EMERGENCY HEALTH CARE LECTURE 4 Care of Unconscious Patients

CONSCIOUSNESS  Implies awareness and attention to one's surroundings and to oneself.  Consciousness is maintained by impulses mediated via Grey Matter in the Reticular Activating System (R.A.S.)

CONSCIOUSNESS  Sleep is a physiological process which is usually accompanied by reduction of impulses in the R.A.S. The individual is easily arousable from sleep & basic protective reflexes are also intact.  Unconsciousness is different from normal sleep in that unconscious subjects are not usually arousable and quite often, there is loss of or interference with basic protective reflexes such as:

1. Maintenance of free airway 2. Coughing and swallowing 3. Withdrawal from noxious stimuli etc.

Unconsciousness may be:  Partial (semi-coma or stupor)  Complete (deep coma)  Accurate diagnosis of the cause of unconsciousness is important for specific treatment  But for the general care of the patient, level of consciousness is more important.

Causes Of Unconsciousness Include: 1. Shock 2. Asphyxia 3. Poisoning 4. Head Injury 5. Cerebro-Vascular Accidents CVA, or Stroke 6. Epilepsy 7. Hysteria 8. Infantile Convulsions 9. Hypothermia Or Hyperthermia

10. Diabetes Mellitus – Hypo/Hyper 11. Fainting/Syncope, Vasovagal Attacks 12. Heart Attacks 13. Meningo-encephalitis 14. Fluids and Electrolyte Disorders

CARE OF THE UNCONSIOUS PATIENT  There are two stages of providing care for the unconscious patient: 1. Emergency care or first aid 2. Long term care-usually as inpatient

EMERGENCY CARE General rules  Remove the casualty from any obvious hazard and call for help. Be aware that injury to the spine may be present.  Check the breathing and remove any airway obstruction caused by flaccid tongue, food particles, blood clots, denture etc.  If subject is not breathing or breathing is inadequate, commence artificial respiration immediately

 This is easier with the patient in supine position.  Next, check the pulse and out external chest compression if there is no pulse. In the absence of both pulse and breathing, carry out the sequence of one-rescuer CPR until help arrives.  If both breathing and pulse are present, loosen all tight clothing, and treat any obvious life threatening injury such as profuse bleeding.  Give oxygen by mask if available and elevate the legs if the pulse is feeble or fast.

 Place and support the casualty in the semi- prone or "tonsil" position.  Do not leave the patient unattended unless absolutely necessary and constantly watch the breathing and check the pulse.  Do not administer any oral fluids or food to an unconscious subject.  Keep warm with blanket if necessary but do not apply heat.

 Remove the subject to medical aid (hospital) as soon as possible and preferable on a stretcher.

LONG TERM CARE  In order to optimize the care of the unconscious patient in a hospital, it will be helpful to know the cause of the unconsciousness.  This will involve the usual steps of history taking, examination, investigations etc.  General care is necessary, no matter the cause of consciousness is important in determining the extent of care required and may involve doctors, nurses, physiotherapists, nutritionists etc. It may also require an intensive care unit