Unconsciousness
Level of Consciousness
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. The level of consciousness of a person is determined by the activity of the brain.
It can be categorized as follows
(1) Alert (A): The person has a sound and clear mind and is able to respond normally and answer questions swiftly.
(2) Response to voice (V): The person feels tired and sleepy, gets woken up easily and is able to do as told or answer simple questions. He is in a state of confusion nevertheless and get easily agitated.
(3) Responsive to pain (P): The person is difficult to be woken up but responsive to pain. He cannot answer questions properly.
(4) Unresponsive (U): The person is impossible to be woken up with no response to external stimulation.
There are many causes that may lead to unconsciousness. The most common cases are
(1) Respiratory system failure: asphyxia, carbon-monoxide poisoning.
(2) Circulatory system failure: severe haemorrhage, heart attack and electrical shock.
(3) Disorder in metabolic rate: blood sugar level is too high or too low.
(4) Brain damage: cardiovascular accident (apoplexy), compression or concussion.
(5) Others: drunkness, heat stroke, exposure to cold weather, epilepsy & infantile convulsion, etc.
General Treatment
(1) Keep the patient's airway unobstructed. Press down his forehead and raise his chin to open up the airway. Clear any obstructing body inside his mouth.
(2) Check the patient’s 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, his pulse is running and his neck or spine is not injured, lay him down on his side or place him in a recovery position 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.
Cerebrovascular Accident (Stroke)
The pathological condition underlying a cerebrovascular accident is a lack of blood and oxygen in brain cells. Smoking, arteriosclerosis, hypertension and aneurysm can evoke its occurrence.
Clinical Features
(1) Headache
(2) Nausea and vomiting
(3) Strong & fast pulse
(4) Slow & noisy respiration
(5) Unequal pupils
(6) Paralysis of face muscle
(7) 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 and raise his head and shoulders with a cushion in order to reduce the pressure on his brain.
(5) Send him to hospital as soon as possible.
Epilepsy
The patient's eyes will roll up during an epileptic attack. He will clench his teeth tightly and convulse. In worse cases, he will bite his own tongue or hurt himself by crashing his own body against other objects. Generally, the patient will convulse for up to ten minutes. Then the convulsion stops and he will regain consciousness gradually.
Treatment
(1) Try to protect the patient from falling due to collision.
(2) Do not forcibly restrain the patient’s convulsion.
(3) When the convulsion is over, treat him as an unconscious patient.
(4) Send him to hospital if necessary.
Infantile Convulsion
Infantile convulsion refers to the condition occurring in infants aged between 0-6 suffering from high fever: convulsion of the body, unconsciousness, lips in purple colour and incontinence. After cramping, the patient will usually be in a stupor or in drowsiness.
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 the patent's airway open. Let him lie on one side of his body so that the saliva and the vomit can flow out.
(2) Do not stop the patient’s movements.
(3) Move the patient away from dangerous objects such as electrical appliances and combustible materials.
(4) Look after the patient closely. Observe and record his condition.
(5) Send the patient to hospital immediately if his condition persists quite a long time (fever and convulsion usually do not last for more than 5 minutes).
Hypothermia
This refers to an abnormally low body temperature, which is below 35° C. Newborn babies and old people are most likely to suffer from it if the environment is too cold and they do not have sufficient warmth. Downing victims also display symptoms of hypothermia.
Clinical Features
(1) Pale face for adult. For baby the face and skin are pink in colour.
(2) His body is trembling.
(3) Body temperature below normal.
(4) The pulse is slow, weak or imperceptible.
(5) The breathing is slow and shallow.
(6) There is a gradual loss of consciousness.
Treatment
(1) Put off the patient’s wet clothes. Wrap him in dry clothes, blankets, newspapers, silver foils or other insulating materials in order to keep him warm.
(2) Take the patient to a warm shelter as quickly as possible.
(3) Gradually raise the patient’s body temperature.
(4) If necessary, share your body heat with the patient.
(5) If the patient is conscious, give him hot drinks and high-energy food.
(6) Send the patient to hospital.
Hypoglycaemia/ Hyperglycaemia
Diabetes is a chronic systemic disease characterized by disorders in the metabolism of insulin, carbohydrates, fats and proteins. Type 1 diabetes results from the body’s failure to produce insulin or sufficient insulin. Type 2 diabetes results from insulin resistance.
The cause of diabetes is unknown. The insulin disorder may be due to either heredity or viruses. Diabetes may be controlled with diet, medication and exercise. However, the disease can become uncontrollable, leading to complications. The most common acute complications are insulin shock caused by decreased blood sugar and diabetic acidosis caused by elevated blood sugar. The patient may become unconscious in both situation.
Clinical Features (Hypoglycaemia)
(1) The skin is pale and wet.
(2) The pupils dilate.
(3) The breathing is slow and shallow.
(4) The pulse is slow and weak.
(5) The vision is blurred.
Clinical Features (Hyperglycaemia)
(1) Skin flushing.
(2) The pulse is slow and weak.
(3) Shortness of breath with fruity-smelling.
(4) Thirst.
(5) Frequent urination.
Treatment
(1) Although the conditions for hypoglycaemia and hyperglycaemia are different illnesses, their treatments are the same for both conditions:
- Maintain the patient's airway free.
- Check the patient’s respiratory and circulatory systems.
- Check for any diabetic identification.
- Obtain the patient’s history about:
- the insulin or oral hypoglycemic agent.
- the last meal time.
- the change in activity.
- the recent illness and / or infection.
- the other medications.
(2) If possible, lay the patient in a recovery position.
(3) If the patient with hypoglycaemia is conscious, give him sweet drinks and food.