Coma

Coma is a state of prolonged unresponsiveness — the person doesn't open their eyes, doesn't respond purposefully, and doesn't speak. Coma is a symptom of serious underlying disease — the goal is to find and treat the cause while keeping the person safe until they recover.

Common causes

• Brain injury — severe head trauma, stroke, brain haemorrhage, subarachnoid haemorrhage.
• Infection — meningitis, encephalitis, cerebral malaria, severe sepsis.
• Metabolic — low/high blood sugar, low sodium, liver/kidney failure, severe acid-base disturbance.
• Toxins and overdose — alcohol, opioids, sedatives, poisons.
• Low oxygen — after cardiac arrest, drowning, severe asthma.
• Severe electrolyte abnormalities.
• Post-seizure state — can be prolonged.
• Structural brain lesions — tumours, abscesses.

First aid and urgent action

• Dial 112.
• Check the airway; recovery position if breathing and no neck injury.
• If not breathing normally — start CPR.
• Check for obvious cause — head injury, diabetic medication in pocket, medicine bottles, insect sting, poison container.
• Take all medicines/containers to hospital with the person.

In hospital

• Airway, breathing, circulation — intubation and ventilation if needed.
• Immediate glucose check — hypoglycaemia is a rapidly reversible cause.
• Blood tests, toxicology, imaging (CT/MRI), lumbar puncture as indicated.
• Specific reversals — opioid-reversal injection for opioid overdose, benzodiazepine-reversal (cautiously), antibiotics for meningitis, anti-epileptics for status epilepticus.
• Intensive care — for supportive management.

Prognosis and next steps

Recovery depends on the cause, duration, and underlying brain injury. Some coma is fully reversible (overdose, metabolic); some is not. Structured assessment (Glasgow Coma Scale), serial examinations, neurophysiology, and imaging guide prognosis. Brain death — distinct from coma; a formal, legally defined diagnosis of no brain function; discussed in a separate page. Long coma/vegetative state raises ethical and family decisions — specialist support and advance directives help.