After Establishing That An Adult Patient Is Unresponsive You Should

After Establishing That an Adult Patient is Unresponsive: A Comprehensive Guide

Determining that an adult patient is unresponsive is a critical first step in a medical emergency. It triggers a cascade of actions designed to assess the patient's condition and provide appropriate life-saving interventions. This article will delve into the steps to take after establishing unresponsiveness, focusing on a systematic approach that prioritizes airway, breathing, and circulation (ABCs), and ultimately, the potential need for advanced life support. We will cover the initial assessment, crucial interventions, and the importance of ongoing monitoring and communication with emergency medical services (EMS). Remember, this information is for educational purposes and should not replace professional medical training. Always follow your local protocols and guidelines.

1. Confirm Unresponsiveness and Call for Help

The first step, after determining the patient is unresponsive, is crucial. Do not assume. Gently shake or tap the patient's shoulders and loudly ask, "Are you okay?" Observe for any response, even the slightest movement or sound. This seemingly simple act helps eliminate the possibility of a mild syncopal episode or transient confusion.

Calling Emergency Services:

Simultaneously, or immediately after confirming unresponsiveness, call for emergency medical services (EMS). This is paramount. Do not delay this step. Clearly explain the situation, including the patient's apparent condition, location, and any known medical history.

2. Check for Breathing and Pulse

Once you've confirmed unresponsiveness and contacted EMS, immediately assess the patient's breathing and pulse. This is the cornerstone of the ABC approach.

Checking for Breathing:

Look, listen, and feel for breathing. Look for chest rise and fall. Listen for breath sounds by placing your ear close to the patient's mouth and nose. Feel for the breath on your cheek. Even shallow or gasping breaths should be considered breathing. The absence of breathing, or only gasping breaths (agonal breaths), signifies respiratory arrest.

Checking for a Pulse:

Simultaneously, or immediately after assessing breathing, check for a pulse. The carotid artery (located in the neck) is typically checked in unresponsive adults. Using two fingers, gently palpate the artery for at least 5-10 seconds. The absence of a pulse indicates cardiac arrest.

3. Initiate CPR if Necessary

If the patient is both unresponsive and not breathing or only gasping, immediately begin cardiopulmonary resuscitation (CPR). CPR combines chest compressions and rescue breaths to provide artificial circulation and respiration.

Chest Compressions:

• Position: Place the heel of one hand on the center of the chest (between the nipples). Place your other hand on top, interlacing your fingers.
• Depth: Compress the chest at least 2 inches (5 cm) for adults.
• Rate: Aim for a rate of 100-120 compressions per minute.
• Technique: Allow the chest to fully recoil between compressions. Avoid leaning on the chest between compressions.

Rescue Breaths (if trained):

If trained and comfortable performing rescue breaths, give two rescue breaths after every 30 chest compressions. Ensure an airtight seal over the patient's mouth and nose, and deliver each breath over approximately 1 second, watching for chest rise. If you are untrained or uncomfortable performing rescue breaths, focus solely on chest compressions.

4. Use an AED if Available

If an automated external defibrillator (AED) is available, immediately use it. An AED is a portable device that can analyze the heart rhythm and deliver an electric shock if necessary. Follow the AED’s voice prompts carefully. This is a crucial step in treating cardiac arrest. AEDs are designed for layperson use and can significantly improve survival rates.

5. Continued Monitoring and Collaboration with EMS

Once EMS arrives, seamlessly transfer care. Provide a clear and concise handover report, including:

• Time of event and when CPR was initiated.
• Time of AED use (if applicable).
• Patient's responsiveness, breathing, and pulse before intervention.
• Any known medical history.
• Any medications the patient takes.

6. Potential Underlying Causes of Unresponsiveness

The causes of unresponsiveness are numerous and varied. They range from relatively benign conditions to life-threatening emergencies. Some possible underlying causes include:

Medical Conditions:

• Cardiac arrest: This is a life-threatening condition where the heart stops beating effectively.
• Stroke: A stroke occurs when blood flow to a part of the brain is interrupted.
• Hypoglycemia (low blood sugar): Particularly common in individuals with diabetes.
• Seizures: Seizures can cause a temporary loss of consciousness.
• Drug overdose: Overdoses can depress the central nervous system, leading to unresponsiveness.
• Head injury: Trauma to the head can cause a loss of consciousness.
• Respiratory failure: Failure of the lungs to provide adequate oxygen to the body.
• Anaphylaxis (severe allergic reaction): Can cause airway compromise and circulatory collapse.
• Shock (hypovolemic, septic, cardiogenic): A life-threatening condition characterized by inadequate blood flow to organs and tissues.

Environmental Factors:

• Heatstroke: Extreme heat can lead to loss of consciousness.
• Hypothermia (low body temperature): Extreme cold can significantly affect body functions.
• Carbon monoxide poisoning: Carbon monoxide displaces oxygen in the blood.

7. Importance of Continued Education and Training

Mastering the skills and knowledge necessary to respond effectively to an unresponsive adult requires ongoing education and training. Courses such as CPR and first aid provide crucial knowledge and practical skills in managing such emergencies. Regular refresher courses help maintain proficiency and ensure that individuals can confidently and effectively apply the necessary life-saving techniques. Furthermore, understanding the underlying medical conditions that can cause unresponsiveness enhances the ability to make informed decisions and provide more effective care.

8. Beyond the Basics: Advanced Life Support

This article primarily focuses on the immediate actions to take after establishing unresponsiveness in an adult patient. However, it's crucial to understand that advanced life support (ALS) techniques, such as advanced airway management, intravenous fluid administration, and the administration of medications, are essential components of managing cardiac arrest and other life-threatening conditions. These techniques are administered by trained paramedics and emergency medical technicians (EMTs) and form a critical part of the chain of survival.

9. Legal and Ethical Considerations

Providing emergency care comes with legal and ethical considerations. Always act within the scope of your training and knowledge. Obtain consent whenever possible, understanding that implied consent may apply in emergency situations. Good Samaritan laws protect individuals who act in good faith to provide emergency care, but it's still crucial to act reasonably and within the bounds of your training.

10. Psychological Impact

Responding to an unresponsive adult can be emotionally challenging. It is important to acknowledge the psychological impact of such experiences and to seek support if needed. Debriefing with colleagues or seeking professional counseling can help process the emotional stress associated with managing medical emergencies.

In conclusion, the steps taken immediately after determining that an adult patient is unresponsive are critical. A systematic approach, focusing on the ABCs (airway, breathing, circulation), prompt initiation of CPR and AED use if indicated, and seamless handover to EMS, greatly increases the chances of survival. This requires training, understanding, and preparedness, alongside a commitment to ongoing learning and professional development. Remember, every second counts in a medical emergency. Knowing what to do, and acting decisively, can make a life-saving difference.