Can speak to a person in a coma
Living will and coma: 10 important questions at a glance
1. What is a coma?
The term “coma” comes from the Greek. Translated, coma means "deep sleep" - a patient in a coma does not sleep, but is in a deep unconsciousness. In a fully developed coma stage, people neither react to external stimuli nor can they be woken up by strong painful stimuli. Usually the cardiovascular system has to be artificially maintained through intensive medical measures.
By the way: A coma can last a few days or several weeks. During this period, the patient's condition must improve - or brain death occurs.
2. What are the levels of coma?
A distinction is made between four different stages of a coma, the transition of which is fluid:
- Mild coma, level I: The patient reacts to painful stimuli with targeted defensive movements. Pupillary reactions and breathing are also still normal.
- Mild coma, level II: The patient reacts to the pain journey much more slowly and in an untargeted manner. In addition, paralysis and pupillary disorders can be seen as the first signs of brain damage.
- Deep coma, level III: The patient no longer shows any pain defense reactions and only moves in an untargeted manner. In addition, the pupillary reaction is partially restricted.
- Deep coma, level VI: The patient does not show any pain reactions. The pupils are dilated and no longer respond to light. Due to spontaneous breathing, many patients can still breathe independently.
3. How does a coma arise?
A comatose condition is not a disease. It is a symptom that can result from various diseases - for example, traumatic brain injuries or strokes. Heart attacks, brain tumors, inflammatory and degenerative brain diseases, liver or kidney failure and severe thyroid disorders can also cause a coma.
4. How is the coma diagnosed?
Doctors often use the so-called "Glasgow Coma Scale" (GCS). This uniform point system divides coma patients according to various criteria - for example, according to responsiveness, pain reactions and pupillary reactions. While a person with full consciousness scores 15 points, a person with 3 points or less is in a deep coma. Doctors can use imaging techniques (such as magnetic resonance imaging) to diagnose possible causes of coma.
5. Can you wake up from a coma?
In principle, waking up from a coma is not likely, but possible - there are always cases of people who have woken up after a coma. The extent of the brain damage plays an important role in this. The chances of survival are particularly poor if there is a long-term lack of oxygen or if the blood circulation fails. On the other hand, patients who have fallen into a coma as a result of a traumatic brain injury have better chances of recovery.
6. What is a vegetative state?
Persistent vegetative state is the slang term for "Apallic Syndrome". In such a form of coma, only the cerebrum has failed and the brain stem remains functional - therefore the patient appears to be awake and his eyes are open. However, since the patient is not aware of his environment, the term "vegetative state" is misleading. Even movements of limbs, crying or laughing are only reflexes of the patient.
By the way: It is estimated that 3,000 to 5,000 people in Germany fall into a vegetative state every year.
7. What is an artificial coma?
Artificial coma describes the deliberately induced comatose state - mostly through low-dose anesthetic drugs. It is therefore a long-term anesthetic while the patient is being treated in intensive care. The artificial coma reduces the brain's metabolism and oxygen demand and prevents nerve cells from being damaged or swelling and intracranial pressure from increasing further. After successful treatment, the medication is slowly withdrawn and the patient wakes up from his coma.
8. What does artificial nutrition mean?
Coma patients can neither eat nor drink independently. Artificial nutrition is therefore almost always necessary in a comatose state - the body is supplied with nutrients, for example through a feeding tube or via the veins.
9. What is locked-in syndrome?
Locked-in syndrome is to be distinguished from coma. While patients in a coma are no longer conscious, those with locked-in syndrome are fully conscious - but still cannot move or communicate with their surroundings. The body is mostly paralyzed (with the exception of the eyes) and the patients are more or less locked in their own body. Sensation of pain, hearing and sight, and speech understanding continue to function in locked-in syndrome.
10. What can I specify about the coma in my living will?
With a living will you can decide about medical and nursing measures. This of course also includes topics such as (awake) coma, artificial coma and artificial nutrition. You can write down your wishes and thoughts and make restrictions - for example, limit the duration of the coma to a certain period of time or generally reject artificial nutrition. However, avoid generally formulated templates that are available for download from the Internet.
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