First Aid in unconscious patient
●Head injury
●Spine column and spine injury
●Positioning and transport
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Consciousness
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consciousness, spontaneus breathing, blood circulation are basic life signs
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Wikipedia:
Consciousness is THE QUALITY or STATE of AWARNESS, or, of being aware of an
EXTERNAL OBJECT or something WITHIN ONSELF.
- the most common causes of consciousness are alcohol, epilepsy,
cerebrocranial trauma, hypoglycemia, aneurism and poisoning
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dimensions/function/characteristics of consciousnes are: Vigilance (person is
vigilant – wakeful), Lucidity (Clouding), Idiogenesis
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Vigilance – impairment of vigilance are at most characteristic for quantitative (strength) impairment of
consciousnes
Lucidity – impairrment of lucidity is characteristic sign for qualitative disorders (from a perspective of
reality)
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Causes of Unconsciousness
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Primary (Cerebral, brain damge is primary)
- traumatic: concussion, contussion, compression, loss of tissue, intracerebral
bleeding etc.
- nontraumatic: cerebrovascular accidents – CVA, stroke; inflammations, seizures;
expansive processes – such as tumors
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Secundary (Extracerebral, brain damage is secondary) decreased supplementation by
oxygen
- decreased blood supply: chocking, heart attack, bleeding, shock - decreased of amount of oxygen in blood: impairment of respiratory
systém, drowning
- toxicity: endogenous factors – diabetic hyper- or hypoglycemia; failure of liver,
kidneys, any of endocrine glands
exogenous factors – ethanol, drugs, narcotics, carbon monoxide, heavy
metals
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Quantitative disorders
- person is vigilant if she/he is awake and alert
- level of diminution of consciousness is changed in quantitative
disorders
Somnolentia – waking induced by regular stimulation
Soporous – rousable only by a strong (usually
painful) stimulation, does not achieve
complete consciousness, soon a return to sleep
Coma – unrousable
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GCS (Glasgow Coma Scale)
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Interpretation of GCS
Light:
GCS = 13 to 15
Medium:
GCS = 9 to 12
Severe:
GCS = <9
GCS is to be noted at first contact with the patient,
further assessment is usually not possible due to
analgosedatives + relaxation of the patient
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Qualitative disorders
- Lucid person is characterized by clear perception (clarity of
thought) or understanding of itself, place and time she/he is in
- impairment of orientation if place, time, itself (idiogenesis)
Obnubilation – swooning (the affected is not conscious of their
activity, amnesia)
Delirium – impairment of perception, hallucinations
Amentia - disorientation
Amnesia – loss of memory
Stupor – rigidity and stiffness
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Unconsciousness
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Impairment of consciousness can be
accompanied by muscle relaxation (obstruction
of airways), loss of basic reflexes (aspiration of
regurgitation) impairment of other basic life
signs
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Unsconsciousness – First Aid
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Be aware of puttin in danger yourself or the
victim, if possible eliminate any further damage
to the vicitim
Do not move vicitm if not necessary
Do not abandon the patient, continuously
monitor vital functions
Thermal comfort
Do not serve anything per oral pathway
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Head trauma
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General consideration of wounds and their
causes
Brain is enclosed in cranium which can't, in
adults, increase its volume – trauma direct or
indirect leads to damage of tissue what is
accompained by edema – load of volume in
closed space determines THE PRESSURE
- excesive pressure leads to further damage
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Signs of brain damage
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Confusion, strange behaviour, loss of memory
Unusual breathing pattern
Blood or watery substance leakage from ears, nose
Weak, sensations in arms, legs
Visual sensations, visual problems
Nausea, vomitting, worsening headache
Increasing drowsiness
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Few types of brain injury
Concussion = brain shake
- temporal disturbance of brain activity
No structural damage. Signs – temporal confusion, loss of memory, vomitting,
dizziness. Full recovery.
- First Aid >> consider spine injury, check for vital signs, call
Ambulance
Contussion
- Brain tissue damage at the site of trauma (coup) + the opposite site (contrecoup)
Structural damage. Signs - impaired consciousness, abnormal breathing pattern,
different pupil size (anisocory).
- First Aid >> consider spine injury, check for vital signs, call
Ambulance
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Spine trauma
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Damage to spinal cord
causes loss of muscle
strength and
sesnsation below
the injured area
If unconscious – behave as spinal injury is present
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Spine trauma
Spine trauma - can be both isolated and also as a
part of polytraumas
● Common combinations – cerebrocranial and spinal
trauma
● Seriousness – mainly due to the possibility of damage
to the spinal chord, which passes through the spinal
column and ensuing irreversible neurological damage
Most vulnerable to damage is the area of thorax
(stabilization by ribcage) - automotive accidents (neck
vertebrae), falls (thoracic vertebrae)
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Often causes of spine injuries
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Falling from a height
Diving into shallow pool
Falling from horse, motorbike
Sudden deceleration
Unusual movement
fragments of fractured vertebra cut or compress spinal
cord
intervertebral disc displacement – damage to cord by
pressure
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Spine injury – First Aid
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No manipulation if not needed, wait for and
prefere professional transport using vacuum mat
If manipulation with the patient is necessary, ensure a
sufficient number of aiders, for safe manipulation with
an adult five rescuers are needed
If the victim is still in
danger, take care of it
to safe her/his life
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Instruments
The Philadelphia collar is a solid neck collar/brace
made from firm plastic bi-valved shell, which
keeps the head in a neutral position during
transport
Schanz brace – a soft padding, it
stabilizes and supports the spinal
column, an improvised device
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Positioning and transportation
1.check and secure vital functions
2. take care of any further danger
3. choose the right position for
- first aid
- transport
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Positions
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Positioning sitting up, or semi-reclined with
raised knees
Used in patients with abdominal injuries, with
a raised thorax, supported head and the
knees bent at 90 degrees (relaxation of
abdominal muscles). Can be used with
placement on the back with raised knees
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Positions
Fowlers’ position
There are several types of Fowlers positions: low,
semi-, and high Fowler's. High Fowler's position is
when the patient's head is raised 80-90 degrees,
whereas Low Fowler's position is when the
patient's head is elevated 15-45 degrees.
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Autotransfuse position
The aim of the antishock position is to use gravity to
return the blood from the periphery to the heart and
increase blood perfusion of vitally important organs
(heart, brain). The full antishock position entails the
elevation of all four limbs. In practice only the
elevation of lower limbs is used, because the amount
of blood in the upper limbs is low and they cannot be
fixed.
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Positions
In the Trendelenburg position the body is laid
flat on the back (supine position) with the feet
higher than the head. For first aid it can be used
as an alternative to the anti-shock position,
especially if the patient is on a stretcher. The
trendelenburg position can also be combined with
the recovery position
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Transport
Transport using a chair can be used with
patients that are conscious. After ensuring the
chair is solid enough, remove any additional
components. Fix the patient using wide bands of
cloth across the thighs and chest to the chair. One
rescuer holds the backrest, the other one takes
the front chair legs, keeping the chair tilted. If
possible the patient should be transported facing
forwards.
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Transport using a stretcher. There are many
types of strechers. Patient transport on these
should be carried out with the patient on his back
or in a stabilized position
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Getting out of vehicle
Rautek maneuver
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References
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Presentation form MUDr. Bures
Book: První Pomoc, Jan Lejsek, Petr Ruzicka, Jan
Bures; 2010
SIMS' Symptoms in the Mind Textbook of
Descriptive Psychopathology, Fifth Edition,
Saunders
Mentalni postizeni v pedagogickem, psychologickem
a socialne-pravnim kontextu, Milan Valenta, Jan
Michalik, Martin Lecbzch a kolektiv, 2012
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