Unconscious Patient

Excerpt

Consciousness is the state of awareness of oneself and the surrounding environment and the ability to respond to external stimuli. Reduced alertness, diminished wakefulness, and a decreased awareness of oneself and the environment all characterize impaired consciousness. Although some patients may naturally regain full consciousness without medical intervention, others require intensive care and intricate diagnostic assessments.

A coma is a profound and occasionally extended state of unconsciousness. According to Plum and Posner, a coma is defined as a state of unresponsiveness in which the patient lies with their eyes closed and cannot be awakened to respond appropriately to stimuli, even with vigorous stimulation. The Glasgow Coma Scale (GCS) is a medical tool that objectively measures a coma's severity. GCS scores are valuable in predicting the prognosis for patients with traumatic brain injuries (TBIs), subarachnoid hemorrhages, and bacterial meningitis.

During periods of unconsciousness, patients lose their protective reflexes and sensory responses, rendering them vulnerable to aspiration, anoxic brain injuries, airway obstruction, and skin ulcerations. The causes of persistent unconsciousness can be either reversible or permanent. Potential contributors to diminished consciousness include damage to the ascending reticular activating system (RAS), cerebral hemispheres, and toxic or metabolic disruptions.

This review explores the etiologies and physiological aspects of reduced consciousness, with a focus on the significant role of the interprofessional healthcare team in assessing and managing this condition to improve patient outcomes and reduce complications.