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G9

G9

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Published by: salmanalyaly on Sep 05, 2009
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02/07/2013

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Manitoba Health 
 
EMERGENCY TREATMENT GUIDELINES 
GENERAL
 
GENERAL - Unconscious Patient 
 
April 2005 
 
Page G9-1
G9 UNCONSCIOUS PATIENT
 
The unconscious patient presents EMS personnel with numerous serious challenges in patient management.Unconscious patients should receive a rapid assessment to identify immediate life threating conditions.
GENERAL
personal protective equipment should be utilized as appropriate
body substance isolation techniques and equipment should be utilized as appropriate
identify the mechanism(s) of injury if possible
primary survey
scene assessment
may provide information on the mechanism of injury or precipitating factors for the patient's medicalcondition
consider cervical spinal precautions, if indicated
assess of the patient’s level of consciousness
establish and maintain an airway, if indicated
consider the use of airway adjuncts if indicated
suction, if indicated
determine the presence of spontaneous respirations and pulse
be prepared to support respiratory and circulatory functions, if indicated
assess for sources of external bleeding
manage any life threatening conditions when identified
maintenance of an open airway and ensuring adequate respirations has priority over all other treatments,including control of the cervical spine
assist ventilations using a bag-valve mask, if indicated
at all times be prepared for the patient to vomit or regurgitate
consider load and go criteria
secondary survey
perform if circumstances and patient condition permit
obtain vital signs
assess the patient's neurological status using the Glasgow Coma Scale
obtain a reliable bystander history, if available
look for patient identification, assist in determining the cause of the patient's altered level of consciousness
Medic-Alert bracelet, neck pendant, or wallet card
rule out hypoglycemia by obtaining a blood glucose reading (see Diabetic Emergencies Guidelines)
treat, as indicated
 
Manitoba Health 
 
EMERGENCY TREATMENT GUIDELINES 
GENERAL
 
GENERAL - Unconscious Patient 
 
April 2005 
 
Page G9-2 
continue to reassess patient status
load and go if required
record any events that interfere with completing secondary survey
maintain high concentration oxygen delivery to the patient
assist ventilations if required
reassess vital signs at regular intervals (5-15 min.) or when there is a change in the patient’s status
initiate transport
on scene times should be kept to a minimum
treat other conditions en route
transport the patient to the nearest appropriate health care facility
transport the patient in a side lying position, injuries and life threatening conditions permitting
notify the receiving health care facility of the patient's status as soon as possible
monitor and treat the patient en route
report all findings to the receiving facility staff, and document on the patient care report
NOTE
assume the patient has a spinal cord injury if unconsciousness due to trauma or unknown etiology (see CentralNervous System Injuries Guideline)
prepare to handle respiratory and cardiac arrest
keep suction available at all times
never assume a syncopal episode is “just a fainting spell”
assess the patient thoroughly
prepare to handle a combative, disoriented patient
particularly when patient’s level of consciousness is increasing
prepare to manage seizures
talk to the patient, even if apparently unconscious
hearing is the last sense to be lost
find and transport all medications with the patient
a list of medications that includes dosages is equally useful if medications cannot be located
EMS personnel trained and certified in the management of hypoglycemia may do so, as outlined in theHypoglycemia Treatment Protocol
EMS personnel trained and certified in the management of suspected opioid overdose may do so, as outlinedin the Management of Suspected Opioid Overdose with Naloxone Protocol
do not administer anything by mouth unless otherwise indicated
 
Manitoba Health 
 
EMERGENCY TREATMENT GUIDELINES 
GENERAL
 
GENERAL - Unconscious Patient 
 
April 2005 
 
Page G9-3 
Syncope
syncope may be due to many conditions, some of which are life-threatening
cardiac ischemia or arrhythmia
vascular disease
hemorrhage or hypovolemia
nervous system abnormality
hypoglycemia or other metabolic abnormality
psychogenic
syncopal patients are initially unconscious but often regain consciousness prior to EMS arrival
obtain as thorough a history as possible of the precipitating circumstances
position the patient supine
if the patient is hypotensive elevate lower limbs, unless injuries prevent this
look for the underlying cause of the episode of syncope and treat as appropriate
reassure the patient
maintain the patient in the recovery position for transport if syncope persists
do not allow the patient to exert him/herself - e.g. walking, standing unassisted to transfer to the stretcher,etc.
maintain high concentration oxygen delivery to the patient
assist ventilations if required
initiate transport
on scene times should be kept to a minimum
transport the patient to the nearest appropriate health care facility
notify the receiving health care facility of the patient's status as soon as possible
monitor and treat the patient en route
additional surveys and treatments should be conducted en route
report all findings to the receiving facility staff, and document on the patient care report

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