Management of Coma and Hospitalization Protocols

Management of Coma and Hospitalization Protocols

Patients in comatose states are hospitalized in intensive care units (ICUs) of multidisciplinary hospitals or specialized departments. For instance, patients with traumatic coma are admitted to neurosurgery units, those with exotoxic coma to toxicology centers (if available), and those with apoplectic coma to intensive care units of neurovascular departments. Alternatively, they may be admitted to neuro-intensive care units.

The commonality of several pathogenic mechanisms and the presence of life-threatening disorders dictate the primary principles (urgency, intensity, and comprehensiveness) of pathogenic therapy, which must be administered alongside etiological treatment.

Urgency is driven by the presence or potential for rapid development of life-threatening disorders, particularly those affecting respiration, cardiovascular function, and homeostasis. The urgent nature of therapy necessitates immediate initiation of treatment, beginning at the pre-hospital stage. The most critical aspect is ensuring the patency of the upper airways, which includes removing foreign objects from the mouth, clearing vomitus, and inserting an airway. Ambulances must be equipped with all necessary tools for emergency intensive therapy to normalize heart rhythm, manage shock, perform respiratory and cardiac resuscitation, and control convulsive syndromes.

However, recent experiences suggest that the aim for maximal expansion of treatment measures at the pre-hospital stage may not always be justified. This is due to several reasons. For example, extensive use of neuroleptic and tranquilizing drugs can obscure the clinical picture of the disease, complicate the identification of focal symptoms of nervous system damage, and deepen the suppression of consciousness. The widespread use of diuretics without a thorough history can lead to the development of dangerous hyperosmolarity syndrome, particularly in diabetic and uremic coma.


In conclusion, the management of coma involves immediate and intensive measures to address life-threatening conditions, ensuring airway patency, and stabilizing cardiovascular and respiratory functions. Hospitalization should be in specialized units equipped to handle the specific needs of the comatose patient, and while urgent treatment is critical, care must be taken to avoid overuse of certain medications that could complicate the clinical assessment and treatment.