In today’s micro-lecture, Australian Paramedical College Hon. Snr. Lecturer Sam Willis talks about how to manage the unconscious patient.
In today’s micro-lecture, we’re going to talk about how to manage the unconscious patient. Now as a paramedic, you’re going to manage many patients who are deemed unconscious or unresponsive, so let’s see how much we can fit in to this short lecture. Unconsciousness is something that is going to take you many years to actually practice and to apply all that wonderful knowledge that you’re growing and developing, but let’s see what we can do. So, unconsciousness is something that is caused by many, many different conditions, including complex acute medical emergencies, chronic medical emergencies and medical conditions as well as trauma, as well. So when you’re approaching the unconscious patient, you have to follow your primary and secondary survey, that’s the safest thing to do, it’s something you will have drilled into you time and time again, you’ll use it nationally and internationally, and of course it’s something that you will read around and be taught in this program with APC, as well as when you go on to university.
So, danger, response. “Hello, can you hear me? Open your eyes, ambulance.” If there’s no response, if they’re not alert, and that’s if then you move on to the voice. If they’re not responding to voice, you give a gentle trap squeeze and a bit of a shake. “Hello, ambulance, can you hear me?” We’re moving away from doing the sternum rub because it’s a type of assault and it leaves impressions on your patient. And if they don’t respond to any of that, then they are unresponsive. Now, at this point you have to work out, is the airway a problem? Now, the response shake and shout, you can sometimes do that as well as managing the airway, but this comes with experience. So you’ll be, “Hello mate, can you hear me? Open your eyes.” Now, if you hear there’s a problem with the airway, so there’s a snoring noise which sounds like this, you really do need to get that tongue off the back of the throat quickly. Now, you do that in one of two ways.
If the patient is … If you’re suspecting there’s been trauma, you do the jaw thrust or the triple manoeuvre which will be shown at the workshop, or you could just do a head tilt, chin lift if there’s no trauma, put the oropharyngeal tube into the patient’s airway, again you’ll be shown this at the workshop. That will keep the tongue off the back of the throat. Now you have to keep on re-assessing that over and over again to make sure that they haven’t vomited or it hasn’t come out. So that’s the airway done, then it’s breathing. You’re looking at the breathing rate, depth, regularity. Put your hand on the chest, or if they’re laying on their front put them on their back. Don’t rush to move them if you’re suspecting trauma, and you’re calculating the breathing rate and the characteristics of breathing.
You’re then doing the same with the circulation, feel for the absence or presence of the pulse, the rate, the regularity, all the things you know about the circulation as well as the capillary refill time test. Now, at this point if they’re still unresponsive, that’s not good. I mean, people generally are not unconscious for no reason. Now, your crew mate can start to do a set of vital signs, so for example they might just do a blood sugar on scene, they might … You might then go and do a head-to-toe survey to see if there’s any trauma that you can find, but apart from the … In my professional opinion, apart from the glucose monitoring and the head-to-toe survey, if that’s all normal you then need to get your patient into the back of the ambulance in a way that allows the As, Bs and Cs to be protected, and then you do everything else in the back of the ambulance. So if you haven’t found any disabilities and you’ve exposed them in the back of the ambulance just to check for anything, you can do a more thorough patient assessment. You can check the head-to-toe again, which is a separate lecture, and you can them pre-alert the hospital, tell them you’re coming in with somebody who is unresponsive, GCS of three. That’s been a micro-lecture on managing the unconscious patient.
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