This category generally includes minimally conscious state and persistent vegetative state, but sometimes also includes the less severe locked-in syndrome and more severe chronic coma. Differential diagnosis of these disorders is an active area of biomedical research. Finally, brain death results in possible irreversible disruption of consciousness. While other conditions may cause a moderate deterioration (e.g., dementia and delirium) or transient interruption (e.g., grand mal and petit mal seizures) of consciousness, they are not included in this category. Anosognosia
One of the most striking disorders of consciousness goes by the name anosognosia, a Greek-derived term meaning unawareness of disease. This is a condition in which patients are disabled in some way, most commonly as a result of a stroke, but either misunderstand the nature of the problem or deny that there is anything wrong with them. The most frequently occurring form is seen in people who have experienced a stroke damaging the parietal lobe in the right hemisphere of the brain, giving rise to a syndrome known as hemispatial neglect, characterized by an inability to direct action or attention toward objects located to the left with respect to their bodies. Patients with hemispatial neglect are often paralyzed on the left side of the body, but sometimes deny being unable to move. When questioned about the obvious problem, the patient may avoid giving a direct answer, or may give an explanation that doesnt make sense.
In children 2 to 4 J/Kg is recommended.The defibrillation is made by an automated external defibrillator (AED), a portable machine that can be used even by any user because it produces voice instructions that guide the process, automatically checks the victims condition, and applies the correct electric shocks. Some defibrillators even provide feedback on the quality of CPR compressions, encouraging the lay rescuer to press the persons chest hard enough to circulate blood.In addition, there is increasing use of public access defibrillation. This involves placing an automated external defibrillator in public places, and training staff in these areas how to use them. This allows defibrillation to take place prior to the arrival of emergency services and has been shown to lead to increased chances of survival. It has been shown that those who have arrests in remote locations have worse outcomes following cardiac arrest. Medications
As of 2016, medications other than epinephrine (adrenaline), while included in guidelines, have not been shown to improve survival to hospital discharge following out-of-hospital cardiac arrest. This includes the use of atropine, lidocaine, and amiodarone. Epinephrine in adults, as of 2019, appears to improve survival but does not appear to improve neurologically normal survival. It is generally recommended every five minutes. Epinephrine acts on the alpha-1 receptor, which in turn increases the blood flow that supplies the heart. This would assist with providing more oxygen to the heart.