Slurred speech A rapid heartbeat Confusion Dizziness Lightheadedness Uncoordination Suddenly being unable to respond coherently, or unable to respond at all
Are you okay? Can you tell me what year it is? Can you tell me what month it is? What day is it? Who is the president? Do you know where you are? Do you know what happened? If the person answers clearly and coherently, then he is displaying a high level of consciousness. If the person responds but answers incorrectly to several of the first questions, then he’s conscious but showing signs of what is called an altered or changed mental state, which includes confusion and disorientation.
When you call 911, inform them of the patient’s score on an AVPU scale: A — Alert and oriented V — Responds to Verbal stimuli P — Responds to Painful stimuli U — Unconscious/no response Even if the person responds coherently to all of your questions and shows no signs of an altered mental state, you should still call 911 if the person: Has other injuries from the traumatic event Feels chest pain or discomfort Has a pounding or irregular heartbeat Reports impairment to vision Cannot move her arms or legs
Can you tell me what happened? Are you on any medications? Do you have diabetes? Have you ever experienced a diabetic coma? Are you on any drugs or have you been drinking? (You may want to look around for any signs of needle marks on arms/feet or bottles of medication of alcohol nearby) Do you have a seizure disorder? Do you have a heart condition or have you ever had a heart attack? Did you have chest pain or any other symptoms prior to going down?
For instance, if the person has given incoherent answers to most of your questions but also communicated that she has a seizure disorder, then she may continue answering questions incorrectly for five to ten minutes in the post-seizure phase of the disorder, yet she may require little more than a brief period of observation from paramedics. As another example, if the person has confirmed that she is diabetic, then the emergency responder will know to immediately check her glucose levels when you pass along that information.
Severe blood loss Severe injury to the head or chest Drug overdose Alcohol intoxication A car accident or other major injury Blood sugar problems (as in diabetics) Heart problems Low blood pressure (common in the elderly, but they usually regain consciousness shortly thereafter) Dehydration Seizure Stroke Hyperventilating
If you find one, report it immediately to emergency medical personnel when they arrive.
If he remains semi-conscious and appears to be breathing and not in any distress, continue to watch him until medical staff arrives. If the person becomes totally unresponsive, the situation is much more serious and you will need to assess him further and proceed with the steps below.
The most common form of this is a “sternal rub,” which entails making a fist and using your knuckles to rub vigorously into the person’s sternum or breastbone. If the person responds to “pain” — to this sensation — you can continue to monitor her without CPR as this is a sign that she is okay for the moment (if she does not respond to pain, however, you will likely need to proceed to CPR). If you fear the person otherwise has a chest injury from the trauma, other methods of testing her pain response include pinching the person’s fingernail or nail bed or pinching the person’s trapezius muscle (back of the neck). The pinch should be very hard and directly to the muscle. [9] X Research source Graham Teasdale, Paul Brennan, Forty Years: An Update on the Glascow Coma Scale, Nursing Times Oct 2014 110 42 p12-16 If the person responds to the pain by either curling all her limbs in or out, this is referred to as posturing and could be indicative of spinal injury.
Be sure to keep a constant watch on the rise and fall of the person’s chest to ensure that he’s still breathing. If you cannot tell by watching alone, you can place your ear near his mouth or nose and listen for breath sounds. When you listen at someone’s mouth, point your head down his body to the chest and watch his chest rise and fall at the same time. This is the easiest way to see breathing. Note that if you have any reason to suspect a spinal injury but the person is breathing, then do not try to reposition him unless he vomits. In this case, roll his entire body to the side while supporting his neck and back to keep them in the same position. If you have no reason to suspect a spinal injury, then roll the person onto his side, position his top leg so that both his hip and knee are at a 90° angle (to stabilize him on his side), and then softly tilt his head back to help keep his airway open. This is called the “recovery position” and is the safest for the patient to be in, in case he vomits at any point.
If a pulse is absent at any point, and especially if there is no breathing, now is the time to start CPR if you are trained; if not, follow instructions of emergency medical personnel over the telephone. If you accidentally hung up after initially calling them, you can call back at this point for further instructions. They are trained to provide instructions for laypeople over the phone.
If you can easily see something in his airway when you look into his mouth, then try to remove it, but only if the object is loose. If the object is clearly lodged, then do not try to remove it from his throat since you may inadvertently push the object farther down his airway. The reason we check the airway first is that if there is a blockage (or an obstruction, such as often happens in choking victims), and if we can easily remove it, our problem is solved. However, if there is not, check for a pulse and, if there is no pulse (or if you cannot find one and are in doubt), immediately begin chest compressions. Head-tilt chin-lifts should not be done on skull, spine, neck injuries. Instead, use the jaw-thrust method, in which you kneel above the person’s head and place your hands on either side of his head. Place your middle and index finger along his jaw bone and gently push it upward so that the jaw is jutting forward, as though he has an underbite.
Placing the heel of your hand on the person’s breastbone directly between his nipples Placing the heel of your opposite hand over the top of the first Positioning your body mass directly over your positioned hands Compressing hard and fast downward approximately two inches into his chest Allowing his chest to rise completely Repeating to a count of thirty At this point, add in the two rescue breaths if you are trained in CPR. If you are not, continue with compressions and ignore the breaths as they are much less important.
