1428:
understood as having a stake in something that can affect what makes our life good in that domain. An interest is what directly and immediately improves life from a certain point of view or within a particular domain, or greatly increases the likelihood of life improvement enabling the subject to realize some good. That said, sensitivity to reward signals is a fundamental element in the learning process, both consciously and unconsciously. Moreover, the unconscious brain is able to interact with its surroundings in a meaningful way and to produce meaningful information processing of stimuli coming from the external environment, including other people.
1155:
834:
fractures. Angiography is used on rare occasions for TBIs i.e. when there is suspicion of an aneurysm, carotid sinus fistula, traumatic vascular occlusion, and vascular dissection. A CT can detect changes in density between the brain tissue and hemorrhages like subdural and intracerebral hemorrhages. MRIs are not the first choice in emergencies because of the long scanning times and because fractures cannot be detected as well as CT. MRIs are used for the imaging of soft tissues and lesions in the posterior fossa which cannot be found with the use of CT.
1115:
1019:
1197:(below Tentorium cerebelli), (3) metabolic or (4) diffused. This classification is merely dependent on the position of the original damage that caused the coma, and does not correlate with severity or the prognosis. The severity of coma impairment however is categorized into several levels. Patients may or may not progress through these levels. In the first level, the brain responsiveness lessens, normal reflexes are lost, the patient no longer responds to pain and cannot hear.
1282:
since the injury occurred. Common reactions, such as desperation, anger, frustration, and denial are possible. The focus of the patient care should be on creating an amicable relationship with the family members or dependents of a comatose patient as well as creating a rapport with the medical staff. Although there is heavy importance of a primary care taker, secondary care takers can play a supporting role to temporarily relieve the primary care taker's burden of tasks.
319:(ARAS) and keep the system from properly functioning to arouse the brain. Secondary effects of drugs, which include abnormal heart rate and blood pressure, as well as abnormal breathing and sweating, may also indirectly harm the functioning of the ARAS and lead to a coma. Given that drug poisoning is the cause for a large portion of patients in a coma, hospitals first test all comatose patients by observing pupil size and eye movement, through the
1139:
1103:
707:
3904:
65:
3761:
1449:
568:
neural transmission. While a diffuse cause is limited to aberrations of cellular function, that fall under a metabolic or toxic subgroup. Toxin-induced comas are caused by extrinsic substances, whereas metabolic-induced comas are caused by intrinsic processes, such as body thermoregulation or ionic imbalances (e.g. sodium). For instance, severe
3815:"Henry Adams: The Middle Years. By <italic>Ernest Samuels</italic>. (Cambridge, Mass.: Belknap Press of Harvard University Press. 1958. Pp. xiv, 514. $ 7.50.) and Henry Adams: The Major Phase. By <italic>Ernest Samuels</italic>. (Cambridge, Mass.: Belknap Press of Harvard University Press. 1964. Pp. xv, 687. $ 10.00.)".
1423:. Well-being can broadly be understood as the positive effect related to what makes life good (according to specific standards) for the individual in question. The only condition for well-being broadly considered is the ability to experience its 'positiveness'. That said, because experiencing positiveness is a basic emotional process with
373:, or brain tumor may cause restriction of blood flow. Lack of blood to cells in the brain prevents oxygen from getting to the neurons, and consequently causes cells to become disrupted and die. As brain cells die, brain tissue continues to deteriorate, which may affect the functioning of the ARAS, causing unconsciousness and coma.
1338:, the inability to articulate any speech. Recovery is usually gradual. In the first days, the patient may only awaken for a few minutes, with increased duration of wakefulness as their recovery progresses, and they may eventually recover full awareness. That said, some patients may never progress beyond very basic responses.
1356:(DBS), successfully roused communication, complex movement and eating ability in the man with a traumatic brain injury. His injuries left him in a minimally conscious state, a condition akin to a coma but characterized by occasional, but brief, evidence of environmental and self-awareness that coma patients lack.
564:, and then finally to the cerebral cortex. Any impairment in ARAS functioning, a neuronal dysfunction, along the arousal pathway stated directly above, prevents the body from being aware of its surroundings. Without the arousal and consciousness centers, the body cannot awaken, remaining in a comatose state.
1364:
Research by Eelco
Wijdicks on the depiction of comas in movies was published in Neurology in May 2006. Wijdicks studied 30 films (made between 1970 and 2004) that portrayed actors in prolonged comas, and he concluded that only two films accurately depicted the state of a coma patient and the agony of
1065:
is a stereotypical posturing in which the legs are similarly extended (stretched), but the arms are also stretched (extended at the elbow). The posturing is critical since it indicates where the damage is in the central nervous system. A decorticate posturing indicates a lesion (a point of damage) at
1431:
According to
Hawkins, "1. A life is good if the subject is able to value, or more basically if the subject is able to care. Importantly, Hawkins stresses that caring has no need for cognitive commitment, i.e. for high-level cognitive activities: it requires being able to distinguish something, track
1316:
The outcome for coma and vegetative state depends on the cause, location, severity and extent of neurological damage. A deeper coma alone does not necessarily mean a slimmer chance of recovery; similarly, a milder coma does not indicate a higher chance of recovery. The most common cause of death for
1281:
Coma has a wide variety of emotional reactions from the family members of the affected patients, as well as the primary care givers taking care of the patients. Research has shown that the severity of injury causing coma was found to have no significant impact compared to how much time has passed
599:
Structural and diffuse causes of coma are not isolated from one another, as one can lead to the other in some situations. For instance, coma induced by a diffuse metabolic process, such as hypoglycemia, can result in a structural coma if it is not resolved. Another example is if cerebral edema, a
862:
are still intact and functioning and is an important part of the physical exam. Due to the unconscious status of the patient, only a limited number of the nerves can be assessed. These include the cranial nerves number 2 (CN II), number 3 (CN III), number 5 (CN V), number 7 (CN VII), and cranial
567:
The severity and mode of onset of coma depends on the underlying cause. There are two main subdivisions of a coma: structural and diffuse neuronal. A structural cause, for example, is brought upon by a mechanical force that brings about cellular damage, such as physical pressure or a blockage in
833:
In the treatment of traumatic brain injury (TBI), there are 4 examination methods that have proved useful: skull x-ray, angiography, computed tomography (CT), and magnetic resonance imaging (MRI). The skull x-ray can detect linear fractures, impression fractures (expression fractures) and burst
1436:
something. 2. A life is good if the subject has the capacity for relationship with others, i.e. for meaningfully interacting with other people." This suggests that unawareness may (at least partly) fulfill both conditions identified by
Hawkins for life to be good for a subject, thus making the
183:
is a qualitative assessment of the functions mediated by the cortex, including cognitive abilities such as attention, sensory perception, explicit memory, language, the execution of tasks, temporal and spatial orientation and reality judgment. Neurologically, consciousness is maintained by the
1427:
roots, it is likely to occur at a completely unaware level and, therefore, introduces the idea of an unconscious well-being. As such, the ability of having interests is crucial for describing two abilities which those with comas are deficient in. Having an interest in a certain domain can be
560:(RF). The RAS has two tracts, the ascending and descending tract. The ascending tract, or ascending reticular activating system (ARAS), is made up of a system of acetylcholine-producing neurons, and works to arouse and wake up the brain. Arousal of the brain begins from the RF, through the
771:, quantify an individual's reactions such as eye opening, movement and verbal response in order to indicate their extent of brain injury. The patient's score can vary from a score of 3 (indicating severe brain injury and death) to 15 (indicating mild or no brain injury).
1237:
Once a patient is stable and no longer in immediate danger, there may be a shift of priority from stabilizing the patient to maintaining the state of their physical wellbeing. Moving patients every 2–3 hours by turning them side to side is crucial to avoiding
1086:
Pupil assessment is often a critical portion of a comatose examination, as it can give information as to the cause of the coma; the following table is a technical, medical guideline for common pupil findings and their possible interpretations:
995:
The gag, or pharyngeal, reflex is centered in the medulla and consists of the reflexive motor response of pharyngeal elevation and constriction with tongue retraction in response to sensory stimulation of the pharyngeal wall, posterior tongue,
144:. The person may experience respiratory and circulatory problems due to the body's inability to maintain normal bodily functions. People in a coma often require extensive medical care to maintain their health and prevent complications such as
647:
demonstrate active resistance to passive opening of the eyelids, with the eyelids closing abruptly and completely when the lifted upper eyelid is released (rather than slowly, asymmetrically and incompletely as seen in comas due to organic
1272:
Coma patients may also deal with restlessness or seizures. As such, soft cloth restraints may be used to prevent them from pulling on tubes or dressings and side rails on the bed should be kept up to prevent patients from falling.
1298:, and others die. Some patients who have entered a vegetative state go on to regain a degree of awareness; and in some cases may remain in vegetative state for years or even decades (the longest recorded period is 42 years, the
894:
However, failure of both eyes to move to one side can indicate damage or destruction of the affected side. In special cases, where only one eye deviates and the other does not, this often indicates a lesion (or damage) of the
1333:
People may emerge from a coma with a combination of physical, intellectual, and psychological difficulties that need special attention. It is common for coma patients to awaken in a profound state of confusion and experience
1377:(1998). The remaining 28 were criticized for portraying miraculous awakenings with no lasting side effects, unrealistic depictions of treatments and equipment required, and comatose patients remaining muscular and tanned.
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3943:
608:
Although diagnosis of coma is simple, investigating the underlying cause of onset can be rather challenging. As such, after gaining stabilization of the patient's airways, breathing and circulation (the basic
1204:
is a complex scale that has eight separate levels, and is often used in the first few weeks or months of coma while the patient is under closer observation, and when shifts between levels are more frequent.
938:
If the patient's eyes slowly deviate toward the ear where the water was injected, then the brainstem is intact, however failure to deviate toward the injected ear indicates damage of the brainstem on that
767:(alert, vocal stimuli, painful stimuli, unresponsive) scale by spontaneously exhibiting actions and, assessing the patient's response to vocal and painful stimuli. More elaborate scales, such as the
826:, and are important available tools not only for the assessment of the cortical activity but also for predicting the likelihood of the patient's awakening. The autonomous responses such as the
1352:
A man with brain damage and trapped in a coma-like state for six years was brought back to consciousness in 2003 by doctors who planted electrodes deep inside his brain. The method, called
1049:
Assessment of posture and physique is the next step. It involves general observation about the patient's positioning. There are often two stereotypical postures seen in comatose patients.
1217:(ICU) immediately, where maintenance of the patient's respiration and circulation become a first priority. Stability of their respiration and circulation is sustained through the use of
1108:
Normal eye with two pupils equal in size and reactive to light. This means that the patient is probably not in a coma and is probably lethargic, under influence of a drug, or sleeping.
1412:
It has been argued that unawareness should be just as ethically relevant and important as a state of awareness and that there should be metaphysical support of unawareness as a state.
1309:
rates, expressed as the level of chance the person has of recovering. Time is the best general predictor of a chance of recovery. For example, after four months of coma caused by
1213:
Treatment for people in a coma will depend on the severity and cause of the comatose state. Upon admittance to an emergency department, coma patients will usually be placed in an
365:
Twenty percent of comatose states result from an ischemic stroke, brain hemorrhage, or brain tumor. During a stroke, blood flow to part of the brain is restricted or blocked. An
1305:
Predicted chances of recovery will differ depending on which techniques were used to measure the patient's severity of neurological damage. Predictions of recovery are based on
888:
The patient's head is then moved to the patient's left, to observe whether the eyes stay or deviate toward the patient's right; same maneuver is attempted on the opposite side.
1144:
One pupil is dilated and unreactive, while the other is normal (in this case, the right eye is dilated, while the left eye is normal in size). This could mean damage to the
400:, abnormal glucose levels, and many other biological disorders. Furthermore, studies show that 1 out of 8 patients with traumatic brain injury experience a comatose state.
580:
levels in the blood) are examples of a metabolic diffuse neuronal dysfunction. Hypoglycemia or hypercapnia initially cause mild agitation and confusion, but progress to
261:
is also derived from Greek, where it can be found in the roots of several words meaning soporific or sleepy. It can still be found in the root of the term 'carotid'.
3533:
Formisano R; Carlesimo GA; Sabbadini M; et al. (May 2004). "Clinical predictors and neuropleropsychological outcome in severe traumatic brain injury patients".
3510:
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as the control over the muscles in the face and throat is diminished. As a result, those presenting to a hospital with coma are typically assessed for this risk ("
152:. Coma patients exhibit a complete absence of wakefulness and are unable to consciously feel, speak or move. Comas can be the result of natural causes, or can be
3400:
4062:
3639:
3621:
159:
Clinically, a coma can be defined as the consistent inability to follow a one-step command. It can also be defined as having a score of 8 or less on the
1290:
Comas can last from several days to, in particularly extreme cases, years. Some patients eventually gradually come out of the coma, some progress to a
644:
891:
If the patient's eyes move in a direction opposite to the direction of the rotation of the head, then the patient is said to have an intact brainstem.
1844:
3577:
1261:. A coma patient's lack of a gag reflex and use of a feeding tube can result in food, drink or other solid organic matter being lodged within their
2340:
1010:
Those in comatose states will often demonstrate poor gag reflexes if there has been damage to their glossopharyngeal (CN 9) or vagus nerve (CN 10).
4213:
1859:
229:(second century AD). Subsequently, it was hardly used in the known literature up to the middle of the 17th century. The term is found again in
2886:
983:
Those in a comatose state will have altered corneal reflex depending on the severity of their unconscious and the location of their lesion.
3014:
2950:
1265:(from the trachea to the lungs). This trapping of matter in their lower respiratory tract can ultimately lead to infection, resulting in
1795:
1070:, whereas a decerebrate posturing indicates a lesion at or below the red nucleus. In other words, a decorticate lesion is closer to the
3134:
Nakahara, Kuniaki; Shimizu, Satoru; Utsuki, Satoshi; Oka, Hidehiro; Kitahara, Takao; Kan, Shinichi; Fujii, Kiyotaka (January 2011).
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1957:
600:
diffuse dysfunction, leads to ischemia of the brainstem, a structural issue, due to the blockage of the circulation in the brain.
2885:
Daltrozzo J.; Wioland N.; Mutschler V.; Lutun P.; Jaeger A.; Calon B.; Meyer A.; Pottecher T.; Lang S.; Kotchoubey B. (2009c).
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1533:
354:
to decrease and intracellular calcium to increase, which harms neuron communication. Lack of oxygen in the brain also causes
2421:
624:
When an unconscious person enters a hospital, the hospital utilizes a series of diagnostic steps to identify the cause of
549:, relay of the sensory input via the thalamic pathway, and many other neurological functions, including complex thinking.
4048:
3013:
Daltrozzo J.; Wioland N.; Mutschler V.; Lutun P.; Calon B.; Meyer A.; Jaeger A.; Pottecher T.; Kotchoubey B. (2010a).
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3407:
3380:
3325:
2546:
2316:
1828:
1789:
1415:
In the ethical discussions about disorders of consciousness (DOCs), two abilities are usually considered as central:
746:
330:
The second most common cause of coma, which makes up about 25% of cases, is lack of oxygen, generally resulting from
914:
If pupils are reactive to light, then that also indicates that the cranial nerve number 3 (CN III) (or at least its
4203:
1124:
or opiate overdose, which can be responsible for a patient's coma. The pinpoint pupils are still reactive to light
448:
2613:
Thim, Troels; Krarup, Niels Henrik
Vinther; Grove, Erik Lerkevang; Rohde, Claus Valter; Løfgren, Bo (2012-01-31).
2226:
Lombardi, Francesco FL; Taricco, Mariangela; De Tanti, Antonio; Telaro, Elena; Liberati, Alessandro (2002-04-22).
2951:"Predicting Coma and other Low Responsive Patients Outcome using Event-Related Brain Potentials: A Meta-analysis"
2826:
Haupt, Walter F; Hansen, Hans
Christian; Janzen, Rudolf W C; Firsching, Raimund; Galldiks, Norbert (2015-04-16).
2615:"Initial assessment and treatment with the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach"
2813:"Classification and Complications of Traumatic Brain Injury: Practice Essentials, Epidemiology, Pathophysiology"
4167:
3783:
Hawkins, Jennifer (2016-03-01), "What Is Good for Them? Best
Interests and Severe Disorders of Consciousness",
896:
728:
3431:
Qadeer, Anam; Khalid, Usama; Amin, Mahwish; Murtaza, Sajeela; Khaliq, Muhammad F; Shoaib, Maria (2017-08-21).
3240:
Haupt, Walter F; Hansen, Hans
Christian; Janzen, Rudolf W C; Firsching, Raimund; Galldiks, Norbert (2015).
2115:
Siwicka-Gieroba, Dorota; Robba, Chiara; Gołacki, Jakub; Badenes, Rafael; Dabrowski, Wojciech (2022-10-25).
1626:
911:
Pupil reaction to light is important because it shows an intact retina, and cranial nerve number 2 (CN II)
882:
Oculocephalic reflex, also known as the doll's eye, is performed to assess the integrity of the brainstem.
1665:
1489:(vegetative coma), deep coma without detectable awareness. Damage to the cortex, with an intact brainstem.
628:. According to Young, the following steps should be taken when dealing with a patient possibly in a coma:
4208:
4092:
3581:
3181:
Korkmazer, Bora; Kocak, Burak; Tureci, Ercan; Islak, Civan; Kocer, Naci; Kizilkilic, Osman (2013-04-28).
1885:
1486:
1291:
1148:(cranial nerve number 3, CN III) on the right side, or indicate the possibility of vascular involvement.
847:
671:
Check for levels of serum glucose, calcium, sodium, potassium, magnesium, phosphate, urea, and creatinine
495:
320:
193:
108:
3136:"Linear fractures occult on skull radiographs: a pitfall at radiological screening for mild head injury"
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1876:
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Both pupils are dilated and unreactive to light. This could be due to overdose of certain medications,
679:
4087:
2175:
1856:
1394:
1342:
1295:
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away from this deviated position and is often seen in patients who are conscious or merely lethargic.
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43:
822:
can also show a lot about the activity level of the cortex such as semantic processing, presence of
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1257:
Pneumonia is also common in coma patients due to their inability to swallow which can then lead to
408:
370:
17:
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1373:
1341:
There are reports of people coming out of a coma after long periods of time. After 19 years in a
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1058:
717:
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412:
103:
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1313:, the chance of partial recovery is less than 15%, and the chance of full recovery is very low.
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with the soft tip of a cotton applicator and visually inspecting for elevation of the pharynx.
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1022:
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can be instantaneous. The mode of onset may therefore be indicative of the underlying cause.
420:
32:
782:"). If the risk of asphyxiation is deemed high, doctors may use various devices (such as an
289:
Abnormal, difficulty, or irregular breathing or no breathing at all when coma was caused by
2032:
1266:
1258:
877:
843:
842:
Assessment of the brainstem and cortical function through special reflex tests such as the
783:
3654:
2450:
Traub, Stephen J.; Wijdicks, Eelco F. (2016). "Initial
Diagnosis and Management of Coma".
1477:, paralysis of most muscles, except ocular muscles of the eyes, while patient is conscious
8:
3977:
2812:
2697:
Baxter, Cynthia L.; White, William D. (September 2003). "Psychogenic Coma: Case Report".
2283:
1713:
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1367:
1299:
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1218:
1214:
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1190:
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1074:, as opposed to a decerebrate posturing which indicates that the lesion is closer to the
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557:
416:
316:
3909:
3578:"Coma Information Page: National Institute of Neurological Disorders and Stroke (NINDS)"
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2227:
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2056:
1961:
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977:
768:
656:
640:
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is the only lung condition to cause coma, but many different lung conditions can cause
444:
296:
218:
163:(GCS) for at least 6 hours. For a patient to maintain consciousness, the components of
160:
93:
1254:
or other orthopedic deformities which would interfere with a coma patient's recovery.
307:
Many types of problems can cause a coma. Forty percent of comatose states result from
4157:
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3828:
3796:
3750:
3732:
3674:
3550:
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2467:
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2312:
2265:
2247:
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2156:
2138:
2097:
2060:
2048:
2044:
1938:
1930:
1824:
1785:
1781:
1646:
1607:
1558:
1529:
1262:
1165:
791:
779:
686:
432:
77:
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2734:
1602:
1585:
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2644:
2626:
2580:
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2534:
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2239:
2146:
2128:
2087:
2040:
1996:
1920:
1777:
1638:
1597:
1243:
1145:
1071:
1038:
959:
666:
347:
312:
141:
3886:
1154:
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4079:
3993:
3891:
3033:
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1454:
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585:
502:
491:
366:
262:
185:
133:
3363:
Hermanowicz, Neal (2007), "Cranial Nerves IX (Glossopharyngeal) and X (Vagus)",
3183:"Endovascular treatment of carotid cavernous sinus fistula: A systematic review"
3151:
2710:
2200:
2000:
1642:
1432:
it for a while, recognize it over time, and have certain emotional dispositions
935:
Cold water is injected into one ear and the patient is observed for eye movement
265:(1624–89) mentioned the term 'coma' in several cases of fever (Sydenham, 1685).
4004:
3765:
2948:
2781:
2749:
2494:
2390:
2355:
2228:"Sensory stimulation for brain injured individuals in coma or vegetative state"
2076:"Hypoxic-ischemic brain injury: Pathophysiology, neuropathology and mechanisms"
1909:"Historical study of coma: looking back through medical and neurological texts"
1550:
1239:
1222:
976:
Touching the sclera or eyelashes, presenting a light flash, or stimulating the
953:
859:
851:
810:
for example, and is performed to identify specific causes of the coma, such as
610:
577:
459:
404:
397:
331:
308:
290:
3967:
3727:
3546:
3258:
2844:
2463:
2243:
1584:
Bordini, A.L.; Luiz, T.F.; Fernandes, M.; Arruda, W. O.; Teive, H. A. (2010).
1495:, for an approach to working with residual consciousness in comatose patients.
1125:
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4117:
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3736:
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3335:
3299:
3267:
3208:
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2853:
2718:
2640:
2471:
2326:
2251:
2142:
1934:
1849:
1650:
1424:
1398:
613:) various diagnostic tests, such as physical examinations and imaging tools (
506:
467:
463:
424:
230:
176:
3135:
3094:
2422:"Ascending Reticular Activating System - an overview | ScienceDirect Topics"
4152:
3824:
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3678:
3652:
3554:
3491:
3476:
3285:
3226:
3167:
3120:
3041:
3012:
2977:
2913:
2884:
2871:
2793:
2761:
2726:
2658:
2506:
2479:
2402:
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2212:
2160:
2101:
2052:
1942:
1925:
1908:
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1583:
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1346:
1310:
1242:
as a result of being confined to a bed. Moving patients through the use of
1114:
963:
775:
674:
Perform brain scans to observe any abnormal brain functioning using either
569:
534:
479:
471:
440:
393:
385:
359:
254:
153:
136:
in which a person cannot be awakened, fails to respond normally to painful
3858:
3199:
2092:
2075:
1501:, the inducement of a temporary cessation or decay of main body functions.
4097:
3849:
Farisco, Michele (2016-04-28). Farisco, Michele; Evers, Kathinka (eds.).
3320:. Goetz, Christopher G. (3rd ed.). Philadelphia: WB Saunders. 2007.
1690:"The Glasgow structured approach to assessment of the Glasgow Coma Scale"
1462:
1402:
1349:
spontaneously began speaking and regained awareness of his surroundings.
1306:
1251:
1247:
1161:
1067:
1030:
581:
573:
518:
436:
389:
343:
189:
172:
149:
140:, light, or sound, lacks a normal wake-sleep cycle and does not initiate
137:
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2631:
2133:
932:
Caloric reflex test also evaluates both cortical and brainstem function
830:
may also provide further insight on the patient's emotional processing.
4127:
4023:
2572:
1468:
1390:
1335:
1180:
1034:
990:
973:
with a tissue or cotton swab induces a rapid blink reflex of both eyes.
855:
815:
811:
731: in this section. Unsourced material may be challenged and removed.
661:
Take blood work to see if drugs were involved or if it was a result of
546:
475:
428:
381:
86:
3935:
2584:
4134:
2527:"Mechanisms and Morphology of Cellular Injury, Adaptation, and Death"
1406:
1322:
1318:
1075:
943:
652:
643:
present with voluntary movement of their eyes, whereas patients with
635:
Make sure the patient is in an actual comatose state and is not in a
553:
311:. Certain drug use under certain conditions can damage or weaken the
197:
180:
145:
82:
2117:"Cerebral Oxygen Delivery and Consumption in Brain-Injured Patients"
1821:
MedStudy
Internal Medicine Review Core Curriculum: Neurology 11th Ed
1689:
706:
286:
Depressed brainstem reflexes, such as pupils not responding to light
4028:
1523:
1128:(in both eyes, not just one). Another possibility is damage to the
885:
Patient's eyelids are gently elevated and the cornea is visualized.
823:
561:
530:
510:
455:
246:
238:
3532:
3015:"Electrodermal Response in Coma and Other Low Responsive Patients"
2114:
1325:, which can occur in patients who lie still for extended periods.
3764:
Material was copied from this source, which is available under a
2673:"First aid for unconsciousness: What to do and when to seek help"
1465:, lack of activity in both cortex, and lack of brainstem function
1054:
1004:
803:
675:
655:, back of brain...) and assess the severity of the coma with the
621:, etc.) are employed to access the underlying cause of the coma.
614:
552:
The RAS, on the other hand, is a more primitive structure in the
339:
64:
3433:"Caregiver's Burden of the Patients With Traumatic Brain Injury"
1057:
at the elbow, and arms adducted toward the body, with both legs
4112:
3962:
3947:
1121:
1026:
997:
970:
542:
526:
358:
exhaustion and cellular breakdown from cytoskeleton damage and
351:
2949:
Daltrozzo J.; Wioland N.; Mutschler V.; Kotchoubey B. (2007).
1018:
4122:
3760:
2225:
1960:. University of North Carolina at Chapel Hill. Archived from
1483:, type of experience registered by people in a state of coma.
1138:
759:
In the initial assessment of coma, it is common to gauge the
514:
226:
209:
112:
3628:. 2 August 2007. Archived from the original on 6 March 2014.
639:
or experiencing psychogenic unresponsiveness. Patients with
1129:
1102:
1053:
is a stereotypical posturing in which the patient has arms
764:
651:
Find the site of the brain that may be causing coma (e.g.,
538:
3239:
2825:
1982:
1980:
1978:
3511:
Edwarda O'Bara, who spent 4 decades in a coma, dies at 59
3180:
1738:"Glasgow Coma Scale - an overview | ScienceDirect Topics"
819:
807:
618:
3133:
2384:
2382:
283:
Lack of response to physical (painful) or verbal stimuli
3655:"The portrayal of coma in contemporary motion pictures"
3430:
1975:
1907:
Wijdicks, Eelco F. M.; Koehler, Peter J. (2008-03-01).
1760:
958:
The corneal reflex assesses the proper function of the
774:
In those with deep unconsciousness, there is a risk of
632:
Perform a general examination and medical history check
3766:
Creative
Commons Attribution 4.0 International License
3653:
Eelco F.M. Wijdicks, MD; Coen A. Wijdicks, BS (2006).
1987:
Liversedge, Timothy; Hirsch, Nicholas (2010). "Coma".
1033:
or above. This positioning is stereotypical for upper
273:
General symptoms of a person in a comatose state are:
2445:
2443:
2441:
2379:
1229:
fluids or blood and other supportive care as needed.
980:
will induce a less rapid but still reliable response.
498:(RAS) is sufficient to cause a person to enter coma.
3925:
2612:
1444:
3709:Farisco, Michele; Evers, Kathinka (December 2017).
3622:"Electrodes stir man from six-year coma-like state"
2699:
The International Journal of Psychiatry in Medicine
2018:
2016:
2014:
2012:
2010:
1818:
217:, meaning deep sleep, had already been used in the
3604:"Mother stunned by coma victim's unexpected words"
2438:
1845:"Persistent vegetative state: A medical minefield"
1003:This reflex is examined by touching the posterior
818:of the brain structures. Special tests such as an
192:that forms the brain's outermost layer—and by the
4190:
3638:: CS1 maint: bot: original URL status unknown (
2747:
2073:
2007:
1986:
350:, causes sodium and calcium from outside of the
2788:, Treasure Island (FL): StatPearls Publishing,
2756:, Treasure Island (FL): StatPearls Publishing,
2748:Romanelli, David; Farrell, Mitchell W. (2022),
2525:Miller, Margaret A.; Zachary, James F. (2017).
2501:, Treasure Island (FL): StatPearls Publishing,
2397:, Treasure Island (FL): StatPearls Publishing,
2389:Arguinchona, Joseph H.; Tadi, Prasanna (2022),
2388:
2362:, Treasure Island (FL): StatPearls Publishing,
2354:Mercadante, Anthony A.; Tadi, Prasanna (2022),
1906:
1663:
1624:
1557:, Treasure Island (FL): StatPearls Publishing,
241:(pathological sleep), 'coma' (heavy sleeping),
72:Image of a comatose man unresponsive to stimuli
42:"Comatose" redirects here. For other uses, see
4070:
3851:Neurotechnology and Direct Brain Communication
3715:Philosophy, Ethics, and Humanities in Medicine
2573:"Obtundation, stupor and coma Peter Dickinson"
2353:
1524:Weyhenmyeye, James A.; Eve A. Gallman (2007).
175:is a quantitative assessment of the degree of
4056:
3787:, Oxford University Press, pp. 180–206,
2524:
2449:
685:Continue to monitor brain waves and identify
3708:
2339:: CS1 maint: multiple names: authors list (
2176:"Coma: Types, Causes, Treatments, Prognosis"
1317:a person in a vegetative state is secondary
588:. In contrast, coma resulting from a severe
3362:
3006:
2942:
2878:
2780:Jain, Shobhit; Iverson, Lindsay M. (2022),
2779:
2696:
2579:, CRC Press, pp. 140–155, 2012-03-15,
2452:Emergency Medicine Clinics of North America
2391:"Neuroanatomy, Reticular Activating System"
2284:"Coma - an overview | ScienceDirect Topics"
1714:"Coma - an overview | ScienceDirect Topics"
1625:Cooksley, Tim; Holland, Mark (2017-02-01).
474:, and infections involving the brain, like
4063:
4049:
3711:"The ethical relevance of the unconscious"
3077:Lee, Bruce; Newberg, Andrew (April 2005).
3076:
2198:
63:
3793:10.1093/acprof:oso/9780190280307.003.0011
3744:
3726:
3522:Aruna Shanba, who spent 42 years in coma.
3489:
3466:
3448:
3275:
3257:
3216:
3198:
3110:
3079:"Neuroimaging in Traumatic Brain Imaging"
2887:"Cortical Information Processing in Coma"
2861:
2843:
2648:
2630:
2619:International Journal of General Medicine
2556:
2493:Huff, J. Stephen; Tadi, Prasanna (2022),
2259:
2150:
2132:
2091:
1989:Anaesthesia & Intensive Care Medicine
1924:
1601:
1549:Huff, J. Stephen; Tadi, Prasanna (2022),
1471:, a system to assess the severity of coma
747:Learn how and when to remove this message
253:could turn and which he localized in the
122:Can vary from a few days to several years
2492:
1955:
1548:
1385:A person in a coma is said to be in an
1017:
899:(MLF), which is a brainstem nerve tract.
858:. Reflexes are a good indicator of what
338:requires a great deal of oxygen for its
3848:
3782:
2311:(3rd ed.). New York: McGraw-Hill.
2232:Cochrane Database of Systematic Reviews
2199:Ali, Rimsha; Nagalli, Shivaraj (2022).
1823:. MedStudy. pp. (11–1) to (11–2).
14:
4214:Symptoms and signs of mental disorders
4191:
2531:Pathologic Basis of Veterinary Disease
1814:
1812:
1810:
1808:
1761:Laureys; Boly; Moonen; Maquet (2009).
1359:
942:The cortex is responsible for a rapid
797:
277:Inability to voluntarily open the eyes
4044:
3844:
3842:
3778:
3776:
3774:
3704:
3702:
3575:
3395:
3393:
3391:
2577:Small Animal Neurological Emergencies
2173:
2022:
696:
517:. The cerebral cortex is composed of
403:Heart-related causes of coma include
317:ascending reticular activating system
268:
2894:Cognitive & Behavioral Neurology
1579:
1577:
1519:
1517:
1515:
1093:Pupil sizes (left eye vs. right eye)
729:adding citations to reliable sources
700:
376:Comatose cases can also result from
1805:
1666:"What Is a Medically Induced Coma?"
1401:come into play when discussing the
966:(CN 7), and is present at infancy.
529:, whereas the inner portion of the
24:
3839:
3771:
3699:
3671:10.1212/01.wnl.0000210497.62202.e9
3492:"Caring for Care Giver and Family"
3388:
2539:10.1016/B978-0-323-35775-3.00001-1
2306:
2074:Busl, K. M.; Greer, D. M. (2010).
1586:"Coma scales: a historical review"
1528:. Mosby Elsevier. pp. 177–9.
806:(CAT or CT) scan of the brain, or
545:. White matter is responsible for
485:
25:
4225:
3879:
1574:
1512:
1365:waiting for a patient to awaken:
1232:
837:
3902:
3759:
3373:10.1016/b978-141603618-0.10013-x
2121:Journal of Personalized Medicine
2045:10.1111/j.1749-6632.2009.04471.x
1801:from the original on 2014-10-20.
1782:10.1016/B978-008045046-9.01770-8
1526:Rapid Review Neuroscience 1st Ed
1447:
1437:unconscious ethically relevant.
1185:A coma can be classified as (1)
1153:
1137:
1113:
1101:
705:
584:, stupor, and finally, complete
490:Injury to either or both of the
449:decreased level of consciousness
245:(deprivation of the senses) and
208:The term 'coma', from the Greek
3808:
3646:
3614:
3596:
3569:
3526:
3515:
3504:
3483:
3424:
3356:
3310:
3292:
3233:
3174:
3127:
3070:
2819:
2805:
2773:
2741:
2690:
2665:
2606:
2565:
2518:
2486:
2414:
2347:
2300:
2276:
2219:
2192:
2167:
2108:
2067:
1949:
1900:
1869:
1837:
1603:10.1590/S0004-282X2010000600019
863:nerves 9 and 10 (CN IX, CN X).
716:needs additional citations for
3892:Merriam-Webster.com Dictionary
3817:The American Historical Review
3367:, Elsevier, pp. 217–229,
3365:Textbook of Clinical Neurology
3318:Textbook of clinical neurology
3300:"Neurological Assessment Tips"
2174:Durning, Marijke Vroomen; RN.
1754:
1730:
1706:
1682:
1664:Marc Lallanilla (2013-09-06).
1657:
1618:
1542:
897:medial longitudinal fasciculus
802:Imaging basically encompasses
295:Scores between 3 and 8 on the
280:A nonexistent sleep-wake cycle
13:
1:
3304:London Health Sciences Centre
2307:S., Saladin, Kenneth (2011).
1590:Arquivos de Neuro-Psiquiatria
1505:
1276:
1081:
1041:damage. The other variant is
456:severe or persistent seizures
454:Other causes of coma include
132:is a deep state of prolonged
3034:10.1016/j.neulet.2010.03.043
2970:10.1016/j.clinph.2006.11.019
2906:10.1097/wnn.0b013e318192ccc8
2023:Young, G.B. (2009). "Coma".
1819:Hannaman, Robert A. (2005).
1770:Encyclopedia of Neuroscience
1380:
1285:
1208:
603:
342:. Oxygen deprivation in the
336:Central Nervous System (CNS)
203:
7:
4093:Persistent vegetative state
3242:"Coma and cerebral imaging"
3152:10.1097/TA.0b013e3181d76737
2828:"Coma and cerebral imaging"
2711:10.2190/yvp4-3gtc-0ewk-42e8
2356:"Neuroanatomy, Gray Matter"
2001:10.1016/j.mpaic.2010.05.008
1886:Online Etymology Dictionary
1643:10.1016/j.mpmed.2016.12.001
1487:Persistent vegetative state
1440:
1328:
1174:
1120:"Pinpoint" pupils indicate
1045:, not seen in this picture.
794:) to safeguard the airway.
496:reticular activating system
194:reticular activating system
109:Persistent vegetative state
10:
4230:
4072:Disorders of consciousness
3576:NINDS (October 29, 2010).
3187:World Journal of Radiology
1493:Process Oriented Coma Work
1178:
850:test (cold caloric test),
257:) are mentioned. The term
233:' (1621–1675) influential
210:
196:(RAS), a structure in the
29:
4166:
4143:
4088:Minimally conscious state
4078:
4014:
3929:
3728:10.1186/s13010-017-0053-9
3608:The Sydney Morning Herald
3547:10.1007/s00701-004-0225-4
3259:10.1186/s40064-015-0869-y
2845:10.1186/s40064-015-0869-y
2464:10.1016/j.emc.2016.06.017
2244:10.1002/14651858.cd001427
2207:. StatPearls Publishing.
1343:minimally conscious state
1296:minimally conscious state
846:test (doll's eyes test),
828:skin conductance response
451:, but do not reach coma.
302:
118:
102:
92:
76:
71:
62:
57:
44:Comatose (disambiguation)
3490:Coma Care (2010-03-30).
2958:Clinical Neurophysiology
2677:www.medicalnewstoday.com
1694:www.glasgowcomascale.org
1627:"The management of coma"
1246:also aids in preventing
1096:Possible interpretation
409:ventricular fibrillation
321:vestibular-ocular reflex
27:State of unconsciousness
4204:Intensive care medicine
3095:10.1602/neurorx.2.2.372
1417:experiencing well-being
1389:state. Perspectives on
1374:The Dreamlife of Angels
1263:lower respiratory tract
1202:Rancho Los Amigos Scale
594:subarachnoid hemorrhage
537:and is composed of the
413:ventricular tachycardia
3348:: CS1 maint: others (
1354:deep brain stimulation
1046:
1000:, or faucial pillars.
926:Oculovestibular reflex
907:Pupillary light reflex
848:oculovestibular reflex
761:level of consciousness
590:traumatic brain injury
521:which consists of the
505:is the outer layer of
378:traumatic brain injury
37:Comas (disambiguation)
3859:10.4324/9781315723983
3785:Finding Consciousness
3535:Acta Neurochir (Wien)
3200:10.4329/wjr.v5.i4.143
3140:The Journal of Trauma
2426:www.sciencedirect.com
2288:www.sciencedirect.com
2093:10.3233/NRE-2010-0531
1853:: 40–3. July 7, 2007.
1742:www.sciencedirect.com
1718:www.sciencedirect.com
1481:Near-death experience
1063:Decerebrate posturing
1051:Decorticate posturing
1043:decerebrate posturing
1023:Decorticate posturing
1021:
969:Lightly touching the
788:nasopharyngeal airway
572:(low blood sugar) or
421:myocardial infarction
33:Coma (disambiguation)
3825:10.1086/ahr/71.2.709
3022:Neuroscience Letters
2782:"Glasgow Coma Scale"
2025:Ann. N. Y. Acad. Sci
1958:"Glasgow Coma Scale"
1926:10.1093/brain/awm332
1267:aspiration pneumonia
1225:, administration of
878:Oculocephalic reflex
844:oculocephalic reflex
784:oropharyngeal airway
725:improve this article
171:must be maintained.
31:For other uses, see
3584:on December 4, 2010
3450:10.7759/cureus.1590
2632:10.2147/IJGM.S28478
2134:10.3390/jpm12111763
2080:NeuroRehabilitation
2037:2009NYASA1157...32Y
1499:Suspended animation
1368:Reversal of Fortune
1360:Society and culture
1300:Aruna Shanbaug case
1215:Intensive Care Unit
1191:Tentorium cerebelli
928:(Cold Caloric Test)
918:fibers) are intact.
804:computed tomography
798:Imaging and testing
558:reticular formation
556:which includes the
417:atrial fibrillation
315:functioning in the
4209:Emergency medicine
4178:Locked-in syndrome
4015:External resources
3912:has a profile for
3895:. Merriam-Webster.
1862:2017-08-26 at the
1475:Locked-in syndrome
1168:(lack of oxygen).
1047:
978:supraorbital nerve
769:Glasgow Coma Scale
697:Initial evaluation
657:Glasgow Coma Scale
641:locked-in syndrome
445:Respiratory arrest
297:Glasgow Coma Scale
269:Signs and symptoms
219:Hippocratic corpus
184:activation of the
161:Glasgow Coma Scale
4186:
4185:
4158:Vasovagal episode
4038:
4037:
3918:
2594:978-0-429-15897-1
2585:10.1201/b15214-12
1535:978-0-323-02261-3
1172:
1171:
1016:
1015:
792:endotracheal tube
780:airway management
757:
756:
749:
689:of patient using
645:psychogenic comas
433:cardiogenic shock
235:De anima brutorum
154:medically induced
142:voluntary actions
126:
125:
52:Medical condition
16:(Redirected from
4221:
4065:
4058:
4051:
4042:
4041:
3927:
3926:
3916:
3906:
3905:
3896:
3873:
3872:
3846:
3837:
3836:
3819:. January 1966.
3812:
3806:
3805:
3780:
3769:
3763:
3758:
3748:
3730:
3706:
3697:
3696:
3694:
3693:
3665:(9): 1300–1303.
3650:
3644:
3643:
3637:
3629:
3618:
3612:
3611:
3600:
3594:
3593:
3591:
3589:
3580:. Archived from
3573:
3567:
3566:
3530:
3524:
3519:
3513:
3508:
3502:
3501:
3499:
3498:
3487:
3481:
3480:
3470:
3452:
3428:
3422:
3421:
3419:
3418:
3412:
3406:. Archived from
3405:
3397:
3386:
3385:
3360:
3354:
3353:
3347:
3339:
3314:
3308:
3307:
3296:
3290:
3289:
3279:
3261:
3237:
3231:
3230:
3220:
3202:
3178:
3172:
3171:
3131:
3125:
3124:
3114:
3074:
3068:
3067:
3065:
3064:
3058:
3052:. Archived from
3019:
3010:
3004:
3003:
3001:
3000:
2994:
2988:. Archived from
2955:
2946:
2940:
2939:
2937:
2936:
2930:
2924:. Archived from
2891:
2882:
2876:
2875:
2865:
2847:
2823:
2817:
2816:
2809:
2803:
2802:
2801:
2800:
2777:
2771:
2770:
2769:
2768:
2745:
2739:
2738:
2694:
2688:
2687:
2685:
2684:
2669:
2663:
2662:
2652:
2634:
2610:
2604:
2603:
2602:
2601:
2569:
2563:
2562:
2560:
2522:
2516:
2515:
2514:
2513:
2490:
2484:
2483:
2447:
2436:
2435:
2433:
2432:
2418:
2412:
2411:
2410:
2409:
2386:
2377:
2376:
2375:
2374:
2351:
2345:
2344:
2338:
2330:
2304:
2298:
2297:
2295:
2294:
2280:
2274:
2273:
2263:
2223:
2217:
2216:
2201:"Hyperammonemia"
2196:
2190:
2189:
2187:
2186:
2171:
2165:
2164:
2154:
2136:
2112:
2106:
2105:
2095:
2071:
2065:
2064:
2020:
2005:
2004:
1984:
1973:
1972:
1970:
1969:
1953:
1947:
1946:
1928:
1904:
1898:
1897:
1895:
1893:
1873:
1867:
1854:
1841:
1835:
1834:
1816:
1803:
1802:
1800:
1767:
1758:
1752:
1751:
1749:
1748:
1734:
1728:
1727:
1725:
1724:
1710:
1704:
1703:
1701:
1700:
1686:
1680:
1679:
1677:
1676:
1661:
1655:
1654:
1622:
1616:
1615:
1605:
1581:
1572:
1571:
1570:
1569:
1546:
1540:
1539:
1521:
1457:
1452:
1451:
1450:
1409:views on comas.
1292:vegetative state
1244:physical therapy
1157:
1146:oculomotor nerve
1141:
1117:
1105:
1090:
1089:
960:trigeminal nerve
866:
865:
814:in the brain or
752:
745:
741:
738:
732:
709:
701:
667:hyperventilation
371:brain hemorrhage
346:, also known as
213:
212:
67:
55:
54:
47:
40:
21:
4229:
4228:
4224:
4223:
4222:
4220:
4219:
4218:
4189:
4188:
4187:
4182:
4169:
4162:
4139:
4108:Brainstem death
4080:Unconsciousness
4074:
4069:
4039:
4034:
4033:
4010:
4009:
3938:
3924:
3923:
3922:
3907:
3903:
3885:
3882:
3877:
3876:
3869:
3847:
3840:
3814:
3813:
3809:
3803:
3781:
3772:
3707:
3700:
3691:
3689:
3651:
3647:
3631:
3630:
3626:Cosmos Magazine
3620:
3619:
3615:
3602:
3601:
3597:
3587:
3585:
3574:
3570:
3531:
3527:
3520:
3516:
3509:
3505:
3496:
3494:
3488:
3484:
3429:
3425:
3416:
3414:
3410:
3403:
3399:
3398:
3389:
3383:
3361:
3357:
3341:
3340:
3328:
3316:
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3311:
3298:
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3293:
3238:
3234:
3179:
3175:
3132:
3128:
3075:
3071:
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3011:
3007:
2998:
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2889:
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2742:
2695:
2691:
2682:
2680:
2671:
2670:
2666:
2611:
2607:
2599:
2597:
2595:
2571:
2570:
2566:
2549:
2523:
2519:
2511:
2509:
2491:
2487:
2448:
2439:
2430:
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2420:
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2387:
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2352:
2348:
2332:
2331:
2319:
2305:
2301:
2292:
2290:
2282:
2281:
2277:
2238:(2): CD001427.
2224:
2220:
2197:
2193:
2184:
2182:
2172:
2168:
2113:
2109:
2072:
2068:
2021:
2008:
1985:
1976:
1967:
1965:
1954:
1950:
1905:
1901:
1891:
1889:
1875:
1874:
1870:
1864:Wayback Machine
1843:
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1817:
1806:
1798:
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1672:
1670:livescience.com
1662:
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1567:
1565:
1547:
1543:
1536:
1522:
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1508:
1455:Medicine portal
1453:
1448:
1446:
1443:
1421:having interest
1383:
1362:
1331:
1288:
1279:
1235:
1211:
1183:
1177:
1084:
1025:, indicating a
927:
916:parasympathetic
869:Type of reflex
840:
800:
753:
742:
736:
733:
722:
710:
699:
663:hypoventilation
637:locked-in state
626:unconsciousness
606:
586:unconsciousness
533:is composed of
503:cerebral cortex
492:cerebral cortex
488:
486:Pathophysiology
367:ischemic stroke
305:
271:
263:Thomas Sydenham
225:) and later by
206:
186:cerebral cortex
134:unconsciousness
98:Unconsciousness
53:
48:
41:
30:
28:
23:
22:
15:
12:
11:
5:
4227:
4217:
4216:
4211:
4206:
4201:
4184:
4183:
4181:
4180:
4174:
4172:
4164:
4163:
4161:
4160:
4155:
4149:
4147:
4141:
4140:
4138:
4137:
4132:
4131:
4130:
4125:
4120:
4110:
4105:
4100:
4095:
4090:
4084:
4082:
4076:
4075:
4068:
4067:
4060:
4053:
4045:
4036:
4035:
4032:
4031:
4019:
4018:
4016:
4012:
4011:
4008:
4007:
3996:
3985:
3970:
3955:
3939:
3934:
3933:
3931:
3930:Classification
3908:
3901:
3900:
3899:
3898:
3897:
3881:
3880:External links
3878:
3875:
3874:
3867:
3838:
3807:
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3770:
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3645:
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3595:
3568:
3525:
3514:
3503:
3482:
3423:
3387:
3381:
3355:
3326:
3309:
3291:
3232:
3193:(4): 143–155.
3173:
3146:(1): 180–182.
3126:
3089:(2): 372–383.
3069:
3005:
2964:(3): 606–614.
2941:
2877:
2818:
2804:
2772:
2740:
2705:(3): 317–322.
2689:
2664:
2605:
2593:
2564:
2547:
2517:
2485:
2458:(4): 777–793.
2437:
2413:
2378:
2346:
2317:
2299:
2275:
2218:
2191:
2166:
2107:
2066:
2006:
1995:(9): 337–339.
1974:
1956:Russ Rowlett.
1948:
1919:(3): 877–889.
1899:
1868:
1836:
1829:
1804:
1790:
1753:
1729:
1705:
1681:
1656:
1637:(2): 115–119.
1617:
1596:(6): 930–937.
1573:
1541:
1534:
1510:
1509:
1507:
1504:
1503:
1502:
1496:
1490:
1484:
1478:
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1466:
1459:
1458:
1442:
1439:
1382:
1379:
1361:
1358:
1330:
1327:
1287:
1284:
1278:
1275:
1234:
1233:Continued care
1231:
1210:
1207:
1195:infratentorial
1187:supratentorial
1179:Main article:
1176:
1173:
1170:
1169:
1158:
1150:
1149:
1142:
1134:
1133:
1118:
1110:
1109:
1106:
1098:
1097:
1094:
1083:
1080:
1014:
1013:
1012:
1011:
1008:
993:
987:
986:
985:
984:
981:
974:
956:
954:Corneal reflex
950:
949:
948:
947:
940:
936:
930:
922:
921:
920:
919:
909:
903:
902:
901:
900:
892:
889:
886:
880:
874:
873:
870:
860:cranial nerves
852:corneal reflex
839:
838:Body movements
836:
799:
796:
755:
754:
713:
711:
704:
698:
695:
694:
693:
683:
672:
669:
659:
649:
633:
605:
602:
578:carbon dioxide
487:
484:
460:kidney failure
405:cardiac arrest
398:hyperammonemia
332:cardiac arrest
309:drug poisoning
304:
301:
300:
299:
293:
291:cardiac arrest
287:
284:
281:
278:
270:
267:
237:(1672), where
205:
202:
124:
123:
120:
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80:
74:
73:
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26:
9:
6:
4:
3:
2:
4226:
4215:
4212:
4210:
4207:
4205:
4202:
4200:
4197:
4196:
4194:
4179:
4176:
4175:
4173:
4171:
4170:consciousness
4168:Alteration of
4165:
4159:
4156:
4154:
4151:
4150:
4148:
4146:
4142:
4136:
4133:
4129:
4126:
4124:
4121:
4119:
4116:
4115:
4114:
4111:
4109:
4106:
4104:
4101:
4099:
4096:
4094:
4091:
4089:
4086:
4085:
4083:
4081:
4077:
4073:
4066:
4061:
4059:
4054:
4052:
4047:
4046:
4043:
4030:
4026:
4025:
4021:
4020:
4017:
4013:
4006:
4002:
4001:
3997:
3995:
3991:
3990:
3986:
3984:
3980:
3979:
3975:
3971:
3969:
3965:
3964:
3960:
3956:
3954:
3950:
3949:
3945:
3941:
3940:
3937:
3932:
3928:
3920:
3919:
3911:
3894:
3893:
3888:
3884:
3883:
3870:
3868:9781315723983
3864:
3860:
3856:
3852:
3845:
3843:
3834:
3830:
3826:
3822:
3818:
3811:
3804:
3802:9780190280307
3798:
3794:
3790:
3786:
3779:
3777:
3775:
3767:
3762:
3756:
3752:
3747:
3742:
3738:
3734:
3729:
3724:
3720:
3716:
3712:
3705:
3703:
3688:
3684:
3680:
3676:
3672:
3668:
3664:
3660:
3656:
3649:
3641:
3635:
3627:
3623:
3617:
3610:. 2003-07-12.
3609:
3605:
3599:
3583:
3579:
3572:
3564:
3560:
3556:
3552:
3548:
3544:
3541:(5): 457–62.
3540:
3536:
3529:
3523:
3518:
3512:
3507:
3493:
3486:
3478:
3474:
3469:
3464:
3460:
3456:
3451:
3446:
3442:
3438:
3434:
3427:
3413:on 2010-06-27
3409:
3402:
3396:
3394:
3392:
3384:
3382:9781416036180
3378:
3374:
3370:
3366:
3359:
3351:
3345:
3337:
3333:
3329:
3327:9781416036180
3323:
3319:
3313:
3305:
3301:
3295:
3287:
3283:
3278:
3273:
3269:
3265:
3260:
3255:
3251:
3247:
3243:
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3214:
3210:
3206:
3201:
3196:
3192:
3188:
3184:
3177:
3169:
3165:
3161:
3157:
3153:
3149:
3145:
3141:
3137:
3130:
3122:
3118:
3113:
3108:
3104:
3100:
3096:
3092:
3088:
3084:
3080:
3073:
3059:on 2011-08-14
3055:
3051:
3047:
3043:
3039:
3035:
3031:
3027:
3023:
3016:
3009:
2995:on 2011-08-14
2991:
2987:
2983:
2979:
2975:
2971:
2967:
2963:
2959:
2952:
2945:
2931:on 2011-08-14
2927:
2923:
2919:
2915:
2911:
2907:
2903:
2899:
2895:
2888:
2881:
2873:
2869:
2864:
2859:
2855:
2851:
2846:
2841:
2837:
2833:
2829:
2822:
2815:. 2022-02-07.
2814:
2808:
2795:
2791:
2787:
2783:
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2763:
2759:
2755:
2751:
2744:
2736:
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2728:
2724:
2720:
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2712:
2708:
2704:
2700:
2693:
2678:
2674:
2668:
2660:
2656:
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2646:
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2638:
2633:
2628:
2624:
2620:
2616:
2609:
2596:
2590:
2586:
2582:
2578:
2574:
2568:
2559:
2554:
2550:
2548:9780323357753
2544:
2540:
2536:
2532:
2528:
2521:
2508:
2504:
2500:
2496:
2489:
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2357:
2350:
2342:
2336:
2328:
2324:
2320:
2318:9780073525600
2314:
2310:
2309:Human anatomy
2303:
2289:
2285:
2279:
2271:
2267:
2262:
2257:
2253:
2249:
2245:
2241:
2237:
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2222:
2214:
2210:
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2195:
2181:
2177:
2170:
2162:
2158:
2153:
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2118:
2111:
2103:
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2058:
2054:
2050:
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2038:
2034:
2030:
2026:
2019:
2017:
2015:
2013:
2011:
2002:
1998:
1994:
1990:
1983:
1981:
1979:
1964:on 2018-06-04
1963:
1959:
1952:
1944:
1940:
1936:
1932:
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1903:
1888:
1887:
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1858:
1852:
1851:
1850:New Scientist
1846:
1840:
1832:
1830:1-932703-01-2
1826:
1822:
1815:
1813:
1811:
1809:
1797:
1793:
1791:9780080450469
1787:
1783:
1779:
1776:: 1133–1142.
1775:
1771:
1764:
1757:
1743:
1739:
1733:
1719:
1715:
1709:
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1691:
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1479:
1476:
1473:
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1464:
1461:
1460:
1456:
1445:
1438:
1435:
1429:
1426:
1422:
1418:
1413:
1410:
1408:
1404:
1400:
1399:consciousness
1396:
1392:
1388:
1378:
1376:
1375:
1370:
1369:
1357:
1355:
1350:
1348:
1344:
1339:
1337:
1326:
1324:
1320:
1314:
1312:
1308:
1303:
1301:
1297:
1293:
1283:
1274:
1270:
1268:
1264:
1260:
1255:
1253:
1249:
1245:
1241:
1230:
1228:
1224:
1220:
1216:
1206:
1203:
1198:
1196:
1192:
1188:
1182:
1167:
1163:
1159:
1156:
1152:
1151:
1147:
1143:
1140:
1136:
1135:
1131:
1127:
1123:
1119:
1116:
1112:
1111:
1107:
1104:
1100:
1099:
1095:
1092:
1091:
1088:
1079:
1077:
1073:
1069:
1066:or above the
1064:
1060:
1056:
1052:
1044:
1040:
1036:
1032:
1028:
1024:
1020:
1009:
1006:
1002:
1001:
999:
994:
992:
989:
988:
982:
979:
975:
972:
968:
967:
965:
961:
957:
955:
952:
951:
945:
941:
937:
934:
933:
931:
929:
924:
923:
917:
913:
912:
910:
908:
905:
904:
898:
893:
890:
887:
884:
883:
881:
879:
876:
875:
871:
868:
867:
864:
861:
857:
853:
849:
845:
835:
831:
829:
825:
821:
817:
813:
809:
805:
795:
793:
789:
785:
781:
777:
772:
770:
766:
762:
751:
748:
740:
730:
726:
720:
719:
714:This section
712:
708:
703:
702:
692:
688:
684:
681:
677:
673:
670:
668:
664:
660:
658:
654:
650:
646:
642:
638:
634:
631:
630:
629:
627:
622:
620:
616:
612:
601:
597:
595:
591:
587:
583:
579:
575:
571:
565:
563:
559:
555:
550:
548:
544:
540:
536:
532:
528:
524:
520:
516:
512:
508:
507:neural tissue
504:
499:
497:
493:
483:
481:
477:
473:
469:
468:hyperglycemia
465:
464:liver failure
461:
457:
452:
450:
446:
442:
438:
434:
431:when severe,
430:
426:
425:heart failure
422:
418:
414:
410:
406:
401:
399:
395:
391:
387:
383:
379:
374:
372:
368:
363:
361:
357:
353:
349:
345:
341:
337:
333:
328:
326:
322:
318:
314:
310:
298:
294:
292:
288:
285:
282:
279:
276:
275:
274:
266:
264:
260:
256:
252:
248:
244:
240:
236:
232:
231:Thomas Willis
228:
224:
220:
216:
201:
199:
195:
191:
187:
182:
178:
177:consciousness
174:
170:
166:
162:
157:
155:
151:
147:
143:
139:
135:
131:
121:
117:
114:
110:
107:
105:
104:Complications
101:
97:
95:
91:
88:
84:
81:
79:
75:
70:
66:
61:
56:
50:
45:
38:
34:
19:
4153:Heat syncope
4102:
4022:
3998:
3987:
3972:
3957:
3942:
3914:
3890:
3850:
3816:
3810:
3784:
3718:
3714:
3690:. Retrieved
3662:
3658:
3648:
3625:
3616:
3607:
3598:
3586:. Retrieved
3582:the original
3571:
3538:
3534:
3528:
3517:
3506:
3495:. Retrieved
3485:
3443:(8): e1590.
3440:
3436:
3426:
3415:. Retrieved
3408:the original
3364:
3358:
3317:
3312:
3303:
3294:
3249:
3246:SpringerPlus
3245:
3235:
3190:
3186:
3176:
3143:
3139:
3129:
3086:
3082:
3072:
3061:. Retrieved
3054:the original
3028:(1): 44–47.
3025:
3021:
3008:
2997:. Retrieved
2990:the original
2961:
2957:
2944:
2933:. Retrieved
2926:the original
2900:(1): 53–62.
2897:
2893:
2880:
2835:
2832:SpringerPlus
2831:
2821:
2807:
2797:, retrieved
2785:
2775:
2765:, retrieved
2753:
2750:"AVPU Score"
2743:
2702:
2698:
2692:
2681:. Retrieved
2679:. 2021-06-11
2676:
2667:
2622:
2618:
2608:
2598:, retrieved
2576:
2567:
2533:: 2–43.e19.
2530:
2520:
2510:, retrieved
2498:
2488:
2455:
2451:
2429:. Retrieved
2425:
2416:
2406:, retrieved
2394:
2371:, retrieved
2359:
2349:
2308:
2302:
2291:. Retrieved
2287:
2278:
2235:
2231:
2221:
2204:
2194:
2183:. Retrieved
2179:
2169:
2127:(11): 1763.
2124:
2120:
2110:
2083:
2079:
2069:
2031:(1): 32–47.
2028:
2024:
1992:
1988:
1966:. Retrieved
1962:the original
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1403:metaphysical
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1068:red nucleus
1031:red nucleus
962:(CN 5) and
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