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Evaluating an individual’s consciousness level during an emergency scenario is pivotal for responders and can potentially save crucial minutes when providing treatment upon their arrival. There are several measures you can take to evaluate an individual’s consciousness level or to assist in stabilizing an unresponsive individual while awaiting responders during an emergency situation.
Steps
Evaluating Consciousness Level in a Responsive Individual
Assess the surroundings. The initial step in any emergency scenario is to pause and assess the surroundings. Determine the cause of the individual's injury and ascertain whether it is safe to approach. Rushing into a situation prematurely serves no one; risking becoming a casualty yourself doesn't aid the individual, and emergency medical services (EMS) don't need to rescue two individuals instead of one.
Recognizing Indications of Impending Loss of Consciousness These indicators encompass:
- Impaired speech
- Elevated heart rate
- Disorientation
- Vertigo
- Feeling faint
- Lack of coordination
- Sudden inability to communicate clearly, or inability to communicate at all
Interrogate the Individual A series of inquiries promptly yields significant insight into the individual’s condition. Questions should be straightforward yet require basic cognitive function. Commence by asking if the individual is alright to determine responsiveness. If the individual responds or emits a groan indicating consciousness, attempt the following queries:
- Are you alright?
- Can you disclose the current year?
- Can you disclose the current month?
- What day is it?
- Who is the current president?
- Do you know your whereabouts?
- Do you recall what transpired?
- If the individual articulates clear and coherent responses, they exhibit a high level of consciousness.
- If the individual responds but provides incorrect answers to several initial questions, they are conscious but display signs of an altered mental state, indicative of confusion and disorientation.
Summon Emergency Services If the individual is conscious but exhibits signs of an altered mental state (such as inability to clearly respond to simple questions), immediate contact with emergency services (911) is imperative.
- When contacting 911, relay the patient's AVPU scale rating:
- A — Alert and oriented
- V — Responds to Verbal stimuli
- P
— Responds to Painful stimuli
- U — Unconscious/no response
- Even if the individual responds coherently to all inquiries and exhibits no signs of an altered mental state, 911 should still be contacted if the individual:
- Sustains additional injuries from the traumatic incident
- Experiences chest pain or discomfort
- Experiences a pounding or irregular heartbeat
- Reports visual impairment
- Experiences immobility in limbs
Pose Additional Queries This aids in garnering insights into the cause of the individual's loss of consciousness or diminished consciousness level. The individual may or may not be able to respond, contingent upon their consciousness level and responsiveness. Attempt inquiries such as:
- Can you recount what transpired?
- Are you currently on any medications?
- Do you suffer from diabetes? Have you ever experienced a diabetic coma?
- Have you consumed any drugs or alcohol? (Inspect for signs of needle marks on arms/feet or presence of medication/alcohol containers nearby)
- Do you have a history of seizures?
- Do you have a heart condition or have you ever suffered a heart attack?
- Did you experience chest pain or any other symptoms prior to losing consciousness?
Document Responses The individual's responses—whether coherent or nonsensical—aid emergency responders in determining the most appropriate course of action. Document all responses if necessary to convey the information exactly as communicated by the individual.
- For instance, if the individual provides incoherent responses to most inquiries but also discloses a history of seizures, they may continue to respond incorrectly for five to ten minutes during the post-seizure phase, necessitating only brief paramedic observation.
- Alternatively, if the individual confirms diabetes, emergency responders will promptly assess glucose levels upon receiving this information.
Engage the Individual in Conversation If the individual has responded with nonsensical answers to your inquiries—or exhibits signs of impending unconsciousness—endeavor to sustain dialogue. Emergency responders can more effectively evaluate the situation if the individual remains conscious upon their arrival. Encourage the individual to keep their eyes open and pose additional questions to keep them engaged.
Recognize Other Potential Causes of Unconsciousness If you have knowledge of the individual or witnessed their loss of consciousness, you may provide vital clues to emergency medical personnel regarding potential diagnoses or triggers. Common causes of decreased consciousness or loss of consciousness include:
- Excessive blood loss
- Severe head or chest trauma
- Drug overdose
- Alcohol poisoning
- Automobile accidents or other significant injuries
- Glucose imbalances (as in diabetic individuals)
- Cardiovascular issues
- Low blood pressure (particularly prevalent among the elderly, with consciousness typically restored shortly thereafter)
- Dehydration
- Seizures
- Stroke
- Hyperventilation
Inspect for Medical Alert Identification Individuals with certain medical conditions, such as diabetes, may wear identification items to alert responders.
- If such an item is discovered, promptly inform emergency medical personnel upon their arrival.
Supervise the Individual Until Emergency Medical Assistance Arrives It is crucial to have constant supervision over the patient.
- If they remain semi-conscious and exhibit normal breathing without distress, continue monitoring until medical assistance arrives.
- If the individual becomes completely unresponsive, the situation is considerably more severe, requiring further assessment and the following steps.
Evaluating an Unresponsive Individual
Try to Rouse the Individual with a Loud Noise Attempt shouting, 'Are you alright?' and gently shaking the individual. Sometimes, this simple action can restore consciousness.
Apply Painful Stimulation If the individual remains unresponsive to verbal cues, but the situation does not warrant immediate CPR, avoid administering painful stimuli to test for a conscious response.
- A common method is a 'sternal rub,' where you use your knuckles to vigorously rub the person's sternum or breastbone. If the individual reacts to this stimulation, you can continue monitoring without CPR, indicating they are stable for the moment. If there's no response, CPR may be necessary.
- If there's a concern for a chest injury, alternative methods include pinching the fingernail or nail bed or pinching the trapezius muscle at the back of the neck.
- Observing the person's response to pain, such as limb movement or posturing, can offer insight into their condition, including the possibility of a spinal injury.
Confirm That You've Called 911 Ensure that emergency services are en route, especially if the individual doesn't respond to painful stimuli. Stay on the line with the operator or pass the phone to someone else present for further guidance.
Assess Breathing If the individual is unconscious but breathing, CPR may not be immediately necessary, particularly if no one present is trained in CPR.
- Monitor the rise and fall of the chest to confirm breathing.
- If unsure, listen for breath sounds by placing your ear near their mouth or nose while observing their chest movements.
- Exercise caution if suspecting a spinal injury; avoid repositioning unless necessary for airway management.
- If no spinal injury is suspected, place the individual in the recovery position to maintain airway patency.
Check for a Pulse Assess the individual's pulse on the underside of their wrist (radial pulse) or by gently feeling one side of their neck below the ear (carotid pulse). Always check the carotid pulse on the same side of the body where you're positioned.
- If no pulse is detected, especially in conjunction with absent breathing, initiate CPR if trained; otherwise, follow instructions provided by emergency medical personnel over the phone.
- If disconnected from the call, call back for further instructions. Dispatchers are trained to guide laypersons through emergency procedures over the phone.
Administering CPR to an Unresponsive Person
Check for CPR Knowledge Among Bystanders Cardiac arrest is a common cause of sudden unresponsiveness. Administering CPR promptly can significantly increase the chances of survival. Inquire if anyone nearby is trained in CPR while awaiting paramedics.
Assess the Individual's Airway If the person is not breathing, check their airway. Gently tilt their head back to open the airway and listen for breath sounds. If an obstruction is visible and easily removable, clear it. If no obstruction is found or there is no pulse, proceed to chest compressions. Avoid head-tilt chin-lifts in cases of head or neck injuries; use the jaw-thrust method instead.
Perform Chest Compressions Prioritize chest compressions in CPR, maintaining a ratio of 30 compressions to 2 rescue breaths. Position your hands correctly over the individual's breastbone and apply firm pressure, allowing their chest to fully rise between compressions. If not trained in rescue breaths, focus solely on compressions.
Monitor Breathing Status Continuously reassess the individual's breathing every two minutes during CPR. Cease CPR once the person resumes breathing independently. Observe the rise and fall of their chest and listen for breath sounds near their mouth.
Continue CPR until paramedics arrive. If the individual remains unresponsive and does not breathe independently, maintain CPR with two rescue breaths for every thirty chest compressions until emergency help arrives.
