Timothy M. Cox Timothy M. Cambridge, UK Close. John D. Firth John D. A newer edition of Oxford Textbook of Medicine is available. Latest edition 6 ed. Latest update The September update includes amendments to several chapters, including Traumatic brain injury, and Diseases of the autonomic nervous system. Featured content This title features a number of videos to further illustrate concepts and procedures. Access token activation If you have an access token, please click here to activate it.
Google Preview. Read More. Bend one arm up and one arm down, to support the upper and lower body. Tilt the person's head back to allow air to move freely in and out of the mouth. Keep the person warm until emergency medical help arrives. Unconsciousness can be caused by many injuries and types of illnesses. Common causes of unconsciousness are injury to the head by a fall or blow. Causes of unconsciousness specific to fainting can be found in the Fainting topic.
Diabetes affects blood sugar, and too much sugar hyperglycemia and too little sugar hypoglycemia can lead to unconsciousness in the form of diabetic coma or insulin shock, respectively. This can push the object farther into the airway. Continue CPR and keep checking to see if the object is dislodged until medical help arrives. DO NOT give an unconscious person any food or drink. DO NOT leave the person alone. DO NOT place a pillow under the head of an unconscious person. DO NOT slap an unconscious person's face or splash water on their face to try to revive them.
When to Contact a Medical Professional. Call or the local emergency number if the person is unconscious and: Does not return to consciousness quickly within a minute Has fallen down or been injured, especially if they are bleeding Has diabetes Has seizures Has lost bowel or bladder control Is not breathing Is pregnant Is over age 50 Call or the local emergency number if the person regains consciousness, but: Feels chest pain, pressure, or discomfort, or has a pounding or irregular heartbeat Cannot speak, has vision problems, or cannot move their arms and legs.
To prevent becoming unconscious or fainting: Avoid situations where your blood sugar level gets too low. Avoid standing in one place too long without moving, especially if you are prone to fainting. Get enough fluid, particularly in warm weather. If you feel like you are about to faint, lie down or sit with your head bent forward between your knees.
Alternative Names. Patient Instructions. Concussion in adults - discharge Concussion in adults - what to ask your doctor Concussion in children - discharge Concussion in children - what to ask your doctor Preventing head injuries in children.
Recovery position - series. Ultrasound examination may be a RUSH exam for hypotension , an aorta exam, or a more focal exam based depending on the findings of the primary survey. Interventions at this point: For hypotension, I will start a fluid bolus or blood products depending on the context.
If there is any suspicion of anaphylaxis, I will give epinephrine 0. If there is reason to suspect hyperkalemia, or any bizarre appearing ECG, I will empirically give calcium amps of calcium gluconate IV. After the rapid assessment and management of immediate life threats, the next step is to ensure the patient is adequately resuscitated before the inevitable trip to the CT scanner. A definitive airway should be in place before traveling to radiology.
Blood work, probably already drawn reflexively by the nurses, should be sent off. Unless there is a clear alternative diagnosis, I start empiric antibiotics on everyone. Acyclovir can also be considered for herpes encephalitis. Non-convulsive status epilepticus is a difficult diagnosis to make, but warrants specific consideration. It is important to use all possible sources of information, including old charts, family, friends, and EMS.
If the initial temperature check was with a peripheral thermometer, I will ask for a core temperature. The LP, although possibly a necessary test, is not an emergent test. In sick patients, it is generally better to get therapy started empirically, and worry about the LP later. Finally, once the patient is stabilized, I will get them to the CT scanner for images of their brain and any other organs indicated by the primary survey. After ruling out initial life threats, starting empiric therapy, and getting the patient to the CT scanner, I focus on running through the larger differential diagnosis.
This mnemonic is useless as a memory aid. There is no way that you will be able to consistently reproduce this list from memory in emergent situations. However, it can be useful as a checklist after completing the initial resuscitation. In addition to empiric antibiotics, there are other empiric therapies that should occasionally be considered depending on the speed and availability of testing: thyroxine for possible myxedema, dexamethasone for adrenal crisis, benzodiazepines for possible non-convulsive status epilepticus, and specific antidotes for any suspected toxidromes.
Killer coma cases part 1 the found down patient and part 2 the intoxicated patient on Emergency Medicine Cases. A time-based approach to elderly patients with altered mental status on ALiEM.
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