LECTURE 5
Care of Unconscious Patients
CONSCIOUSNESS
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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
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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.
2.
3.
Maintenance of free airway
Coughing and swallowing
Withdrawal from noxious stimuli etc.
Unconsciousness may be:
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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
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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
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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.
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Place and support the casualty in the semiprone 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.
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Remove the subject to medical aid (hospital) as
soon as possible and preferable on a stretcher.
LONG TERM CARE
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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