A fully conscious person is awake, alert and aware of
their surroundings. Whereas sleep is a normal state of lowered consciousness,
unconsciousness is an abnormal state that disables the body's reflexes.
The
Nervous System
Unconsciousness
Head Injuries
Head Injuries:
Concussion
Head Injuries:
Skull Fracture
Epilepsy
Stroke
Other Disorders
Hypoglycemia
Drunkeness
Substance
Abuse
Very little is known about the nervous system except that it can respond to certain stimuli. It is comprised of a brain, which is cushioned by a watery fluid called cerebrospinal fluid, and various nerves, the largest of which is the spinal nerve.
This is an abnormal state and whatever the cause there are certain guidelines to follow. First it is imperative to ensure the patient's airway is open, particularly if they are lying face up. The tongue may drop back in these circumstances and block the airway. There is also no cough reflex to clear saliva from the throat and the stomach contents may be regurgitated and inhaled. Check and re-check the level of response in an unconscious patient. There are many degrees and by noting them, it is possible to determine if the patient is improving or deteriorating.
Make a rapid initial assessment by following the 'AVPU'
aide-memoir:
A Alert
V Responds to Voice
P Responds to Pain
U Unresponsive
Impaired consciousness can mask other injuries so be thorough in your diagnosis. Open their airway by lifting the chin and tilting the head. Then you check their breathing and pulse rates before finally, checking and recording the level of the response. Examine the casualty quickly for signs of other injuries and treat, or support, as necessary. If there is no spinal injury you can move the casualty into the recovery position. Repeat the checks on the level of response every ten minutes using the checklist in the following section as a guideline.
- Eyes:
Do they open spontaneously?
Do they open on command?
Do they open to a painful stimulus?
Do they remain closed?
- Speech:
Does the casualty respond sensibly to questions?
Does the casualty appear confused?
Does the casualty make incomprehensible sounds?
Does the casualty make no response?
- Movement:
Does the casualty obey commands?
Does the casualty move in response to painful stimuli?
Does the casualty make no response?
All injuries are potentially dangerous and some may cause
impaired consciousness. Examine the patient thoroughly to effectively
diagnose the condition.
The brain is free to move a little within the skull and a violent blow may 'shake' it. This may cause concussion, which is a widespread but usually temporary disturbance of the brain. The period of unconsciousness is always brief and is always followed by complete recovery. Thus, concussion can only be safely diagnosed once the patient has fully recovered. Dizziness and nausea may accompany recovery after the brief lack of consciousness. A mild, generalized headache and amnesia may also result. Watch carefully and get the patient to bed for a day or so.
A fracture of the skull is a serious condition, which may be fatal and can be associated with subsequent brain damage. Suspect a fracture when the casualty is unconscious for more than three minutes and examination yields a soft boggy area, or depression, on the scalp. Rest is the only treatment available, with some of the fractures healing with little or no damage to the underlying brain. However, a condition known as cerebral compression may also result. There is no aid available for this condition.
Convulsions, or fits, are simultaneous involuntary contractions of many of the body's muscles, which can be accompanied by a lack of consciousness. Minor and major epileptic fits can be observed. Minor fits might be exhibited by no more than a 'switching off' with the casualty staring straight ahead, a slight twitching of the lips, eyelids, or head, or strange 'automatic' movements, such as lip-smacking, chewing, making odd noises, or fiddling with clothing. In these circumstances help the patient to a seat and remove possible sources of harm, for example hot drinks. Talk to calm and reassure them and stay with them until you are sure there are themselves once more. Sometimes a major fit follows a minor one, so close observation is necessary.
In major epileptic fits, the patient will suddenly fall unconscious, often letting out a cry as they do so. They will become rigid, arching their backs (tonic phase) and breathing may cease. Cyanosis and congestion of the face may be present. Next the patient may make convulsive movements, this is known as the clonic phase. Here the jaw may clench, breathing may become noisy and saliva may appear at the mouth, sometimes being bloodstained if the lips, or tongue, have been bitten. There may also be loss of bowel and bladder control. Gradually the muscles relax, and breathing returns to its normal pattern. The casualty will regain consciousness but may feel dazed. A fit may also be followed by a deep sleep. If you observe the fall, you should try to support, or ease them to the floor. Make space around them, loosen clothing and if possible protect their head with soft padding. When the convulsions cease put them into the recovery position and stay with them until they are completely recovered. Be careful not to use cinnamon, sage, fennel or hyssop on epileptic patients.
Strokes are common in the elderly and in those who suffer from high blood pressure, or other circulatory disorders. The effect depends on the severity of the stroke, with many being fatal. Symptoms include a sudden, severe headache and a confused, emotional mental state, that could almost be mistaken for drunkenness. Sudden, or progressive, loss of consciousness may follow, as may signs of weakness or paralysis, possibly confined to one side of the body, though not always. Drooping, dribbling from the mouth, slurred or impaired speech and loss of power and movement of limbs are the most recognizable symptoms. Pupils may also be unequal and there may be loss of bladder, or bowel, control. You should lie the casualty down, with head and shoulders slightly raised and supported. Incline their head to one side and place a towel to absorb any dribbling. If the casualty becomes unconsciousness attempt resuscitation.
The nervous system is vulnerable to disorder and damage, not only by physical injury and disruptive conditions, but by the composition of the blood.
This is a condition when the sugar level in the blood drops below normal. It can be a condition (diabetes) or can result after heavy binge drinking, heat exhaustion and hypothermia, or accompany an epileptic fit. The signs include weakness, faintness, hunger, palpitations and muscle tremors, sweating and shallow breathing. The patient many also exhibit strange actions or behavior, they may be confused, belligerent or even violent. Pale, cold clammy skin with a strong bounding pulse and a deteriorating response are not uncommon. If the casualty is already unconscious then open the airway and check breathing and pulse rates. Turn them into the recovery position, or resuscitate if necessary. For a conscious casualty help them to sit or lie down and give them a sugary drink or sweet food. If they improve quickly give more sweet food, or drinks, and let them rest until they feel fully recovered.
The unconscious drunkard is at danger from a blocked
airway, especially if they are lying face up, or have vomited. There may
also be head or neck injuries as a result of a fall. Check the airway
and remove any obstruction. Maintain this airway and treat other injuries
before placing into the recovery position and letting them sleep it off.
There are a variety of narcotic drugs on Pern, the most common of which is fellis. Some narcotics can cause unconsciousness and severely impair breathing. Little treatment is available. Maintain an open airway, placing them into the recovery position and monitor carefully, resuscitating if necessary. Counseling should be given after such abuse.
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Last updated April 2001
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