Orginal Publication Date
MCV/Q, Medical College of Virginia Quarterly
Coma is defined as an altered state of consciousness from which arousal due to appropriate stimuli is not adequately achieved. Such a definition of the state of coma is plagued with semantic problems, and terminology describing various comatose states is vast and even more ambiguous when applied to the infant. Rather than using such terms as coma, semicoma, stupor, or obtundation, it is better to describe the physical state of the unresponsive patient. The description should include the patient’s appearance, movements either spontaneous or elicited from stimuli, the patient’s response to the stimulus, and the nature of the stimulus, whether voice, pressure, or pain. A detailed neurological description is not warranted when describing the comatose state, but it is appropriate to include whether or not respirations are spontaneous or supported, and the patient’s cardiovascular state. Pupillary size and activity should be included in the description of the stuporous patient. The comatose state of an infant may be much more difficult to recognize and is often confused with physiological sleep states. An infant is considered to be in a coma when there is no appropriate response to shaking, pinching, visual, or auditory stimuli. As with the older child, a detailed description of the state is necessary. More difficult to recognize in infants and children are the less severe forms of coma, especially since fluctuating metabolic situations with rapid changes can occur and the state of consciousness may change equally rapidly. Notwithstanding these difficulties of definitions and recognition, a classification of coma in an infant and child is essential.
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