Dealing with an Unconsciousness Casualty

The Main Causes of Unconsciousness

The causes of unconsciousness can be remembered by using FISH SHAPED.

• Fainting
• Imbalance of Heat
• Shock
• Head Injury
• Stroke
• Heart Attack
• Asphyxia
• Poisoning
• Epilepsy
• Diabetes

Unconsciousness can be defined as an interuption in the normal activity of the brain. Unlike sleep, unconsciousness can disable the body’s natural reflexes sucha s coughing. Therefore, if the unconscious patient is laying on their back the tongue may fall back blocking the airway, or they may even drown themselves in vomit.

You should take immediate action to treat an unconscious casualty. This will involve protecting the airway, calling an ambulance and possible treating the underlying cause of the condition.

Levels of response

In order to accurately measure a casualty’s conscious level, we can use a scale of consciousness called the ‘AVPU’ scale:

Primary survey

When you check for Danger, Response, Airway and Breathing this is called the ‘Primary Survey.’

The primary survey ensures that the patient is breathing, so it should be carried out first.

Once you are sure that the patient is breathing effectively, it is safe to move on and carry out a secondary survey.

The primary and the scondary survey methods of checking a patient give us a systematic order in which to deal with the most urgent problem first, then move on to find other clues, helping with diagnosis and treatment.

Secondary survey

If a casualty is unconscious you are concerned about the airway for any reason (e.g. vomiting), place them in the recovery position immediately.

The Secondary Survey should be done quickly and systematically, first checking for major bleeding and then broken bones.

Bleeding

• Do a quick head to toe check for bleeding.
• Check the hidden area such as under the arch of the back.
• Control any major bleeding that you find.

Head and neck

• Clues to injury could be bruising, swelling, deformity or bleeding.
• Check the whole head and face.
• Feel the back of the neck.
• Has the patient had an accident that might have injured the neck?.

Shoulders and chest

• Place your hands on opposite shoulders and compare them.
• Run your fingers down the collar bones checking for signs of a fracture.
• Gently squeeze and rock the ribs.

Abdomen and pelvis

• Push the abdomen with the palm of your hand to check for abnormality or response to pain.
• Gently check the pelvis for signs of a fracture.
• Look for incontinence or bleeding.

Legs and arms

• Feel each leg for the signs of a fracture.
• Feel each arm for the signs of a fracture.
• Look for other clues (medic alert bracelets, needle marks ete).

Pockets

• Look for clues and make sure nothing will injure the patient as you roll them into the recovery position.
• Have a witness if you remove items from pockets.
• Be very careful if you suspect there could be sharp objects such as needles.
• Loosen any tight clothing.
• Recovery
  Place the patient in the recovery position.
• If you suspect neck injury, get someone to help you keep the
  head in line with the body as you turn the patient.
• Be careful not to cause further damage to any suspected injuries.

Mechanics of injury

Before you move a patient, it is important to consider the ‘mechanics of injury’.
This involves trying to work out what happened and what injuries this could have caused the patient.

• If you suspect neck injury, get someone to help you keep the head in line with the
  body at all times. 
• If you have to use the recovery position, try not to move any suspected injuries.

The recovery position

When a person is unconscious and lying on their back, the airway can become compromised by the tongue touching the back of the throat, or vomit if the patient is sick. Placing the casualty in the recovery position protects the airway from both of these dangers – the tongue will not fall backwards and vomit will run out of the mouth.