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    Assessment and Management of The Unconscious Patient

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    Red Devil
    This document provides guidelines for the assessment and management of unconscious patients. It outlines that [1] a thorough history and examination are essential. [2] Management follows CAB principles of circulation, airway, and breathing. [3] Additional assessments include exposure, glucose levels, and neurological exams. [4] Appropriate investigations and treatments are then initiated depending on the cause, such as hypoglycemia, overdose, or stroke.

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    Assessment and Management of The Unconscious Patient

    Uploaded by

    Red Devil
    173 views6 pages
    This document provides guidelines for the assessment and management of unconscious patients. It outlines that [1] a thorough history and examination are essential. [2] Management follows CAB principles of circulation, airway, and breathing. [3] Additional assessments include exposure, glucose levels, and neurological exams. [4] Appropriate investigations and treatments are then initiated depending on the cause, such as hypoglycemia, overdose, or stroke.

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    Assessment and management of the unconscious patient

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    This document provides guidelines for the assessment and management of unconscious patients. It outlines that [1] a thorough history and examination are essential. [2] Management follows CAB principles of circulation, airway, and breathing. [3] Additional assessments include exposure, glucose levels, and neurological exams. [4] Appropriate investigations and treatments are then initiated depending on the cause, such as hypoglycemia, overdose, or stroke.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    173 views6 pages

    Assessment and Management of The Unconscious Patient

    Uploaded by

    Red Devil
    This document provides guidelines for the assessment and management of unconscious patients. It outlines that [1] a thorough history and examination are essential. [2] Management follows CAB principles of circulation, airway, and breathing. [3] Additional assessments include exposure, glucose levels, and neurological exams. [4] Appropriate investigations and treatments are then initiated depending on the cause, such as hypoglycemia, overdose, or stroke.

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    MOHW August 2020

    Assessment and Management of the


    unconscious patient
    Adapted from NICE Guidelines 2020

    1. A good proper history and clinical examination is mandatory. The


    unconscious patient is traditionally defined on having a GCS of 8 or less.

    2. Priorities in management will follow CAB principles:


    a. Circulation:
    i. Pulse and Blood pressure
    ii. Establish IV access

    b. Airway
    i. Ensure an adequate airway

    c. Breathing

    d. Disability
    i. Glasgow Coma Score

    ii. Full neurological examination


    1. Pupils
    a. Unilateral dilatation: Intracerebral bleed,
    cerebral infarct or tumour
    b. Bilateral pinpoint: Pontine bleed or infarct
    : Opiate or
    organophosphorus
    poisoning

    c. Bilateral dilated: Benzodiazepine or Tricyclic


    Antidepressants
    2. Neck rigidity
    a. Meningitis
    b. Subarachnoid haemorrhage

    3. Check for any neurological deficit

    3. Exposure
    a. Check for rash
    i. Meningitis (Purpura fulminans)
    ii. Septicaemia

    b. Puncture mark: Drug overdosage

    c. Tongue bite: Epilepsy

    4. Check Glucose level


    a. Hypoglycaemia: Blood glucose less than 4.0 mmol/L

    5. After a detailed history and clinical examination, appropriate


    investigation and treatment is initiated like:

    a. Hypoglycaemia: should be treated immediately with intravenous


    50% Dextrose 50ml

    b. Overdose of Opiate: Intravenous Naloxone 0.4-2.0 mg, to repeat


    2-3 minutes PRN, not exceeding 10mg

    c. Overdose of Benzodiazepine: Intravenous Flumazenil 0.2 mg 15-


    30s, if no response to administer 0.3mg over 30s

    d. Meningococcal meningitis: Intravenous antibiotic should be given


    immediately (see Protocol for meningitis)
    e. Acute cerebrovascular accident

    i. Ischemic

    Initial management of suspected and confirmed TIA

    Offer aspirin (300 mg daily), unless contraindicated, to


    people who have had a suspected TIA, to be started
    immediately.

    Do not offer CT brain scanning to people with a suspected TIA


    unless there is clinical suspicion of an alternative diagnosis
    that CT could detect.

    Brain imaging for the early assessment of people with suspected acute stroke

    Perform brain imaging as soon as possible with a non-enhanced CT for


    people with suspected acute stroke if any of the following apply:

    • on anticoagulant treatment

    • a known bleeding tendency

    • a depressed level of consciousness (Glasgow Coma Score below 13)

    • unexplained progressive or fluctuating symptoms

    • papilloedema, neck stiffness or fever

    • severe headache at onset of stroke symptoms

    • indications for thrombolysis or thrombectomy- If available

    Perform scanning as soon as possible and within 24 hours of symptom


    onset in everyone with suspected acute stroke without indications for
    immediate brain imaging
    Aspirin and anticoagulant treatment

    People with acute ischaemic stroke

    Offer the following as soon as possible, but certainly within 24 hours, to


    everyone presenting with acute stroke who has had a diagnosis of
    intracerebral haemorrhage excluded by brain imaging:

    • aspirin 300 mg orally if they do not have dysphagia

    ● Do not use anticoagulation treatment routinely for the treatment


    of acute stroke.

    People with acute venous stroke


    Offer people diagnosed with cerebral venous sinus thrombosis (including
    those with secondary cerebral haemorrhage) full-dose anticoagulation
    treatment (initially full-dose heparin and then warfarin [international
    normalised ratio 2 to 3]) unless there are comorbidities that preclude its
    use.
    Anticoagulation treatment for other comorbidities
    ● Ensure that people with disabling ischaemic stroke who are in
    atrial fibrillation are treated with aspirin 300 mg for the first 2
    weeks before anticoagulation treatment is considered. [2008]
    ● For people with prosthetic valves who have disabling cerebral
    infarction and who are at significant risk of haemorrhagic
    transformation, stop anticoagulation treatment for 1 week and
    substitute aspirin 300 mg.
    ● Ensure that people with ischaemic stroke and symptomatic
    proximal deep vein thrombosis or pulmonary embolism receive
    anticoagulation treatment in preference to treatment with aspirin
    unless there are other contraindications to anticoagulation.
    ● Treat people who have haemorrhagic stroke and symptomatic
    deep vein thrombosis or pulmonary embolism to prevent the
    development of further pulmonary emboli using either
    anticoagulation.
    Statin treatment

    ● Immediate initiation of statin treatment is not recommended in


    people with acute stroke
    ● Continue statin treatment in people with acute stroke who are
    already receiving statins.

    Provide optimal insulin therapy, which can be achieved by the use of


    intravenous insulin and glucose, to all adults with type 1 diabetes with
    threatened or actual stroke.
    Blood pressure control for people with acute ischaemic stroke
    Refer to hypertension guidelines.
    Anti-hypertensive treatment in people with acute ischaemic stroke is
    recommended only if there is a hypertensive emergency with one or
    more of the following serious concomitant medical issues:
    • hypertensive encephalopathy
    • hypertensive nephropathy
    • hypertensive cardiac failure/myocardial infarction
    • aortic dissection
    • pre-eclampsia/eclampsia.

    Hemorrhagic
    Aim for adequate Blood pressure control for people with acute
    intracerebral haemorrhage
    Refer to the neurosurgical team for further management.

    For people with acute stroke consider the following


    Optimal positioning
    Early mobilisation
    Avoiding aspiration pneumonia

    6. If no neurological deficit present, consider alcohol/sleeping


    pill/Diazepam overdosage
    a. Monitor vitals and Plan for investigation accordingly: FBC, Urea
    and Electrolytes, creatinine, Blood glucose, Urine/Blood/Gastric
    Aspirate for Toxicology and CT scan/MRI brain as required.

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