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This guideline is applicable to adults, children and infants.

Definition

  1. Top of page
  2. Definition
  3. Introduction
  4. Causes of unconsciousness
  5. Recognition
  6. Objectives
  7. Principles to be followed when positioning the victim on the side
  8. References

Unconsciousness is a state of unrousable unresponsiveness, where the victim is unaware of their surroundings and no purposeful response can be obtained.

Introduction

  1. Top of page
  2. Definition
  3. Introduction
  4. Causes of unconsciousness
  5. Recognition
  6. Objectives
  7. Principles to be followed when positioning the victim on the side
  8. References

The brain requires a constant supply of oxygenated blood and glucose to function. Interruption of this supply will cause loss of consciousness within a few seconds and permanent brain damage in minutes.

Causes of unconsciousness1,2,3,4,5,6,7

  1. Top of page
  2. Definition
  3. Introduction
  4. Causes of unconsciousness
  5. Recognition
  6. Objectives
  7. Principles to be followed when positioning the victim on the side
  8. References

The causes of unconsciousness can be classified into four broad groups:

  • • 
    blood oxygenation problems
  • • 
    blood circulation problems.
  • • 
    metabolic problems (e.g. diabetes, overdose).
  • • 
    central nervous system problems (e.g. head injury, stroke, tumour, epilepsy).

Fainting is a common cause of unconsciousness and may occur when the victim's heart rate is too slow to maintain sufficient blood pressure for the brain.

Combinations of different causes may be present in an unconscious victim e.g. a head injury victim under the influence of alcohol.

Recognition6,7

  1. Top of page
  2. Definition
  3. Introduction
  4. Causes of unconsciousness
  5. Recognition
  6. Objectives
  7. Principles to be followed when positioning the victim on the side
  8. References

Assess the collapsed victim's response to verbal and tactile stimuli (‘talk and touch’), ensuring that this does not cause or aggravate any injury.

Give a simple command such as, ‘open your eyes, squeeze my hand, let it go’. Then grasp and squeeze the shoulders firmly to elicit a response.

A person who fails to respond should be managed as if unconscious. A victim who shows only a minor response, such as groaning without eye opening, should be managed as if unconscious. [Class B; LOE Expert Consensus Opinion]

Positioning an unconscious breathing victim

With an unconscious victim, care of the airway takes precedence over any injury, including the possibility of a spinal injury. All unconscious victims must be handled gently and every effort made to avoid any twisting or forward movement of the head and spine.

Objectives

  1. Top of page
  2. Definition
  3. Introduction
  4. Causes of unconsciousness
  5. Recognition
  6. Objectives
  7. Principles to be followed when positioning the victim on the side
  8. References

All unconscious breathing victims are turned onto the side to:

  • • 
    establish and maintain a clear airway
  • • 
    facilitate drainage and reduce the risk of inhaling foreign material

Principles to be followed when positioning the victim on the side

  1. Top of page
  2. Definition
  3. Introduction
  4. Causes of unconsciousness
  5. Recognition
  6. Objectives
  7. Principles to be followed when positioning the victim on the side
  8. References

Many versions of the recovery (also known as lateral) position exist. When considering the specific position to be used, the following principles should be observed:1

  • • 
    the victim should be in as near a true lateral position as possible with the head dependent to allow free drainage of fluid
  • • 
    the position should be stable
  • • 
    any pressure on the chest that impairs breathing should be avoided
  • • 
    it should be possible to turn the victim onto the side and return to the back easily and safely, having particular regard to the possibility of cervical spine injury
  • • 
    good observation of and access to the airway should be possible
  • • 
    the position itself should not give rise to any injury to the victim
  • • 
    rescuers should continuously assess for, and manage deterioration.

References

  1. Top of page
  2. Definition
  3. Introduction
  4. Causes of unconsciousness
  5. Recognition
  6. Objectives
  7. Principles to be followed when positioning the victim on the side
  8. References
  • 1
    Bleck TP, Smith MC, Pierre-Louis SJ et al. Neurological complications of critical medical illnesses. Crit Care Med 1993; 21: 98103.
  • 2
    Hamel MB, Goldman L, Teno J, Lynn J, Davis RB, Harrell FE Jr, Connors AF Jr, Califf R, Kussin P, Bellamy P et al. Identification of comatose patients at high risk for death or severe disability. SUPPORT Investigators. Understand prognoses and preferences for outcomes and risks of treatment. [Journal Article. Multicenter Study] JAMA 1995; 273(23): 18428.
  • 3
    Levy DE et al. Prognosis in non traumatic coma. Annals of Internal Medicine 1981; 94(3): 293301.
  • 4
    Martin GJ et al. Prospective evaluation of syncope. Annals of Emergency Medicine 1984; 13(7): 499504.
  • 5
    Kapoor WN. Evaluation and outcome of patients with syncope. Medicine 1990; 69(3): 16075.
  • 6
    Koster RW, Sayre MR, Botha M, Cave DM, Cudnik MT, Handley AJ, Hatanaka T, Hazinski MF, Jacobs I, Monsieurs K, Morley PT, Nola JP, Travers AH. Part 5: Adult basic life support: 2010 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Resuscitation 2010; 81: e48e70. http://www.resuscitationjournal.com
  • 7
    Markenson D, Ferguson JD, Chameides L, Cassan P, Chung KL, Epstein J, Gonzales L, Herrington RA, Pellegrino JL, Ratcliff N, Singer, A, on behalf of the First Aid Chapter Collaborators. Part 17: First Aid: 2010 American Heart Association and American Red Cross Guidelines for First Aid. Circulation. 2010; 122(suppl 2): S934S946.