G9

Manitoba Health

EMERGENCY TREATMENT GUIDELINES GENERAL

G9

UNCONSCIOUS PATIENT

The unconscious patient presents EMS personnel with numerous serious challenges in patient management. Unconscious patients should receive a rapid assessment to identify immediate life threating conditions.

GENERAL •

personal protective equipment should be utilized as appropriate

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body substance isolation techniques and equipment should be utilized as appropriate

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identify the mechanism(s) of injury if possible

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primary survey • scene assessment • may provide information on the mechanism of injury or precipitating factors for the patient's medical condition • consider cervical spinal precautions, if indicated • assess of the patient’s level of consciousness • establish and maintain an airway, if indicated • consider the use of airway adjuncts if indicated • suction, if indicated • determine the presence of spontaneous respirations and pulse • be prepared to support respiratory and circulatory functions, if indicated • assess for sources of external bleeding • manage any life threatening conditions when identified

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maintenance of an open airway and ensuring adequate respirations has priority over all other treatments, including control of the cervical spine • assist ventilations using a bag-valve mask, if indicated

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at all times be prepared for the patient to vomit or regurgitate

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consider load and go criteria

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secondary survey • perform if circumstances and patient condition permit • obtain vital signs • assess the patient's neurological status using the Glasgow Coma Scale • obtain a reliable bystander history, if available • look for patient identification, assist in determining the cause of the patient's altered level of consciousness • Medic-Alert bracelet, neck pendant, or wallet card • rule out hypoglycemia by obtaining a blood glucose reading (see Diabetic Emergencies Guidelines) • treat, as indicated

GENERAL - Unconscious Patient

April 2005

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Manitoba Health

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EMERGENCY TREATMENT GUIDELINES GENERAL

continue to reassess patient status • load and go if required • record any events that interfere with completing secondary survey maintain high concentration oxygen delivery to the patient • assist ventilations if required reassess vital signs at regular intervals (5-15 min.) or when there is a change in the patient’s status

initiate transport • on scene times should be kept to a minimum • treat other conditions en route transport the patient to the nearest appropriate health care facility • transport the patient in a side lying position, injuries and life threatening conditions permitting • notify the receiving health care facility of the patient's status as soon as possible • monitor and treat the patient en route report all findings to the receiving facility staff, and document on the patient care report

NOTE • assume the patient has a spinal cord injury if unconsciousness due to trauma or unknown etiology (see Central Nervous System Injuries Guideline) •

prepare to handle respiratory and cardiac arrest • keep suction available at all times

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never assume a syncopal episode is “just a fainting spell” • assess the patient thoroughly

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prepare to handle a combative, disoriented patient • particularly when patient’s level of consciousness is increasing

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prepare to manage seizures

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talk to the patient, even if apparently unconscious • hearing is the last sense to be lost

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find and transport all medications with the patient • a list of medications that includes dosages is equally useful if medications cannot be located

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EMS personnel trained and certified in the management of hypoglycemia may do so, as outlined in the Hypoglycemia Treatment Protocol

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EMS personnel trained and certified in the management of suspected opioid overdose may do so, as outlined in the Management of Suspected Opioid Overdose with Naloxone Protocol

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do not administer anything by mouth unless otherwise indicated

GENERAL - Unconscious Patient

April 2005

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Manitoba Health

EMERGENCY TREATMENT GUIDELINES GENERAL

Syncope • syncope may be due to many conditions, some of which are life-threatening • cardiac ischemia or arrhythmia • vascular disease • hemorrhage or hypovolemia • nervous system abnormality • hypoglycemia or other metabolic abnormality • psychogenic • syncopal patients are initially unconscious but often regain consciousness prior to EMS arrival • obtain as thorough a history as possible of the precipitating circumstances • position the patient supine • if the patient is hypotensive elevate lower limbs, unless injuries prevent this • look for the underlying cause of the episode of syncope and treat as appropriate • reassure the patient • maintain the patient in the recovery position for transport if syncope persists • do not allow the patient to exert him/herself - e.g. walking, standing unassisted to transfer to the stretcher, etc. • maintain high concentration oxygen delivery to the patient • assist ventilations if required • initiate transport • on scene times should be kept to a minimum • transport the patient to the nearest appropriate health care facility • notify the receiving health care facility of the patient's status as soon as possible • monitor and treat the patient en route • additional surveys and treatments should be conducted en route • report all findings to the receiving facility staff, and document on the patient care report

GENERAL - Unconscious Patient

April 2005

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Manitoba Health

EMERGENCY TREATMENT GUIDELINES GENERAL

NOTES :

GENERAL - Unconscious Patient

April 2005

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