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Coma



O estado de coma não deve ser encarado como uma doença mas sim como um sintoma (ex: de um traumatismo craniano grave) ou a manifestação de uma doença (ex: problema metabólico) ou de uma resposta a um determinado evento (ex: efeito de uma droga ou um tóxico).


Define-se “coma” como um estado de inconsciência, mais ou menos alongado, durante o qual não é possível acordar a pessoa mesmo através de estímulos dolorosos e intensos. Por norma, a pessoa em questão não consegue iniciar qualquer actividade voluntária.


Dependendo da resposta da pessoa aos estímulos externos existem vários estados de coma, podendo verificar-se uma resposta sonora ou motora a estímulos dolorosos e apresentar respostas apenas reflexas.


Causas:

A mais frequente é o traumatismo craniano, outros casos incluem as intoxicações (por álcool, monóxido de carbono, drogas de abuso), alterações metabólicas (coma por doença da tiróide; coma diabético), estado de choque com hipotensão prolongada, infecção envolvendo o sistema nervoso central (meninge ou encefalite), acidente vascular cerebral (isquémico ou hemorrágico) grave.


O que fazer perante uma pessoa em coma:

O estado de coma pressupõe a existência de uma lesão mais ou menos grave no sistema nervoso central pelo que qualquer pessoa que esteja numa situação de coma deve ser encaminhada para o hospital (ligue 112). Estando em coma, a pessoa pode apresentar sinais de dificuldade respiratória, obstrução das vias aéreas (aspecto azulado, respiração ruidosa) e apresenta um elevado risco de aspirar algum vómito para os pulmões. Até à chegada da equipa de emergência médica, deve permanecer-se junto da pessoa que está em estado de coma e proceder de acordo com as indicações que são dadas pelo telefone. Geralmente e se possível, a pessoa deve ser colocada de lado e coberta com um cobertor, principalmente nos meses frios, mas de forma a que se possa verificar se a pessoa está a respirar. Caso a temperatura corporal esteja acima dos 38ºC não deverá ser coberta. Algumas situações de coma podem ser reversíveis, como é o caso do coma diabético por baixa de açúcar (hipoglicemia), nesse caso deve-se preparar uma papa constituída por açúcar e água e aplicar na fase interna da bochecha, no interior da boca da pessoa em coma. Ao encontrar uma pessoa em estado de coma deve-se observar se nas imediações existe algum produto tóxico ou embalagens de medicamentos, pois poder-se-á estar perante um coma provocado por uma intoxicação, a informação quanto aos tóxicos envolvidos pode ser determinante para a posterior resolução da situação.


Escala de Glasgow:

Em 1970 o Nation Institutes of Health, , U.S. Department of Health and Human Services, financiou dois estudos internacionais paralelos. Enquanto um estudou o estado de coma de pacientes com traumatismos cranianos graves, o segundo focalizou-se no prognóstico médico do coma. Os pesquisadores desses estudos desenvolveram o “índice de coma” que posteriormente se transformou na escala de Glasgow.

A escala de coma de Glasgow foi publicada oficialmente por Teasdale e Jennet em 1974, na revista Lancet, como uma forma de se avaliar a profundidade e duração clínica de inconsciência e coma.


Elementos da Escala:

Abertura ocular (AO)

Existem quatro níveis:

4. Olhos abrem-se espontaneamente;

3. Olhos abrem-se ao comando verbal. (Não confundir com o despertar de uma pessoa adormecida; se assim for, marque 4, se não, 3.);

2. Olhos abrem-se por estímulo doloroso;

1. Olhos não se abrem.


Melhor resposta verbal (MRV)

Existem 5 níveis:

5. Orientado. (O paciente responde coerentemente e apropriadamente às perguntas sobre seu nome e idade, onde está e porquê, a data etc.);

4. Confuso. (O paciente responde às perguntas coerentemente mas há alguma desorientação e confusão.);

3. Palavras inapropriadas. (Fala aleatória, mas sem troca conversacional);

2. Sons ininteligíveis. (Gemendo, sem articular palavras.);

1.Ausente.


Melhor resposta motora (MRM)

Existem 6 níveis:

6. Obedece ordens verbais. (O paciente faz coisas simples quando lhe é ordenado.);

5. Localiza estímulo doloroso;

4. Retirada inespecífica à dor;

3. Padrão flexor à dor (decorticação);

2. Padrão extensor à dor (descerebração);

1. Sem resposta motora.


Interpretação


Pontuação total: de 3 a 15

    • 3 = Coma profundo (85% de probabilidade de morte; estado vegetativo);
    • 4 = Coma profundo;
    • 7 = Coma intermediário;
    • 11 = Coma superficial;
    • 15 = Normalidade

Classificação do Trauma cranioencefálico (ATLS, 2005)
    • 3-8 = grave (necessidade de intubação imediata)
    • 9-13 = moderado
    • 14-15 = leve


Escala pediátrica

  • Melhor resposta motora:
  1. Nenhuma resposta.
  2. Extensão (descerebração).
  3. Flexão(decorticação).
  4. Se afasta da dor.
  5. Localiza a dor.
  6. Obedece aos comandos.
  • Melhor resposta verbal:
  1. Nenhuma resposta.
  2. Inquieto, inconsolável.
  3. Gemente.
  4. Choro consolável, interacção adequada.
  5. Sorri, orientado pelo som acompanhando objectos, ocorre interacção.
  • Olhos:
  1. Nenhuma.
  2. Com a dor (ex. leve beliscão).
  3. Com a fala.
  4. Espontâneo.

Posted by Immuniselectrun at 07:53

Hall of fame

Louis Pasteur

Birthday date: 27th December, 1822

The truth is surprising: as young, Louis Pasteur was a lazy student. His teachers never thought he was quite clever, as ahead he would show.

He studied physics and chemistry in Paris and chemistry was even the discipline in which we got a lower grade. Despite of that, later, He became a wise teacher and was one of the bigger scientists of ever, a genius of science. Only through one huge thirst of knowledge and an inexhaustible will of work the immortality was conquered and the death was defeated.

Facing all the expectations, the success arrived much early. With twenty six years he discovered the secret of crystals and a few time later he realized that the air we breathe it’s full of very small beings, He called them the invisible giants. Perhaps Pasteur already knew that these beings, apparently armless, were responsible for much part of the diseases shown in living beings. For sure he knew that the microorganisms used to enter in our organism with the purpose of unleash diseases. It was not easy to prove such theory in a time when all scientists thought that microorganisms were fruit of our own organism and not from outside. He wouldn’t give up anyway, He even bottled air to prove it, under the laugh of his colleagues , of course they didn’t even guess that what he was doing would become indispensable to his theory: none living being, including microorganisms, can appear in the world without descend from at least other of the same specie. In the course of his experiences, Pasteur could show up that microorganisms live in the air and reproduce themselves, entering in our body when they “feel” we are weakened and is the best shot to take. This was a very important discovery but his greatest feat, vaccine, would take more time to be created.

Before it, he helped the French farmers, solving a big problem: the quick sourness of wine. He observed microscopically the wine and found some kind of very short vegetation, called yeasts. Therefore, the yeasts were spoiling the wine, making it vinegary. Pasteur understood that wasn’t possible to take out those little creatures, they had to be killed and the only possible way: heat them up. The problem lied in the fact that the wine couldn’t heat up to high temperatures because it would change its quality. Persistent, Pasteur made a lot of experiences and found the solution: it was only necessary rise the wine’s temperature about sixty degrees centigrade to kill the microorganisms. These experiences gave rise to a much known process called pasteurization.

Pasteur was, undoubtedly, a chemistry genius and started to be called to solve the riddles that more nobody could. There was even a time when he was asked to find the origin of a plague which was killing thousands of silkworms. Pasteur, after some research, figured out that the butterfly was transmitting to her own eggs the disease and hence died so many of them. It was necessary to exterminate all larvae, butterflies and eggs which weren’t healthy. He had saved the French Industry of Silk and now, he’s stories of success were told not only in France but also abroad.

Modest, simple and not vain, Pasteur used to say that he only worked to help mankind. But, the fact of two of his sons have died with typhoid fever explain the dedication to Medicine and to studies about diseases caused by microorganisms.

Carbuncle was one of the first diseases studied by Pasteur. In that time, were dying many animals, mostly sheep due this disease. He discovered the responsible microorganism and made an experience: vaccinated twenty five sheep with the germ which caused the disease and left other twenty five sheep for vaccinate. Then he infected them all with the microorganism which made they feel sick. Happened that all vaccinated sheep survived and the others died. This was the first success of vaccination. However, he refused money to patent the medicine.

He wondered if would be worthwhile try to apply the same principles in the cure of human diseases. About 1880 Pasteur started to study the rage disease (affect animals, especially dogs, and normally is transmitted to humans by a nibble). Firstly, he discovered the rage virus. Then he used its “good” part to create an antidote and transformed it into a vaccine. Later, He started to inoculate it in the dogs but he didn’t have the courage to do the same in humans, until when on 6th July, 1885, a woman knocked on his door. She was carrying a boy with nine years old that was bitten by a dog fourteen times. The mother begged him to heal her son but the scientist didn’t want to experiment the serum in the kid named Joseph Meister because so far he never had used the vaccine in humans. However, once there was no other solution, eventually the kid would die with or without the inoculation, he applied the first of twelve anti-rage vaccines. During many weeks, the scientist and boy’s family feared the worst but in the end, Joseph Meister survived. From that time, people that had been bitten by raged dogs started to go to his laboratory asking for help. They came from different places of France and even from abroad although doctors didn’t recognize the worthwhile of Pasteur, what’s unthinkable, even because before his investigations, the only medicine available against rage was a spike in hot coal to burn the dog’s bite.

The vaccines were a huge triumph to medicine. Without them it’s difficult even think in survival.

Pasteur Institute:

The success of anti-rage vaccine was so enormous that the French Academy of Sciences decided to build one Institution dedicated only to laboratorial investigation. The Pasteur Institute was established in 1888 and is nowadays one of the most known centers of scientific investigation.

Curiosity – The HIV virus was isolated for the first time in these laboratories. This Institution without profitable ends was presided by Louis Pasteur until his death (28th September, 1895) and has a team of scientists that globally has eight Nobel Prizes in Medicine.

Microscope:

Nobody knows for sure who created it. Generally, its invention is attributed to Hans Janssen, Dutch glasses manufacturer, and his son Zacarias, in the year of 1590. However, will have been the Dutch Anton van Leeuwenhoek, that lived between 1632 and 1723, who made the first microscopic observations. He was a textile trader that used to mount lends. It was precisely through curved glasses that he mounted in a rudimental microscope that he saw little creatures which were walking along the drops of rain, vinegar and saliva. He was not a scientist but woke up the interest of scientific community. The first microscope had only one lend and so it couldn´t amplify very much.