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Unconsciousness

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

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:

1. Skull for irregularity or scalp wounds
2. Ears (blood or CSF)
3. Eyes for pupil size and reaction (PEARL)
4. Lips for colour (cyanosed)
5. Jaw for displacement
6. Mouth for loose or missing teeth or bitten tongue (Epilepsy)
7. Skin colour, texture and temperature (Flushed, Dry and Hot) etc

Thorax, check:

1. Clavicles for bruising and possible fractures
2. Sternum
3. Ribs - fractures and abnormal breathing

Abdomen, check:

1. Rigidity and guarding
2. Pulsating masses
3. Bruising
4. Pelvis fractures or abnormal movement
5. Groin for dampness

Limbs, check:

1. Irregularity, deformity and fractures (compare limbs with each other)
2. Flexion and extension without aggravating any injury
3. Signs of drug abuse (Needle marks)
4. Identity bracelets
5. Capillary refill and distal pulses

Back, check:

1. Scapulae for fractures
2. Spine for irregularities

Identity

1. 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

1. Allergies
2. Medication
3. Previous medical history (Epilepsy, Diabetes)
4. Last meal
5. 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.