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When dealing with an unconscious unresponsive patient you will want to follow the ABCs of CPR and First Aid

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:
  1. Skull for irregularity or scalp wounds
  2. Ears (blood or CSF)
  3. Eyes for pupil size and reaction (PEARL)
  4. Lips for color (cyanosed)
  5. Jaw for displacement
  6. Mouth for loose or missing teeth or bitten tongue (Epilepsy)
  7. Skin color, 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. Signs & Symptoms
  2. Allergies
  3. Medication
  4. Past pertinent medical history (Epilepsy, Diabetes)
  5. Last meal
  6. Events leading up to the illness or injury- What has happened?

Vital Signs - Monitor
  • Respiratory Rate
  • Pulse Rate
  • Blood Glucose Levels (Correct hypoglycaemia with Glucagon/Hypostop if required)
  • Oxygen Saturation (SP02)
  • Temperature
Treat any obvious injuries e.g. bleeding, fractures (support and immobilize)
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.

Unconscious patients

In the unconscious patient, after the airway is opened the next area to assess is the patient's breathing,[15] primarily to find if the patient is making normal respiratory efforts. Normal breathing rates are between 12 and 30 breaths per minute,[18] and if a patient is breathing below the minimum rate, then in current ILCOR basic life support protocols, CPR should be considered, although professional rescuers may have their own protocols to follow, such as artificial respiration.
Rescuers are often warned against mistaking agonal breathing, which is a series of noisy gasps occurring in around 40% of cardiac arrest victims, for normal breathing.[15]
If a patient is breathing, then the rescuer will continue with the treatment indicated for an unconscious but breathing patient, which may include interventions such as the recovery position and summoning an ambulance.[19]

Vocabulary:
ABCs
artificial respiration
agonal breathing
recovery position
ambulance

Resources:
Wikipedia - ABCs