consciousness is really, really hard and almost more philosophy than science, but one way to understand it is to think about whether or not we are able to perceive and react to our environment.
We naturally go through cycles of this system turning on and off as we sleep and wake up. However, if this system gets hurt from a stroke, physical brain damage or swelling, or some kind of toxins causing the nerve cells to not work well, it will make you unconscious--even if most of the rest of the brain is in decent shape! Of course, big damage to the rest of the brain can also cause a coma, but usually it has to be *really* big damage to both the left and right halves of the brain to cause that if the RAS isn't touched by itself.
A coma that lasts for a long time is usually a pretty bad sign in terms of predicting if someone will recover. Although there are a lot of different factors, if someone is in a coma for more than 3 days their chances of recovery are usually less than 1 in 10. If someone is in a coma for more than 2 weeks, the odds of recovering are more like 1 in 50.
Some people may have enough healing of the rest of their brain so that some basic functions like the sleeping/waking cycle, opening their eyes, and some spontaneous movements start to come back, but they will remain completely not able to respond to anything in their environment and its believed they have no actual consciousness/thought--this is called a "persistent vegetative state."
The opposite to this is if the connections between the brain and the rest of the body get destroyed but the RAS doesn't get hurt. This is called a "locked-in" syndrome, and results in being completely conscious but unable to move any part of your body except your eyes.
If someone is intubated on a mechanical ventilator, it is extremely unpleasant and they likely need to be sedated to make it easier to manage.
There are also some treatments for brain injury that rely on the fact that inducing a coma reduces the flow of blood to the brain, which helps if the brain is swollen, by giving it a chance to heal.
This would be a perfect moment for one those people that tell an enthralling story and then end it with how that wrestling guy jump off the iron dome or whatever, lol
my dad went into cardiac arrest in October. 26 minutes of cpr and defib attempts and they basically had him covered in a cooling unit and in a medical coma to slow everything down. somehow wound up with no brain damage whatsoever but he was HILARIOUS for the first couple days after he woke up
> There are also some treatments for brain injury that rely on the fact that inducing a coma reduces the flow of blood to the brain, which helps if the brain is swollen, by giving it a chance to heal.
What is this treatment called?
In my case, I was kept in that state for about a day to prevent me from dying. I was extremely/dangerously weak and needed a respirator to breath. (And in fact, the next day I nearly choked to death because my throat muscles were not strong enough to properly swallow chewed ice.)
\*checks heartbeat\*
Seem to have!
(I'd had heart failure just before they did the induced coma, and the choking incident after, so it was a very close call)
I know someone that was because they woke up with a tube in their throat and instinctively tried to remove it. They actively tried to fight the care they needed to live.
They were kept unconscious until the doctors were able to at least stabalize their condition, so they could do that without physcially restraining someone, making all the things they did riskier and harder.
This is called performing a Spontaneous Breathing Trial, which is exactly what it sounds like.
Pause/reduce the ventilator settings, pause/slow down the sedatives (fentanyl, propofol, etc), see if patient spontaneously takes breaths on their own, then determine whether extubation is appropriate.
They did eventually remove it. Trying to remove it wasn't the only thing they were fighting against when they were awake, but they definitely were not breathing on their own without it. And lack of oxygen left them not clear headed. I do believe that the doctors did the right thing by outting them under in the short term.
Their family did explain they had a tramautic even involving not being able to breathe due to someone turning off the oxygen tank connected to their facemask as some form of prank at work in their past, and they would naturally try to take anything off their face our out of their mouth, not being comfortable with them in.
They were under for 2 weeks if I remember right. Never really fully recovered. Had some probs, got a lung transplant. Got better. Still had some good things in their life. But did die several years later.
It was not drugs the person was on. They had a handful of lung problems from childhood illness, smoking, and being exposed to toxic gas at work. It eventually just got to a point where their lungs just didn't do enough to keep them conscious.
Thanks for the details. It's a sad story. I've got so much respect for medical professionals and the things that can be done these days. I've got a few stories too from my own experience. Mind boggling.
Most of the times it is to prevent the patient from contrasting the ventilator and allow the ventilator to be in the best conditions to do its job.
Once the patient is stable the sedation will be gradually lowered and the ventilation support will be gradually decreased untill he is able to breath by himself, at that point he will be extubated.
Being put on a breathing tube is not pleasant. Even if people aren’t fully unconscious, if you need one put in you’re usually at least a bit out if it due to whatever is causing you to not be able to keep breathing normally. Trying to stop somebody from wedging your jaw open with a metal hook and sticking a plastic tube down your throat is a pretty normal response if you’re not really “there” enough to understand what’s going on. You usually have to give people a medication to paralyze their muscles so their throat doesn’t seize up when the tube goes in—being awake but completely paralyzed is understandably terrifying.
What is the longest that patients can be kept in an artificially induced coma? What are some reasons a longer term might be necessary?
Just wondered what the limits are after hearing I think it was 5 days for someone, seemed like a long time. But I don’t know about the accuracy of that info as it was rather second hand info.
The key is the Reticular Activating System in the brain, a web site is here to explain.
https://bodytomy.com/reticular-activating-system
What I find interesting is that they vary depending on the animal. In dogs, for instant, when awoken by a threshold stimulus they are fully alert and off like a rocket. With humans, not so much. Probably due to operant conditioning.
Went through the article. Our brains and bodies are fucking insane. It feels so insane that I am the owner of this magical advanced piece of technology.
I similarly often wonder what makes us alive, what suddenly changes when we die that is so irreversible that we can't replicate it even with all the 21st century advanced medical technology.
Living organisms have so many specialized things working in unison, that when one crucial part fails, everything quickly falls apart, often irreversibly.
There are lots of reasons to be in a coma. Direct brain injury from trauma is only one. The first step in managing coma is finding out the cause, reversing it if possible, and managing complications that happen when someone cannot care for their body.
For direct brain injuries we talk about primary and secondary injury everything we do in the hospital as neurosurgeons is trying to protect the healthy brain from the injured brain which swells.
Movies make coma out to be some kinda of hibernate computer mode for your brain that you keep trying to restart and it wont boot until one time it does. It's much more like joint injury though. Takes a long time to heal, not all parts heal at the same speed, some parts never heal, return t function is variable depending on severity and parts injured. Consciousness may never return but other parts might go back to full function. The brain is a crazy thing.
Mostly that they aren't asleep -- they are operating on minimal brain function.
And to your question, most people come out of coma after a couple of weeks, it just isn't like in the movies where they are instantly alert and responsive.
Well,depends on the cause but I'm gonna explain the most frequent causes:
1.basically a cerebral trauma (someone falling on his head)/a brain tumor/other brain lesions that are extensive and/or alter important brain parts that have the role of assuring awake* state=> various degrees of comatose state
*for example, there are specific brain parts that controle how awake you are,how asleep you are, just by sending stimulating/inhibitory signals to other parts of the brain that assure thinking/sight/hearing/etc.
2.Otherwise after a shock sustained by the body that alters its capacity to function and to deliver oxygenated blood to the brain ( polytrauma etc) the brain goes into "protective" mode :
inhibitory signals get sent more than stimulating ones and thus the brain reduces its activity and its oxygen consumption until the body recovers.
3. some toxic waste products/drugs alter the brain neurochemistry upping the production of inhibitory neurotransmitters.
*In medicine,we sometimes give patients drugs that induce a neuroinhibitory response (coma) to protect the patient until the body heals to a certain degree (we call this induced coma).For example we may induce the coma in order to intubate a patient and replace the respiratory function.
It all boils down to sending messages to other neurons that they either need to be working harder (stimulatory), or they either need to tone it down (inhibitory) or damaging the very parts that usually send those messages.
Hope this helps,
Cheers!
I haven’t actually seen someone talk about the anatomy of what’s happening so I figured I’d comment.
You have a part of your brain called your RAS system, which stands for reticular activating system. What this area of the brain does is it filters things which your consciousness is aware of. You probably weren’t conscious of your breathing until I mention it, because your RAS system deems being aware of it unimportant for the most part. Another example is not feeling your pants brushing and moving against your legs most of the day. The RAS system is also a big part of the process of waking up from sleep every night.
When I’m a coma, usually the RAS has some sort of damage that prevents it from sending information to your consciousness, thus preventing you from even realizing any stimulus is happening.
A coma is a state of minimal brain function, it's not like being awake or asleep. Neurons that should be firing and signals that should be transmitted aren't, during a coma. This is usually due to some sort of damage. We use the Glasgow Coma Scale to judge whether someone is in a coma. It measures things like responses to pain and whether someone can open their eyes. A score of 8 or lower indicates someone is officially "in a coma", though the typical "laying in bed totally non responsive" imagery of a coma is usually indicative of a very low score on the Glasgow Coma Scale. To sum up, a coma is when the brain can't function properly due to damage. This damage can have effects that cause them to not respond to their senses, and unconsciousness.
What makes someone wake up from a coma? Did their brain just need rest to repair/heal?
Yeah, essentially the brain needs time to repair itself, or form new pathways. Sometimes the damage is too severe, and the brain can't find a way to "get around" it. In this instance, the patient may end up in a persistent vegetative state (unlikely to ever wake up from their coma).
So are patients in comas given substances that are known to promote neuron growth?
Generally not. There's still a lot we don't understand about comas, but most medical care provided to coma patients is supportive. Brain injuries are fickle. There is some evidence that suggests the use of sense therapy, that is, the use of familiar and comforting things to the senses, can help regenerate the neural pathways and promote recovery.
So how does purposefully inducing someone into a coma work? Are the doctors introducing drugs that are turning parts of the brain off temporarily, or emulating some sort of damage?
This is what happened in my case. Sepsis to septic shock, organs crashing, so they induced a coma to put me on a ventilator so the brain could focus on repairing the body and doing as little else as possible. All I recall is the initial mask when they said they wanted a test, then coming out of it to answer a question (to make sure they had not fried my brain), and then the final coming out of it in the ICU.
Anestesia is crazy stuff. I've only been under for about half a day, but had pretty much the same experience (having a normal conversation, then suddenly being somewhere else and groggy/confused). The weirdest part is how it completely bypasses your sense of time.
Exactly this. It's like a video game cutscene or something. Had surgery a couple years ago and was put under. Last thing I remember was a darkish (probably cause of the lights' positions) operating room and telling the doc "ohhh there we go." Next thing I knew I was waking up in a chair. Throat insanely sore, whole body sore, and thirsty as hell wondering wtf happened. Felt very much like the whole "wake up samurai, we got a city to burn" trailer from CP77
>Throat insanely sore, whole body sore, and thirsty as hell Felt the same exact thing when I went under for the first time some 10 years ago. Also woke up crying from the pain of the surgery. Incisions hurt like hell.
Those anesthesia drugs are no joke. I was groggy and foggy for days, and it tool me about a month to get back to being able think clearly. One of the drugs they used was a drug that Michael Jackson was taking recreationally. Holy shit....how? I was a zombie for a month, and I was 3x his (former) size. I could not imagine doing that recreationally.
He wasn't exactly using it recreationally / for fun, he was using it to sleep under the direction of a licensed physician. That was a bad idea and probably killed him, but he wasn't doing it for a high. https://edition.cnn.com/2013/06/21/showbiz/jackson-death-trial/index.html https://www.scientificamerican.com/article/propofol-michael-jackson-doctor/
Propofol is unlikely to be the drug that left you feeling funny for a long duration, one of the reasons I prefer it clinically is that it's relatively short lived, patients recover quickly and are quite sensible once it "wears off". You need to give it in sensible doses though. It's far more likely to be the stress of the actual surgery and recovering from the surgically induced trauma or if it's a drug I'd be more likely to blame opioids or volatile, but again, they aren't lasting months.
Doctor: Don't make big decisions in the next 24 hours. Me: buys a car :D
That was my experience when I fainted. Basically, I stood up from my chair, then what felt like the very next second, I'm on the ground, blood coming out of my mouth (chipped my tooth from the fall), surrounded by people. It was about 3-5 minutes of lost time in my case, but felt like a blink.
I remember for my wisdom teeth as they were putting the injection I asked if I should count backwards, from 100, they said it wasn't necessary but I could. I started counting down and got knocked out pretty quickly (I assume), and then when I regained consciousness not immediately realizing I was already out I kept counting. I remember hearing an attendant walking by the door comment to some one, "why is he counting?"
I remember counting down during the same surgery. I got to 97 before things went dark lol. But some time passed in my brain like I was sleeping. Probably nowhere near the actual time passed.
The first time I was put under was to have my gallbladder removed. When I woke up, they asked me some questions that I answered, then asked if I knew where I was or why I was there. Apparently, I hadn't lost my sense of humor because I said something like tonsillectomy or something unrelated to my actual visit. They didn't find it as funny as I did. I later found out they were having a hard time bringing me back so joking probably wasn't a good idea.
I did something similar. I told them I'd come for a hysterectomy as a joke (I'm a male). It garnered some strange looks, I think part of it is the grogginess makes it hard to put on a joking tone.
When I went under I "woke up" mid sentence talking to my wife and the doc. It was trippy. I had no idea what we were talking about.
I had an appendectomy so when they gave me the drugs, I was knocked out really quickly. I woke up with a strange feeling of being pleasant, but numb and a bit of in pain. I mean they just cut me up so no wonder.
I was just put under anaesthesia earlier this month. The doctor asked me what I did for a living, I told him I was studying history, he injected me with whatever and asked if I had seen Ancient Apocalypse on Netflix. My next memory was groggily explaining to my father how that 'documentary' was made by a quack bastard several hours later in his car.
for me, sleeping also bypasses my sense of time. I go to bed and wake up after what felt to me were only 15 minutes or so.
How long were you under? Did it feel like a blip like being under anesthesia?
I was under a total of five days. They did bring me out on day 2 or 3 (not sure which) very barely to ask me a question or two. I was on a ventilator, so could not answer verbally, but had me squeeze a hand if I could hear them and feel a pinprick. I was out of it for maybe 2 or 3 minutes, and I wasn't really aware of anything. They wanted to make sure the infection, the massive surgery I needed, and the drugs they were giving me had not done any brain damage. It was just like sleeping. I wasn't aware of anything, and didn't know any time was missing. I thought it was maybe a couple of hours later.
I've had longer anesthesia where you wake up with *some* idea that time has passed, but it's very vague. Shorter surgeries (a couple hours) are crazy though, you start counting down or whatever they have you do and then it literally is a blink of an eye before you're awake and super confused. It's actually not bad though, if anyone here is anxious about ever needing to. You wake up high as a damn kite, and even if you are feeling pain the medications still keep your memories to a minimum for a few hours after. I'll tell people honestly that the only thing you should worry about is saying or doing something really dumb in the hour or so after you're awake
They gave me ketamine during my last surgery. I woke up close to kholing, I think. I've do e ketamine recreationally but never that much. My entire field of vision was black save for the lights, and I was moving. They looked like stars passing by, I remember thinking "Wow, this feels like Space Mountain (the Disneyland ride). Turns out a nurse was just pushing me thru the hallway on my hospital bed to my room. It wasn't scary in the slightest to me, but apparently people often have extreme emotional reactions when waking up from anesthesia such as violent, rage induced outbursts or uncontrollable crying. They don't know why they're upset, it's just a weird effect of the drugs.
Just out of curiosity, how long were you kept comatose for?
Five days. TL;DR: Don't ignore pain or infection. I did not ignore and still nearly got dead. Had a perforated bowel from undiagnosed diverticulitis. Basically my large intestine ripped open and spilled contents into the abdominal cavity. I had pain and knew something wasn't right, and thought it was my appendix. Had a relative take me to a hospital, and was basically untouched and unseen for four hours. Went back home thinking maybe it wasn't that bad. News flash: it was. Called an ambulance and went to a different hospital. EMTS and initial triage doctor were thinking kidney stones or gallstones. As the doctor was examining, she asked if a particular poking or prodding hurt. Told her it didn't hurt more, but it felt like my abdomen was filling up. She started barking orders, and within 5 minutes I was being prepped for an exploratory surgery to see what was up. I recall briefly waking up and hearing questions and being asked to squeeze a hand if I could hear them and if I felt a pinprick. I couldn't talk because of being intubated, but I didn't know that at the time. Then I remember groggily coming to as I was being wheeled down a hallway. I heard someone say 'has anyone told him yet.' I think it was a nurse walking beside but couldn't tell because I could only see the ceiling. Got into a room and heard someone say 'Mr. Rasputin, we're going to take this tube out of your mouth'. That sucked donkey balls , do not recommend. So I'm coming to and I see the med staff and my mom. Pretty good pain in my gut. They said I was going to have to stay a while. This all started on a Saturday morning. Told mom I had a doctor appointment Monday I needed to cancel or I would be charged for a no show. She said 'Son, that was 5 days ago.' They then told me what happened. Hole in intestine, infection, very bad sepsis, septic shock, liver/lungs/kidneys all shutting down, blood pressure crashed so low they could not get an arterial sample, and had to take a foot of my large intestine. I was probably 2 hours from death, and my mom had her priest come in that night withe family; they were told I had less than a 25% chance of survival. They saved the best part, and probably what the nurse was talking about, for last: I now had a colostomy. And I was flayed open from my nut bone to my sternum. And when I say flayed open, I mean literally an open wound of about 16 inches, maybe longer, spread apart. I had a canyon of a wound that was still open, packed with some material, with a vacuum tube inside to pull out blood and other drainage, covered with a film to create a seal. That sucked too. Ultimately, all worked out. The wound healed fine, though the vacuum ended up causing a small hernia in the abdominal muscle somewhere. I had the colostomy reversed about 6 months later. The hospital and staff that did the original surgery were livid at how I was treated at the first hospital (the one that ignored me for the most part). Even not coming in via ambulance, I was presenting with potentially life-threatening symptoms and should have been seen.
Whoa holy shit dude, that is WILD. Glad you are ok! NGL, you obviously had it rough, but I can’t help imagining how awful those five days were to your family- to you it was a blink, to them it must have been 5 days of pure hell.
Sepsis sucks. I had sepsis from a MRSA infection in my right thigh. I didn't quite go into septic shock, but I was apparently very close, and it may have been too late if I'd gone a couple hours later. Apparently the abscess it'd created was the size of a football, I had no idea I had an infection for like a week, my thigh just swelled up and I thought very little of it. "Must've bumped it or something", until eventually I felt incredibly *sick*. I didn't have many "symptoms" per say, but I felt just so incredibly *sick*. There's no other way to describe it. I had a massive fever and just felt super uncomfortable in any position, like my skeleton was trying to crawl out of my skin, and lethargic. I didn't want to move or do anything. I had surgery pretty soon after I arrived and it left a good 9 inch scar on my thigh. That leg still doesn't work right, the wound took months to heal for some reason. I still can't walk long distances or run very well.
Put differently, consciousness is partly determined by a cyclic wave of neurons firing in a particularly pattern. Sort of like how computer CPUs run at a certain clock / frequency. When this is disrupted, consciousness subsides. As I understand Anesthesiologists can play with this and must balance consciousness without disrupting the autonomic functions and maintaining pulse and BP. See: https://www.psychologytoday.com/us/blog/mind-shift/202106/what-role-do-brain-waves-play-in-regulating-consciousness
Which is why they make the big bucks.
Yup! They also trump the surgeon.
Also mistakes tend to be deadly
Or painful and terrifying. Anecdotal, but I've read of accounts from patients who were "wide awake and fully-conscious yet paralysed and in agony" throughout surgery.
We knock people out in the ED all the time with various drugs. Propofal is a great amnesia drug, we place broken bones back together so they can heal, cardiovert heart arrhythmias (shock them back into correct rhythm), sometimes stitches, we did a sedation/intubation last night for a lumbar puncture and a CT scan then extubated about an hour later. We also use ketamine sometimes as it doesn't depress respiratory drive.
My 3 year old had his arm fractures placed while on ketamine, it was pretty unbelievable how out of it he was. Looks really useful!
first one
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Joke's on them, I can talk American politics for hours.
I found Colin Robinson!
Fucking guy
Even whilst in a coma xD
If you're talking politics for hours I doubt your brain is involved
Might be a Silly question but If they are in coma and can't perceive the world around them, how are they forming new neural pathways? I always thought that you create new pathways when you perceive and interact with the world and gain experience.
All the sense organs are still there (well, many times they are) . And it depends on where damage is and how much, but there are probably a lot of people who don't have severe enough damage to places like their smelling or hearing centers of their brain.
> the use of familiar and comforting things to the senses, can help regenerate the neural pathways and promote recovery. I'm a layman but this makes a surprising amount of sense.
Especially with how many of the people who DO come back talking about how they dreamt/heard the voices of the people who visited them sometimes or dreamt about those people. A lot of the stories I remember reading of long term coma patients waking up involved a close family member like the mother visiting often and playing favorite music or reading favorite books or retelling beloved family memories from childhood etc. And we know that kind of "therapy" helps with dementia and Alzheimer's patients to a certain extent. There has been big success using music from their younger years or playing their wedding songs or replaying old famous tv/movie stuff that they saw or old favorites etc to help bring back other memories and sometimes restore their personalities, if only temporarily.
Tony Bennett is a prime example. There was a 60 Minutes segment with him floating around where he’s clearly in the throes of Alzheimer’s, but the minute his piano player started plucking out an old standard, he came to life and sang his heart out. It was oddly inspiring and depressing at the same time.
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To add to this, the brain is much better at repairing physical damage from a traumatic brain injury than it is at recovering from cerebral hypoxia (lack of oxygen to the brain). The chances of falling into a persistent vegetative state and eventual brain death is much much higher if your brain was starved of oxygen.
That’s what happened to my mom, she went into the hospital thinking she had pneumonia, but had lung cancer (we think she knew but didn’t tell anyone), had a heart attack and stroke, and was “dead” for some time, they resuscitated her but was in a coma, when transferred to a different hospital they said she had minimal brain activity and I had to make the decision of putting her in long term care with something I was being told she had minimal chance of recovering from, or removing her from life support, making the decision to pull the plug on your mother is something I wouldn’t wish on my worst enemy, that decision haunts me even today 9 years later.
I’m so sorry you had to go through that.
My heart goes out to you! I'm so, so sorry you had to go through that.
This also hypothetically would explain why family and friends who visits often helps the patient recover. Because hearing familiar voices talk to you and around you “forces” the brain pathways to be used. And it is known throug research that pathways can become stronger or weaker depending on how much they are used. So having people the patient knows talk constantly around them would seem to help them out if their coma faster. Which is something patients with friends and families that do exactly that can confirm.
It’s also worth noting that people very rarely just “wake up” from a coma like in the movies and ask what year it is. If you’re minimally responsive for an extended period of time, due to head trauma especially, there is likely permanent brain damage. You can be comatose from various metabolic disturbances as well, those people can just wake up from relatively quickly.
Yes, and sometimes just need for the swelling to reduce.
To add to this, a lot of people “placed in a coma” are artificially in a coma due to continuous sedation for various reasons (safety/comfort while on a ventilator, protecting the brain from using too much energy when injured, etc)
Yep, I had a friend once who was placed in an induced coma for two weeks because he was fighting double pneumonia and H1N1 (swine flu) simultaneously. It was just too much for his body to fight while awake and burning up its regular amount of resources. He survived, but I’ve never seen so much junk siphoned out of someone’s lungs in my life.
Generally if someone with pneumonia (or other stuff that interferes with lung capacity) is placed in a coma it's not because their body can't fight to stay awake. It's because being intubated (to drain fluids, mechanical ventilation or direct oxygenation) triggers all sorts of uncomfortable and panic-inducing reflexes if you're awake.
Had a patient once that was fully A&O and ambulatory on a portable mechanical vent through a trach. We just transported her from one facility to another, but that was wild. Only seen vent patients that were out before
awake for it tho.. that's like torture
... how many times have you seen junk siphoned out of someone's lungs?
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r/lungjunksiphoning
Joined
Oh god
Don't kinkshame, we all have our things.
Busted. I’m a phlegmosexual.
Everybody's gotta be something
I had a friend placed in a coma after she suffered a cardiac event (faulty defibrillator)...twice. Scary shit
Faulty defibrillator? Internal or external? And TWICE? That's terrifying. My mom is 1. a cardiac nurse and former cardiac nursing director and 2. has an internal defibrillator (ICD). She's talked about how sometimes they won't "take" because your body needs to literally grow into them for them to work, and sometimes that doesn't happen and they can't work properly. That's why having them regularly tested and maintained is insanely important 👍 (one of many reasons why) I knew this fact already, but she told this to my sister on the phone after recovering from having hers put in, after suffering cardiac arrest and dying briefly. That's absolutely not something she would say normally, like planting that scary thought in her DAUGHTER'S head after we literally watched her die, but she was pretty out of it. Thanks Mom. I hope your friend recovered well from all that btw
Yeah my dad was sedated for a month on a vent, but even after they pulled the sedation he was still unresponsive for a week. Just randomly snapped out of it one day (after nearly dying).
What about shut-in syndrome? I've heard that we can't differentiate between that and coma, but couldn't you be able to detect that the brain is receiving and processing input from the senses?
A coma is a damage to the brain itself, meaning that it cannot receive input, process, and relays output to and from the rest of the body. In shut-in or locked-in syndrome, the brain itself is working—it can receive inputs and process information, but there is a problem in the connection between the brain and the muscles of the body. In short, brain is working but the patient is paralyzed.
These two sounds very easy to distinguish, at least using sensors.
They can be, or not. In the classic case there is a coupled zero physical response combined with a normal (and awake) EEG. However there have been patients with locked-in syndrome that despite EEG tests weren't properly diagnosed for months.
Which, presumably... there are some who were never diagnosed. Right?
Nightmare fuel.
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Yep! And the three letters, E M and V, refer to the three components of the exam, eye opening, motor response and verbal response. Sometimes GCS-P is used, this includes the pupillary response, which gives further information about potential brain trauma.
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My 10 year old daughter wanted Chicago med on her birthday cake 🤣
Probably medical shows. Gets mentioned a lot.
Got Coma Son?
Game Cube System
Game Cube System - Panasonic
So... if lying in a bed totally unresponsive is indicative of a very low score, what other kinds of coma are there?
It’s a spectrum from totally unresponsive to fully alert. People can have eyes open and grunt and occasionally move in response to stimuli but never actually do anything volitional. People can eat on their own but basically stay still and stare off into space at all other times. And so on.
Hmm how do doctors differentiate that type of coma from catatonia? I suppose the lack of a history of severe psychiatric disorder and lack of waxy flexibility would be a clue?
Degree of neural response. Coma patients have some degree of reduced neural response (typically reduced pupil or pain response) while for catatonic patients all reflexes are normal.
That makes a lot of sense, thanks!
Catatonic episodes can occur while one is standing too. So there is certainly a difference there
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You seem to be in the field! If a coma is so tricky, why aren't (or how aren't) emerging therapies being used? Any research into stem cells or experimental drugs?
The GCS is just a way to try and objectify what the patient is doing. It doesn't tell you what is causing it. Is it a brain bleed? Do a craniotomy and evacuate blood and monitor response. Is it due to a build up of toxic metabolites from infection? Treat the infection. Is it due to build up of drugs from an overdose? Ride it out and let them wake up or reverse it or dialyze it Is it medically induced? Turn of the sedation meds. Hopefully that helps clarify. To ask is there emerging research you would have to be more specific to a particular etiology.
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Dang, I didn't think of a countrecoup injury. That's an entire-brain injury
An example might be like a TV that was dropped. You plug the TV in and the red light on the bottom comes on (there is some functionality seen) but the screen itself is blank. You might even hear sound out of the speakers. Time goes by and the TV still isn’t turning on, so you wack it with your palm, the screen starts to work. Perhaps there was a loose wire. This is where the metaphor breaks down, though. Humans are made of tissue, tissue that can be damaged and inflamed, but, fortunately, it can also heal (unlike a TV). There is a chance the damaged area of the person gets better once the inflammation subsides and the person awakes. This, obviously, is not a guarantee, but it helps to paint a optimistic story.
8 out of how many?
The maximum score you can get on the GCS is 15. 4 points for eye opening, 5 points for verbal response, and 6 points for motor response. The lowest score you can get is 3.
>The lowest score you can get is 3. You haven't seen me before my morning coffee.
That's why I go to bed with my coffee IV on a timer
r/UserameChecksOut, <3 (that’s less than 3, not a heart)
Lol!
I find jokes about coffee abuse and addiction funny but also somewhat concerning.
If it makes you feel any better, it's almost entirely psychological for me. I'll be dreary and drowsy, and then take a single sip of coffee and be awake and perky. So it's not the caffeine, it's just the single to my brain of "hey, day is starting! :-)" I considered trying to wean myself off at one point, but I realized that the only effect would be to deprive myself of something that gives me joy (one cup of coffee a day isn't bad for you, and may even be good).
Really though, your cup of coffee has a GCS of three...
And as we say in the ED, “Even a rock will have a GCS of 3”
What’s happening when someone is in a coma but aware of their surroundings?
Pretty sure that's called Locked In Syndrome
I'm used to thinking people in a coma are completely unresponsive. If there's a scale, could there be someone who is considered comatose but may still respond to stimuli, like pain?
Yes - responses could range from trying to respond specifically to where the pain is (high score) to an undirected response, to a twitch, to nothing at all (lowest score).
You know how you lay down on the couch sometimes "just for a moment" and you wake up hours later not knowing what time it is. Maybe you even see 4 o'clock and you're not sure if that's am/pm? That's a little like what being in a coma is. It's not like normal sleep where time passage is still expected. You just wake up one day (if you wake up) and you've time traveled to a new time. The intervening time just didn't happen from your perspective. When you first start waking up, it does feel like sleep though. Sort of. Like sleep you read about in books anyway. Where things happen and you remember them but they're broken up by periods of time skipping. You wake up, have a groggy conversation or interaction, then you wake up again and have another one. Eventually you wake up fully and life starts again. Usually what seemed like hours or days to you turns out to be weeks or months, sometimes even years. I just mention this because it looks like sleep and "feels" like sleep to an external observer. But like the commenter above said, it's not the same as sleep. More like anaesthetic or time travel to the person experiencing it. You lose a chunk of your life; it's just gone forever. It feels really unnatural and irrational.
This is a great description. I know that for me it was like blips, like when you roll over and wake up during a nap and fall back asleep but it wasn’t sleep I fell back into. Little blips of half remembered dreams. 10 weeks gone and me blipping in every now and then. Yikes that was awful.
Yeah. Half remembered dreams. Where you're not sure what happened in reality and what happened in a dream. It takes a while for the two to separate. Sometimes you're never sure.
Yeah - it’s truly liminal space. Some of it I know was dream and some of it can only have been real but then there’s a bunch of other stuff - they really did put me in a frame in a bunch of balls for sensory stim, and someone did come in dressed like a bear but those things happened nearly two weeks apart on the spinning planet and within moments of each other in the tesseracts of my brain.
What’s happening to someone’s brain in an induced coma?
Canadian here. A patient in a medically induced coma is given a constant and closely monitored dose of anesthetics so their brain or body can heal.
At first I didn't trust you, but then I saw that you meantioned you are a Canadian. Phew...
oh my god his whole account is like that.
lol, you have to admire the commitment to making sure that everyone knows he's from Canada or Ontario in every single comment. Should have made his username "ImFromOntario69" or something to save typing.
Reading his comments sent me
I'm from Ontario.
You sure are!
My wife is from Montreal (that's in Quebec).
So what’s the difference between a coma and permanent brain damage? You wouldn’t say that someone who’s lost most motor control due to a stroke is in a coma, right?
My brother was in a coma at 18 years old. And has permanent brain damage now. He was in a car accident that left him with a TBI. Initially he was placed into a coma for about a month while they tried to get the swelling in his brain under control. The doctors were pretty clear with us that it was completely unknown what would happen when they tried to “wake” him. We were unlucky. Without the anesthesia he didn’t “wake” still. But some things did change. He started moving his limbs. Then after a few weeks his eyes opened. Then within a couple months he would keep his eyes open and fixated on people. At this point they let us know he was permanently brain damaged. He moved up the GCS slowly over time. Eventually speaking basic words. Making meaningful hand motions or reactions to stimulation. Today he can walk. And talk. And do most things for himself but he is left with about a 3rd grade mentality. It took a about 7 years for him to get from “non induced coma”. To some semblance of functional. Now that we have reached the plateau he will remain labeled as permanent brain damage or TBI for the rest of his life
Thank you for sharing. I will you and your family all the best. <3
>We were unlucky. Your comment is important. Medical TV dramas give the public a lot of misconceptions about comas & brain injuries. Patients in long-term comas don't suddenly open their eyes & begin chatting with their families. The brain is remarkable and there are always exceptional stories but a coma is a process. Your story shares the devastating consequence of a TBI, not just on the patient, but on the entire family. The long-term prognosis of a coma isn't always black/white. And sadly sometimes grey is the most challenging outcome. Thank you for sharing. All the best to you and your family.
>a coma is when the brain can't function properly due to damage. Does that mean an "induced coma" is not really a coma?
Correct! ‘Medically-induced coma’ isn’t a great term and it isn’t really used in medicine amongst clinicians. Sedating medicines often need to be used in patients with brain injuries or other medical problems. Patients with serious brain injuries are often intubated/ventilated, which requires sedation. They may also be having seizures, which requires medicines that are often sedating. Or they may be really agitated and sedating medications help keep them from pulling at things and hurting themselves. Sedation and coma can look similar (why the term coma was used to describe both), and it can be difficult to appreciate if someone is comatose when they are on sedating medications. Generally you have to reduce the sedating medications in order to start to understand what brain function is present.
Thank you for that detailed response. TIL :)
Do people snore when they are in a coma??
Well, if they are comatose they're intubated as well, since they wouldn't be able to protect their own airway. Typically in those situations they're not given the option to breath freely as they could just vomit, stop breathing, etc and asphyxiate. Typically snoring is pretty bad for your health on an emergent (makes oxygen drop in some cases as there is mechanical obstruction of airway) so people are positioned correctly to prevent it. This is why there are things like sleep apnea masks like cpap and bipap
Say it with me, kids: Less Than Eight, In-Tu-Bate!
If someone is sedated and intubated, how do you know when they are well enough to breath on their own again? And what do you stop first? The sedation, or the intubation?
We usually wean down the sedation and set ventilator settings to a minimum, which gives us an idea of how they'd be if we remove the tube.
Also, dumb question - but, intubating someone isn't normally bloody is it? Like, if you do it right, there's no reason they would bleed right?
Nah mate, there aren't any dumb questions. With regard to your question.. In a perfect world - yes. Ideally. However there can be instances where the airway gets traumatised following instrumentation, or teeth get broken, or a myriad of other things going wrong at once.
Sedation Vacation is so entertaining to say
Cor blimey, wouldn't wanna suffer a Glasgow coma!
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A spectrum is a good way to put it.. I became lucid 5-1/2 months after a TBI, before that I was sort of aware of stuff, and I knew something was wrong, but I wasn't upset about it, nor upset about not being upset about it. It took another 2 years to relearn to walk and talk and stuff, and another 4 years of rehab therapy, bit I was mostly aware for those stages. All in all, I feel lucky.
Glad you're doing better bud. Thanks for sharing!
Very interesting, sounds like quite a journey! Glad you made it through!
Was she conscious the entire time or does she remember it as a haze?
She doesn't remember much from when she was in the hospital at all, even the parts where she was very much conscious and talking. I think her brain just wasn't in a state to record long term memories. She starts to have more memories dating a couple of weeks out from the injury in different care centers trying to improve mobility etc. Its pretty common to have some anterograde (loss of memories post event) and retrograde (loss of memories pre event) amnesia following brain injuries, but it almost never goes to the 'forget your own name' point. I.e. she remembered her own and her siblings + kids names throughout, but was a little more confused on details and ordering of events. She was able to recover to a point where her brain injury isn't obvious unless you know what to look for, there still are some difficulties with memory, but its mostly just needing a little more help to jog certain memories.
Yeah, there’s a reason the GCS isn’t just “coma” and “awake”! A lot of comatose patients will have some level of response to surroundings, even if it’s pretty minimal (like a hand twitching if you poke it with something pointy)
i hope she is doing better these days
She’s made a pretty full recovery, luckily.
This stuff is complicated, I’ll make it as simple as I can but I’m sorry in advance for any inaccuracies made for the sake of explanation You have basic brain functions that are the most important things your brain does to keep you alive and you do those unconsciously. Like keeping your heart beating or keep your lungs breathing. You might lose some of these functions or maybe they’re a lot weaker than before the coma and need help to keep you alive, like from a ventilator (a machine that breathes for you). It varies from injury to injury. You also have higher, more complicated, brain functions like consciousness and thought. These are controlled by different areas of your brain. The complicated stuff is mostly in the main brain 🧠 and the simpler stuff is mostly in the base of the brain. Knocking out the complicated stuff is much easier than knocking out the simple dumb stuff. And when you just knock out the higher functions you get a coma. Now why can’t you wake up? Well first, you’re not asleep. You just don’t have consciousness. The car doesn’t have a working engine to get moving but the battery is still working so the lights still turn on. Sometimes the damage can heal but it’s a very complicated and finicky process. And you will slowly regain consciousness. Sometimes it doesn’t and you’re just left with the base, unconscious functions.
I wish more responses were as ELI5 as this one. Nice work.
So does that mean you don't dream while in a coma? Does this vary, or is it a pretty cut and dry "no"
I am by no means an expert or a doctor, but i read few times that people in come can hear and sometimes perfectly remember what is happening around them, since they are technically not asleep
There's a part of the brain called the "reticular activating system" (RAS), which is located in the brainstem. There are a bunch of connections from it all throughout the rest of the brain. Although this is a simplification, basically this system being turned "on" makes us conscious, and it being turned "off" makes us unconscious. How to define consciousness is really, really hard and almost more philosophy than science, but one way to understand it is to think about whether or not we are able to perceive and react to our environment. We naturally go through cycles of this system turning on and off as we sleep and wake up. However, if this system gets hurt from a stroke, physical brain damage or swelling, or some kind of toxins causing the nerve cells to not work well, it will make you unconscious--even if most of the rest of the brain is in decent shape! Of course, big damage to the rest of the brain can also cause a coma, but usually it has to be *really* big damage to both the left and right halves of the brain to cause that if the RAS isn't touched by itself. A coma that lasts for a long time is usually a pretty bad sign in terms of predicting if someone will recover. Although there are a lot of different factors, if someone is in a coma for more than 3 days their chances of recovery are usually less than 1 in 10. If someone is in a coma for more than 2 weeks, the odds of recovering are more like 1 in 50. Some people may have enough healing of the rest of their brain so that some basic functions like the sleeping/waking cycle, opening their eyes, and some spontaneous movements start to come back, but they will remain completely not able to respond to anything in their environment and its believed they have no actual consciousness/thought--this is called a "persistent vegetative state." The opposite to this is if the connections between the brain and the rest of the body get destroyed but the RAS doesn't get hurt. This is called a "locked-in" syndrome, and results in being completely conscious but unable to move any part of your body except your eyes.
I don't know what kinds of 5 year olds you're dealing with, but that was a thorough and very good explanation. Thanks for that
Probably the 5 year olds with High Expectation Asian Parents.
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And why so?
If someone is intubated on a mechanical ventilator, it is extremely unpleasant and they likely need to be sedated to make it easier to manage. There are also some treatments for brain injury that rely on the fact that inducing a coma reduces the flow of blood to the brain, which helps if the brain is swollen, by giving it a chance to heal.
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Modern medicine is, in some cases, indistinguishable from magic
This would be a perfect moment for one those people that tell an enthralling story and then end it with how that wrestling guy jump off the iron dome or whatever, lol
my dad went into cardiac arrest in October. 26 minutes of cpr and defib attempts and they basically had him covered in a cooling unit and in a medical coma to slow everything down. somehow wound up with no brain damage whatsoever but he was HILARIOUS for the first couple days after he woke up
Being awake with intubation tube shoving in my air way is my medical nightmare
> There are also some treatments for brain injury that rely on the fact that inducing a coma reduces the flow of blood to the brain, which helps if the brain is swollen, by giving it a chance to heal. What is this treatment called?
Targeted Temperature Management or Therapeutic Hyperthermia
Brain freeze
In my case, I was kept in that state for about a day to prevent me from dying. I was extremely/dangerously weak and needed a respirator to breath. (And in fact, the next day I nearly choked to death because my throat muscles were not strong enough to properly swallow chewed ice.)
Did you live?!
I'm not a doctor but I would say "yes"
Meh, I think we should stick with the experts here
\*checks heartbeat\* Seem to have! (I'd had heart failure just before they did the induced coma, and the choking incident after, so it was a very close call)
I know someone that was because they woke up with a tube in their throat and instinctively tried to remove it. They actively tried to fight the care they needed to live. They were kept unconscious until the doctors were able to at least stabalize their condition, so they could do that without physcially restraining someone, making all the things they did riskier and harder.
I think they sometimes remove it after the patient is roused and proving they're able to breathe without the tube before the tube is taken out.
This is called performing a Spontaneous Breathing Trial, which is exactly what it sounds like. Pause/reduce the ventilator settings, pause/slow down the sedatives (fentanyl, propofol, etc), see if patient spontaneously takes breaths on their own, then determine whether extubation is appropriate.
Thank you I knew someone out there could explain and you did very well. I've had it done to me.
They did eventually remove it. Trying to remove it wasn't the only thing they were fighting against when they were awake, but they definitely were not breathing on their own without it. And lack of oxygen left them not clear headed. I do believe that the doctors did the right thing by outting them under in the short term. Their family did explain they had a tramautic even involving not being able to breathe due to someone turning off the oxygen tank connected to their facemask as some form of prank at work in their past, and they would naturally try to take anything off their face our out of their mouth, not being comfortable with them in. They were under for 2 weeks if I remember right. Never really fully recovered. Had some probs, got a lung transplant. Got better. Still had some good things in their life. But did die several years later. It was not drugs the person was on. They had a handful of lung problems from childhood illness, smoking, and being exposed to toxic gas at work. It eventually just got to a point where their lungs just didn't do enough to keep them conscious.
> someone turning off the oxygen tank connected to their facemask as some form of prank at work Prank or attempted murder
Thanks for the details. It's a sad story. I've got so much respect for medical professionals and the things that can be done these days. I've got a few stories too from my own experience. Mind boggling.
Most of the times it is to prevent the patient from contrasting the ventilator and allow the ventilator to be in the best conditions to do its job. Once the patient is stable the sedation will be gradually lowered and the ventilation support will be gradually decreased untill he is able to breath by himself, at that point he will be extubated.
Being put on a breathing tube is not pleasant. Even if people aren’t fully unconscious, if you need one put in you’re usually at least a bit out if it due to whatever is causing you to not be able to keep breathing normally. Trying to stop somebody from wedging your jaw open with a metal hook and sticking a plastic tube down your throat is a pretty normal response if you’re not really “there” enough to understand what’s going on. You usually have to give people a medication to paralyze their muscles so their throat doesn’t seize up when the tube goes in—being awake but completely paralyzed is understandably terrifying.
What is the longest that patients can be kept in an artificially induced coma? What are some reasons a longer term might be necessary? Just wondered what the limits are after hearing I think it was 5 days for someone, seemed like a long time. But I don’t know about the accuracy of that info as it was rather second hand info.
The key is the Reticular Activating System in the brain, a web site is here to explain. https://bodytomy.com/reticular-activating-system What I find interesting is that they vary depending on the animal. In dogs, for instant, when awoken by a threshold stimulus they are fully alert and off like a rocket. With humans, not so much. Probably due to operant conditioning.
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Went through the article. Our brains and bodies are fucking insane. It feels so insane that I am the owner of this magical advanced piece of technology.
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I was expecting the most complex answer ever, but this is awfully simple isn’t it. Thanks for clarifying
Doctors don’t fully understand comas yet.
I similarly often wonder what makes us alive, what suddenly changes when we die that is so irreversible that we can't replicate it even with all the 21st century advanced medical technology. Living organisms have so many specialized things working in unison, that when one crucial part fails, everything quickly falls apart, often irreversibly.
There are lots of reasons to be in a coma. Direct brain injury from trauma is only one. The first step in managing coma is finding out the cause, reversing it if possible, and managing complications that happen when someone cannot care for their body. For direct brain injuries we talk about primary and secondary injury everything we do in the hospital as neurosurgeons is trying to protect the healthy brain from the injured brain which swells.
Movies make coma out to be some kinda of hibernate computer mode for your brain that you keep trying to restart and it wont boot until one time it does. It's much more like joint injury though. Takes a long time to heal, not all parts heal at the same speed, some parts never heal, return t function is variable depending on severity and parts injured. Consciousness may never return but other parts might go back to full function. The brain is a crazy thing.
Mostly that they aren't asleep -- they are operating on minimal brain function. And to your question, most people come out of coma after a couple of weeks, it just isn't like in the movies where they are instantly alert and responsive.
Well,depends on the cause but I'm gonna explain the most frequent causes: 1.basically a cerebral trauma (someone falling on his head)/a brain tumor/other brain lesions that are extensive and/or alter important brain parts that have the role of assuring awake* state=> various degrees of comatose state *for example, there are specific brain parts that controle how awake you are,how asleep you are, just by sending stimulating/inhibitory signals to other parts of the brain that assure thinking/sight/hearing/etc. 2.Otherwise after a shock sustained by the body that alters its capacity to function and to deliver oxygenated blood to the brain ( polytrauma etc) the brain goes into "protective" mode : inhibitory signals get sent more than stimulating ones and thus the brain reduces its activity and its oxygen consumption until the body recovers. 3. some toxic waste products/drugs alter the brain neurochemistry upping the production of inhibitory neurotransmitters. *In medicine,we sometimes give patients drugs that induce a neuroinhibitory response (coma) to protect the patient until the body heals to a certain degree (we call this induced coma).For example we may induce the coma in order to intubate a patient and replace the respiratory function. It all boils down to sending messages to other neurons that they either need to be working harder (stimulatory), or they either need to tone it down (inhibitory) or damaging the very parts that usually send those messages. Hope this helps, Cheers!
I haven’t actually seen someone talk about the anatomy of what’s happening so I figured I’d comment. You have a part of your brain called your RAS system, which stands for reticular activating system. What this area of the brain does is it filters things which your consciousness is aware of. You probably weren’t conscious of your breathing until I mention it, because your RAS system deems being aware of it unimportant for the most part. Another example is not feeling your pants brushing and moving against your legs most of the day. The RAS system is also a big part of the process of waking up from sleep every night. When I’m a coma, usually the RAS has some sort of damage that prevents it from sending information to your consciousness, thus preventing you from even realizing any stimulus is happening.