Management of Unconscious Patient

Management of Unconscious Patient

Unconsciousness is a state in which a patient is unable to respond to any kind of external stimuli. The patient may have a faint pulse rate and may or may not be breathing at all. A spell of unconsciousness may be preceded by slurring of speech, increased heart rate, dizziness and confusion. It could last from a few seconds or for longer periods of time. In either case, it requires immediate emergency attention and care.

Causes of unconsciousness can be categorized into 4 main categories:

  • Neurological
    Ischaemic stroke, brain haemorrhage, subdural haematoma, brain tumour, cerebral abscess and oedema, transient ischaemic attack (TIA), brain injury
  • Metabolic
    Hypoglycaemia, hyperglycaemia, electrolyte imbalance, uraemia, hypotension
  • Complications due to drugs or alcohol
    Alcohol intoxication, opioid toxicity, poisoning
  • Psychiatric or functional
    Psychiatric coma

The first step in management of an unconscious patient is to check for breathing. If they are breathing, get them into a recovery position. Carefully roll the person onto one side. Bend the top leg and gently tilt their head back to keep the airway open and reduce the risk of choking. If breathing or pulse stops at any time, roll the person onto their back and begin Cardiopulmonary resuscitation(CPR). In the meantime, a local emergency service should be contacted to move the patient to a hospital.

Once at the hospital, management of unconscious patient depends on the underlying cause. If unconsciousness is due to fluctuation in sugar levels, patient is administered glucose or insulin depending on the blood sugar levels. If there is excessive bleeding that has caused hypotension leading to unconsciousness, measures are taken to stop the bleeding immediately and replenish the fluid loss by administering intravenous fluid and blood transfusion if required. If the doctor suspects a serious cause of unconsciousness, investigations like a CT or MRI scan of the brain is performed. This helps in pin pointing the cause and managing the patient better.

The biggest complication of unconsciousness is choking due to a blocked airway, which can prove fatal if not addressed. Other serious complications include coma and permanent brain damage.

The Centre for Management of Unconscious Patient at Kokilaben Dhirubhai Ambani Hospital, Indore adopts a comprehensive treatment approach for all such patients that require emergency treatment. Patients are treated under the supervision of best physicians and neurologists who with their experience ensure the best possible outcome in the most efficient way. The initial stage after becoming unconscious is critical and treatment received during that time decides the course of the patient. With improvement in intensive and critical care the Centre is able to save many lives and prevent complications.

Patient management consists of a coma stimulation program, hyperbaric oxygen therapy, robotic training on Lokomat® to initiate standing, stepping and walking, cognitive stimulation and retraining, speech and language therapy, and other forms of therapy and stimuli.