UNCONSCIOUSNESS Ambulance Study

Someone who is unconscious is not sleeping. Rather, an unconscious person is hard to rouse or can't be made aware of his or her surroundings. Unconsciousness is caused by illness, injury or emotional shock.

Signs and Symptoms

There are many levels of unconsciousness. Some are more serious than others. Levels include unconscious episodes that are:

Brief - Examples are fainting or blacking out.
Longer - The victim is incoherent when roused.
Prolonged - A person in a coma, for example, can be motionless and not at all aware of his or her surroundings for a very long time.

Causes of Unconsciousness

Head Injury
Skull Fracture
Asphyxia
Fainting
Concussion
Compression
Extremes of Body Temperature
Cardiac Arrest
Blood Loss
Cerebrovascular Accident
Epileptic Fits
Infantile Convulsions
Hysteria
Hypoglycaemia
Hyperglycaemia
Drug Overdose
Hypothermia
Poisonous Substances and Fumes
Management of The Unconscious Patient

An unconscious patient is unable to give an account of what has happened to them. Try and gain as much history from those at the scene and from any injuries sustained as to what may of happened.

Primary Survey

Danger - Looking for Dangers to yourself and Casualty
Response - Checking Response (AVPU). Use the Glasgow Coma Scale to ascertain level of consciousness
Airway - Examining the Airway for obstruction and Cervical Spine Control in the event of any possible trauma
Breathing - Look, Listen and Feel for adequate respiratory effort. Supplement with O2 to correct hypoxia if saturations are below 95%
Circulation - Checking the Circulation. If a carotid pulse is not palpable then resuscitation should be commenced
Rectify any problems encountered in your primary survey before moving onto your secondary survey

Secondary Survey

Head, check:

Skull for irregularity or scalp wounds
Ears (blood or CSF)
Eyes for pupil size and reaction (PEARL)
Lips for colour (cyanosed)
Jaw for displacement
Mouth for loose or missing teeth or bitten tongue (Epilepsy)
Skin colour, texture and temperature (Flushed, Dry and Hot) etc
Thorax, check:

Clavicles for bruising and possible fractures
Sternum
Ribs - fractures and abnormal breathing
Abdomen, check:

Rigidity and guarding
Pulsating masses
Bruising
Pelvis fractures or abnormal movement
Groin for dampness
Limbs, check:

Irregularity, deformity and fractures (compare limbs with each other)
Flexion and extension without aggravating any injury
Signs of drug abuse (Needle marks)
Identity bracelets
Capillary refill and distal pulses
Back, check:

Scapulae for fractures
Spine for irregularities
Identity

If not done so already look for any form of identity, cards or bracelets
Before moving onto each section on the secondary survey check the patients ABC's

Collate as much information as possible about the patient

Allergies
Medication
Previous medical history (Epilepsy, Diabetes)
Last meal
Event - What has happened?
Vital Signs - Monitor

Respiratory Rate
Pulse Rate
Blood Glucose Levels (Correct hypoglycaemia with Glucagon/Hypostop if required)
Oxygen Saturations
Temperature
Treat any obvious injuries e.g. bleeding, fractures (support and immobilise)

Continue to Observe:

Airway
Respirations
Circulation
Bleeding
Note: Even though the patient may appear unresponsive it doesn't mean they can't hear you. Keep talking to the patient as hearing is the last sense lost.