AUSTRALIAN RESUSCITATION COUNCIL
GUIDELINE 3
RECOGNITION AND FIRST AID MANAGEMENT OF THE UNCONSCIOUS VICTIM
This guideline is applicable to adults, children and infants. DEFINITION Unconsciousness is a state of unrousable, unresponsiveness, where the victim is unaware of their surroundings and no purposeful response can be obtained. CAUSES OF UNCONSCIOUSNESS The causes of unconsciousness can be classified into four broad groups: ! ! ! ! low brain oxygen levels heart and circulation problems (e.g. fainting, abnormal heart rhythms) metabolic problems (e.g. overdose, intoxication, low blood sugar) brain problems (e.g. head injury, stroke, tumour, epilepsy).
Combinations of different causes may be present in an unconscious victim e.g. a head injury victim under the influence of alcohol. RECOGNITION Before loss of consciousness, the victim may experience yawning, dizziness, sweating, change from normal skin colour, blurred or changed vision, or nausea. Assess the collapsed victim's response to verbal and tactile stimuli (talk and touch), ensuring that this does not cause or aggravate any injury. This may include giving a simple command such as, open your eyes; squeeze my hand; let it go. Then grasp and squeeze the shoulders firmly to elicit a response. A person who fails to respond or shows only a minor response, such as groaning without eye opening, should be managed as if unconscious [Class B; LOE Expert Consensus Opinion]. MANAGEMENT If the victim is unresponsive and not breathing normally, follow Australian Resuscitation Council and New Zealand Resuscitation Council Basic Life Support Flowchart (Guideline 8). Guideline 3 November 2012 Page 1 of 2
With an unconscious breathing victim, care of the airway takes precedence over any injury, including the possibility of a spinal injury (Guideline 9.1.6). All unconscious victims must be handled gently and every effort made to avoid any twisting or forward movement of the head and spine. 1. Ensure safety of victim and rescuer. 2. Assist victim to the ground and position the victim lying on the side. Ensure the airway is open (Guideline 4). Do not leave the victim sitting in a chair nor put their head between their knees. 3. Call an ambulance. 4. Stop any bleeding promptly (Guideline 9.1.1). 5. Constantly re-check the victims condition for any change. 6. Ideally, the most experienced rescuer should stay with the victim. REFERENCES 1. Hamel MB, Goldman L, Teno J, et al. Identification of comatose patients at high risk for death or severe disability. SUPPORT Investigators. Understand prognoses and preferences for outcomes and risks of treatment. [Journal Article. Multicenter Study] JAMA 1995; 273(23):1842-8 2. Kapoor WN. Evaluation and outcome of patients with syncope. Medicine 1990; 69(3):160-75 3. Koster RW, Sayre MR, Botha M et al. Part 5: Adult basic life support: 2010 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Resuscitation 2010;81:e48e70. http://www.resuscitationjournal.com 4. Markenson D, Ferguson JD, Chameides L et al., on behalf of the First Aid Chapter Collaborators. Part 17: First Aid: 2010 American Heart Association and American Red Cross Guidelines for First Aid. Circulation. 2010;122(suppl 2):S934-S946. 5. Quinn, Stiell, McDermott et al. A Prediction Rule for Serious Outcomes of Syncope in Emergency Room Patients May Reduce Admissions. Ann Emerg Med 2004;43:22432. 6. Colivicchia, Ammirati, Melina et al. Development and prospective validation of a risk stratification system for patients with syncope in the emergency department: the OESIL risk score. European Heart Journal (2003) 24, 811819 7. Koster RW, Sayre MR, Botha M et al. Part 5: Adult basic life support: 2010 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Resuscitation 2010;81:e48e70. http://www.resuscitationjournal.com 8. Markenson D, Ferguson JD, Chameides L et al., on behalf of the First Aid Chapter Collaborators. Part 17: First Aid: 2010 American Heart Association and American Red Cross Guidelines for First Aid. Circulation. 2010;122(suppl 2):S934-S946. FURTHER READING ARC Guideline 4 Airway ARC Guideline 8 Cardiopulmonary Resuscitation ARC Guideline 9.1.1 Principles of Control of Bleeding for First Aiders ARC Guideline 9.1.6 Management of Suspected Spinal Injury Guideline 3 November 2012 Page 2 of 2
