Management Protocol of Unconscious Patient

Case Definition
Unconsciousness is a state in which a
patient is totally unaware of both self
and external surroundings and unable to
respond meaningfully to external stimuli.

General management of Unconscious patient

• Care of pressure area
• Care of the mouth, eyes and skin
• Nutrition and fluid balance
• Care of bowel and bladder
• Monitoring of the CVS
• Control of infection
• Physiotherapy to protect muscles and joints
• Prevention of deep vein thrombosis
• Maintenance of adequate oxygenation,if
feasible.

Box 2 Box 3 Box 1: Glasgow coma scale

Investigations Eye Opening
CBC,MP Management of Stroke patient Spontaneous‐ 4
Urine R/E To speech ‐3
To pain ‐2
RBS • General management of unconscious patient
S.Creatinine None‐ 1
• Controlled reduction of BP if > 200/110 Best verbal response
ECG
S.Electrolytes
mm Hg Oriented‐ 5
CT scan if indicated • Control DM Confused ‐4
CSF study if indicated • Anti- convulsants if seizure Inappropriate‐3
Incomprehensive‐2
• Consider CT/MRI None‐1
Best Motor response
Obey commands‐ 6
Localises pain‐ 5
Normal withdrawl‐ 4
Abnormal flexion‐ 3
Abnormal extension‐2
None‐1
 Management Protocol of Unconscious Patient

Stabilization by C - circulation
Assessing CAB A- airway
And Hospitalization B- breathing

Level of Consciousness(box 1)

IV access
O2 inhalation (if possible)
Check vitals and pupil
Investigations(box 2)

IV Glucose
Low (<3.5 mmol/L) or Follow up and
Blood Sugar
Suspected hypoglycemia referral if necessary

Normal or High

H/O Head
Referral
trauma

Febrile A febrile
Unconsciousness Unconsciousnes

Resident of malarial
endemic zone or h/o
recent travel Focal neurological
ICT for malaria positive or deficit e.g Follow Box 3
positive MP hemiparesis, Stroke/ICSOL and Referral
extensor plantar
response
Sudden/insidious
t
Give IV Artesunate or iv
quinine and then
H/O IV Diazepam and
referral if necessary
associated Refer
No relation with malarial convulsion
endemic zone or no h/o
recent travel

Neck stiffness with

or without Sub arachnoid Referral
Neck Stiffness +/‐
preceding h/o Hemorrhage
headache, vomiting

First dose of Broad

spectrum antibiotics Circumstantial
and Referral evidence of poisons, Follow Poisoning Protocol
drug strip, smell

Consider Uraemic
encephalopathy if acidotic
Metabolic disturbances breathing, low urine output
and H/O CKD

Consider Hepatic
Consider DKA/ HHS if encephalopathy if
dehydration and H/O CLD, jaundice
blood sugar usually and other stigmata Refer
≥24mmol/L of CLD

IM Insulin, Iv fluid Consider

and Referral hyponatraemia if H/O
Vomiting, Diarrhea,
H/O taking diuretics IV N/S