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Treatment for impaired consciousness
Last reviewed: 06.07.2025
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Treatment of impaired consciousness
Regardless of the cause of the coma, the first steps are to assess vital functions, eliminate and prevent their disorders. The following actions are necessary.
- Providing oxygenation (clearing the airways, intubation, if necessary - tracheostomy, artificial ventilation).
- Normalization and stabilization of blood circulation (administration of antihypertensive drugs or vasopressors, antiarrhythmic agents, maintenance of cardiac activity, normalization of circulating blood volume).
- Administration of large doses of thiamine when alcohol abuse is suspected.
- Administration of anticonvulsants in the presence of seizures.
- Administration of glucose (the risk of hypoglycemic brain damage is higher than the worsening of encephalopathy with hyperglycemia) with subsequent correction after receiving the tests.
- Administration of sedatives in the presence of psychomotor agitation.
- Normalization of water-electrolyte disturbances and acid-base balance.
- Normalization of body temperature.
- Administration of antibiotics (TBI, suspected neuroinfection or presence of signs of bacterial infection).
- Gastric lavage if drug or food poisoning is suspected.
Further treatment depends on the results of the examination and determination of the cause of the coma and includes detoxification (including specific) in cases of poisoning, administration of naloxone in cases of drug overdose, hemodialysis in cases of renal failure, use of large doses of thiamine in cases of alcohol poisoning, etc. It is necessary to remember about neurosurgical care in cases of extensive brain damage, when delay can cost the patient his life (epi- and subdural hematomas, acute occlusion of cerebrospinal fluid pathways, etc.).
Forecast
The outcome of patients with impaired consciousness, especially those in a coma, depends on many factors. The accuracy of the prognosis is determined primarily by the etiology of the lesion and the degree of depression of consciousness, so it is advisable to discuss the prognosis and outcome of the disease only in connection with the specific condition of the patient. In general, in addition to the cause of the coma, the patient's age, speed and volume of medical care are of great importance.
A patient with impaired consciousness, especially in a coma, requires quick decisions, since with timely diagnosis and adequate therapy, coma can be reversible, while delay in some cases can be fatal.