| 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.
|
| 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.
|