Unconsciousness   When a person is unable to recognize the surrounding environment or objects, responds slowly to stimulation or even fails to respond altogether, he is unconscious

1.	Level Of Consciousness The level of consciousness is determined by the activity of the brain. It can be categorized as follows:
	(1)	Alert (A) : Sound and clear mind, responding normally and answering questions swiftly..
	(2)	Response to voice (V) : Feels tired and sleepy. Wakes up easily and able to do as told or answers simple questions. The patient is in a state of confusion nevertheless and is easily agitated.
	(3)	Response to pain (P) : Difficult to wake up but will respond to pain. The patient cannot answer questions properly.
	(4)	Unresponsive (U) : Impossible to be woken up with no response to external stimulation.
2.	Common Cases There are many causes that may lead to unconsciousness. Most common cases are
	(1)	Respiratory system failure : asphyxia, carbon-monoxide poisoning.
	(2)	Circulatory system failure : severe haemorrhage, heart attack & electrical shock.
	(3)	Disorder in metabolic rate : too high or too low blood sugar level.
	(4)	Brain damage : Cardiovascular accident (apoplexy), compression or concussion.
	(5)	Others : drunkness, heat stroke, exposure to cold weather, epilepsy & infantile convulsion, etc.
3.	General Treatment
	(1)	Keep the patient's airway unobstructed. Press down on his forehead and raise his chin to open up the airway and clear any obstructing body inside the mouth.
	(2)	Check his breathing and carotid pulse. If necessary, apply mouth-to-mouth ventilation or cardiopulmonary resuscitation.
	(3)	Check the patient's body for any associated injury or fracture. If any such injury is found, stop the bleeding immediately and treat the wound properly.
	(4)	Determine the level of unconsciousness.
	(5)	Record any injury and seek reference from any medical history documents carried by the patient.
	(6)	If the patient can still breathe and his pulse is running and if the neck or spine is not injured, you can lay him down on his side to maintain a free airway.
	(7)	Keep the patient warm and comfort him. Never give the patient any food or drink. Send him to hospital as soon as possible.
4.	Cardiovascular Accident (Apoplexy) The pathological condition underlying cerebrovascular accident is a lack of blood and oxygen to the brain cells. Smoking, arteriosclerosis, hypertension and aneurysm are the factors affecting the outcome of apoplexy. - Headache - Nausea & vomiting - Strong & fast pulse - Slow & noisy respiration - Unequal pupils - Paralysis of face muscle - Incontinent Treatment :
	(1)	Ascertain the level of consciousness of the patient.
	(2)	Examine his body conditions.
	(3)	If he is unconscious, keep his airway unobstructed.
	(4)	If he is conscious, keep him in a supine position to reduce the pressure on his brain.
	(5)	Send him to hospital as soon as possible.
5.	Epilepsy The patient's eyes will roll up during an epileptic attack. He will clench his teeth tightly and convulse. In worse cases, the patient will bite his own tongue or crash his body against objects. Generally, the patient will convulse for up to ten minutes. Then the convulsion stops and the patient will regain consciousness gradually. Treatment :
	(1)	Try to protect the casualty from injury during a fall
	(2)	Do not forcibly restrain the casualty.
	(3)	When convulsion is over, treat him as for an unconscious casualty.
	(4)	Send him to hospital.

6.	Heat Stroke Working or exercising in a hot, humid or concealed environment, our body is unable to dissipate heat by perspiration. Body heat will be retired & cause a rapid rise of body temperature which in turn results in damage of brain cells. Clinical Features:
	-	Skin is hot, dry and red
	-	Headache, nausea and thirst
	-	When the case deteriorates, the patient will become stupor and gradually lapses into unconsciousness.
	-	The body temperature will rise to over 40°C.
	Treatment :
	(1) Move the patient to a cool place.
	(2) Let his body temperature fall to 38°C.
	-	Take off the clothes accordingly.
	-	Place towels soaked in cold water on the side of the patient's neck, under the arm pits and on the elbows, knee caps and ankles. Cover the patient with a wet bed sheet.
	-	Fan the patient to keep him cool.
	(3) If the patient is conscious, give him a large amount of water to drink to supplement lost moisture and help lower his body temperature. Do not give any hot or stimulating drink. (4) Send the patient to hospital for treatment.

7.	Infantile Convulsion Convulsion may occur with infants aged from 0-6 suffering from high fever. Clinical Features:
	-	At first the body shivers
	-	Then convulsions occur, his fist clenched and eye balls rolling to one side, bending of his body & cyanosis
	Treatment :
	(1)	Maintain patent's airway.
	(2)	Undress and wet his body with warm water.
	(3)	Maintain good ventilation of air.
	(4)	Send him to hospital.

8.	Effect to cold Hypothermia : This refers to an abnormally low body temperature below 35°C. Newborn babies and old people are most likely to suffer from this. If hypothermia is overlooked unconsciousness will result and even death. Furthermore, drowning victims also display symptoms of hypothermia. Clinical Features:
	-	Pale face for adult. For baby the face and skin are pink in colour.
	-	His body is trembling
	-	Body temperature below normal.
	-	The pulse is slow, weak or imperceptible.
	-	The breathing is slow and shallow.
	-	There is a gradual loss of consciousness.
	Treatment :
	(1)	Wrap the casualty in dry clothes, blankets, newspapers, silver foils or other insulating materials.
	(2)	Get him to a warm shelter as quickly as possible.
	(3)	Gradually raise his body temperature.
	(4)	If necessary share your body heat with the casualty.
	(5)	If the casualty is conscious, give him hot drinks and high-energy food. But do not give casualty alcoholic drinks or smoking.
	(6)	Send him to hospital.

	Hypoglycaemia / Hyperglycaemia Diabetes is a chronic systemic disease characterized by disorders in the metabolism of insulin, carbohydrates, fats and proteins. The cause of diabetes is unknown. It seems to be a genetically based insufficiency of insulin, due to either heredity or a viral component. Diabetes may be controlled with diet, medication and exercise. However the disease can be come uncontrollable and most common acute complications are insulin shock due to decreased blood sugar and diabetic acidosis due to elevated blood sugar. The patient may become unconscious in either situation . Clinical Features:
	-	Pale face for adult. For baby the face and skin are pink in colour.
	-	His body is trembling
	-	Body temperature below normal.
	-	The pulse is slow, weak or imperceptible.
	-	The breathing is slow and shallow.
	-	There is a gradual loss of consciousness.
	Treatment : Although the conditions for hypoglycaemia & hyperglycaemia are different, the treatment is the same for both conditions:
	(1)	Maintain patient's airway.
	(2)	Check for his respiratory & circulatory systems.
	(3)	Check for any diabetic identification.
	(4)	Obtain history from: - Insulin or oral hypoglycemic agent - Last meal time - Change in activity - Recent illness and / or infection - Other medications .
	(5)	If possible, lay the casualty in a recovery piston.
	(6)	If the casualty is conscious, may give him sweet drinks & food.

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