Question about unresponsive patients?

[musicislife]

Should a first responder like myslef expose and assess an unresponsive patient after the airway, breathing, and circulation are assessed (lets say I put him in the recovery position because no trauma was suspected) as a lay rescuer?

[paramedicmike]

Are you acting as a lay rescuer? Or are you acting as a first responder? You're claiming to be both in your question.

What do you think you'll need to do?

Why do you think you'll need to do it?

Come on. You knew I would be the one to ask this, didn't you?

[musicislife]

trained as a first responder, acting as a lay rescuer. i should have been more clear, sorry.

I think I would (considering my bag is in the area, and I have my shears) expose every unconscious patient.

This is because I have no idea as to the reason for the unconsciousness...what if I notice (for example) a pulsating mass on the abdomen, or rigidity in the abdmomen. What if I notice signs of shock in the extremeties? Basically, I would expose because I have no idea what is happening, and exposeure plus PT history if obtainable will be a great help in helping the patient.

Question now:..i know that syncope is a breif lapse of consciousness, but how long is "breif" (couldnt get a straight answer online, either that or my google skills suck)

[paramedicmike]

Here's some additional reading you may find useful:

Thread one.

Thread two.

If you'll notice, thread two is yours.

Brief can be widely interpreted. I've always found it best to try and numerically quantify the time lapse. It can be described as simply as "a matter of seconds" to "a minute or two" to "no idea how long s/he was out". This is where being thorough in your history comes in handy.

[Arctickat]

There's no hard and fast rule, but typically no more than a couple of minutes. Syncope is recognised by a rapid return to a lucid state after the patient hits the floor. In essence, the syncope is cause by a lack of perfusion to the brain in a person standing or sitting upright. Once they are laying down the blood will be able to reach the brain easier, so they wake up.

If you notice a pulsating mass or a rigid abdomen (Are you even allowed to palpate the abdomen? Our First Responders can't.) how will it change your treatment? You should be able to recognise the S/S for shock without removing any clothing...unless they're wearing gloves or mittens of course.

[musicislife]

I guess I still cant find a clear answer to exposing an unconscious patient. It is my thinking that all patients, whether suspected medical or trauma with patent airway, present, adequate breathing, and circulation who are unconscious should be exposed to look for any signs of illness, or rule out trauma. Have I drawn the correct conclusion for unconscious patient?

Edited June 7, 2012 by musicislife

[nypamedic43]

If there's no sign of suspected trauma, why would you expose a patient? A syncopal episode that lasts a few seconds to a minute, that's was witnessed, and helped to the ground, rather than hit the ground like a sack of 'tators, doesn't need to be exposed.

Another thing to consider is this. If you are acting in the capacity of a passerby but you are carrying your jump kit...with no identifying uniform or volly shirt or jacket..bystanders could question what your motives are, as to why you are cutting someone's clothes off. It is not unlikely for someone who has no medical training to put a "kit" together and pretend they know whAt they are doing. It's happened before. I am not saying to not help if you are able but I would use caution exposing someone if there is no need to.

Just my 2 cents

[musicislife]

allright, what if the patient is not arousable? How would I go about treating an unconscious medical patient in this situation? I think I would maintain airway, and cool with water if S/S indicates it (ie profuse sweating, warm skin, rapid pulse, hot enviornment, ect) What about general treatment of unconscious medicals?

[nypamedic43]

It depends on the situation. It the patient is an unconscious diabetic, there isn't anything you should do except call 911. Cooling a sweating patient with water is not a recommended practice...unless they are being decontaminated or have a heat stroke. General treatment of unconscious medical patients is maintain an open airway, make sure they are breathing and have a pulse. If you have an oxygen tank in that bag of yours, 100% o2 by NRM would help, IF as a first responder you are allowed to do so.

If you are allowed to do so...cooling a heat stroke patient would be ideal but you should do it passively...like getting them into the shade or air conditioning and off the hot sidewalk or pavement.

Be very careful that you stay within your scope of practice. Exposing a patient or active cooling just because you can or think you should may not work out so well for you.

[paramedicmike]

You're on the right track. Supportive care is what you're looking for. Support and maintain the patient's airway. Compressions if they're in cardiac arrest.

As a first responder you're not going to be able to do much. Even as an EMT, depending on local practices, you're probably not going to be able to do much. If an ambulance has not yet been called then call an ambulance. Try and get as much info as you can about what happened. Supportive care as previously mentioned is in there, too.

How long before you can go to EMT school?