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To determine âcessation of all functions of the entire brain, including the brain stem,â physicians must determine the presence of unresponsive coma, the absence of brainstem reflexes, and the absence of respiratory drive after a CO 2 challenge.
Janet L Wilterdink, MD. Stupor and coma are clinical states in which patients have impaired responsiveness (or are unresponsive) to external stimulation and are either difficult to arouse or are unarousable. Coma is defined as unarousable unresponsiveness [1]. An alert patient has a normal state of arousal.