Unconsciousness Definition
Unconsciousness Definition
Unconsciousness Definition
DEFINITION:
An unconscious person is usually completely unresponsive to their environment or people
around them.
ETIOLOGY:
Structural: Brain lesions that destroy tissue or occupy space that is normally occupied
by the brain. (Epilepsy, Tumors, Trauma)
Cardiovascular: Temporary or permanent interruption to the blood supply to the brain
(Vasovagal response, CVA , Transient Ischemic Attack, Hypertensive encephalopathy,
Shock, Dysrhythmias)
Metabolic: Abnormally high or low levels of circulating metabolites. (Hypoxia,
Hypoglycemia, Hyperglycemia, Renal failure (uremia), Liver failure, Infection (sepsis)
Environmental: External factors that cause deterioration of central nervous system
function. (Overdose, Toxins)
Behavioral: Abnormal mental status that results from internal factors (Psychiatric
disorders)
Unresponsiveness
Lack of consciousness
Lack of awareness of self
Lack of awareness of surroundings
INVESTIGATIONS:
Physical examination
Eye Opening
4. Spontaneous
3. Verbal
2. Painful
1. None
Motor Response
6. Obedient
5. Purposeful
4. Withdraws
3. Flexion
2. Extension
1. None
Verbal Response
5. Oriented
4. Disoriented
3. Inappropriate
2. Incomprehensible
1. None
Invasive method:
MANAGEMENT:
MEDICAL MANAGEMENT:
Drugs:
BLS procedures
Maintain airway: the unconscious patient may need assistance to maintain and
protect their airway.
They cannot control their tongue which can easily block the airway.
Frequent suctioning may be needed to clear away secretions and vomitus.
High flow O2 by mask: to reduce damage to the brain from hypoxia
Left Lateral Position: if there is no trauma present this position will help the patient
to maintain their airway by allowing secretions to flow out of the mouth and away
from the airways.
ALS procedures
Advanced airway : If the patient is deeply comatose and endotracheal tube will
maintain an open airway and allow secretions to be suctioned efficiently.
Venous access: There are many causes of unconsciousness which can be treated with
medications given intravenously.
Glucometer: All patients should have a Glucometer done to rule out hypoglycemia or
hyperglycemia.
Monitor: Dysrhythmias can cause altered level of consciousness.
Valium for active seizures: Give to stop the seizure activity. Only given in the field for
active tonic-clonic seizures. Respirations and blood pressure must be closely monitored
following Valium administration.
Dopamine drip - May be ordered for hypotension if rales are present or if there is no
response to a fluid challenge.
Adenosine, Atropine, and Lidocaine may be given to treat cardiac dysrhythmias.
Electrical cardioversion may be needed to treat poorly perfusing cardiac dysrhythmias.
Diet:
Enteral feeding can be administered (Nasogastric feeding is the most commonly used
method)
Dentures should be removed and note made of any loose teeth or crowns that may
become dislodged and compromise the airway
Insert oropharyngeal airways to prevent the tongue from obstructing the airway
To maintain a patent airway the lateral recumbent position is advised with the head of the
bed slightly tilted upwards, about 10-30 degrees.
Obtaining a 24-hour urine collection is an important means of assessing the protein needs
of the unconscious patient. Nitrogen is lost from the body when protein is broken down.
If nitrogen loss exceeds supply then catabolism (muscle breakdown) occurs.
Care should be taken to examine the skin properly, noting any areas which are red, dry or
broken to prevent bedsore
Clean the eye with gauze and 0.9% sodium chloride to prevent eye infection
SURGICAL MANAGEMENT:
NURSING MANAGEMENT:
COMPLICATIONS:
Falls
Respiratory failure
Bed sore