Manitoba Health EMERGENCY TREATMENT GUIDELINES

GENERAL

G9 UNCONSCIOUS PATIENT

The unconscious patient presents EMS personnel with numerous serious challenges in patient management.
Unconscious patients should receive a rapid assessment to identify immediate life threating conditions.

GENERAL

• personal protective equipment should be utilized as appropriate

• body substance isolation techniques and equipment should be utilized as appropriate

• identify the mechanism(s) of injury if possible

• primary survey
• scene assessment
• may provide information on the mechanism of injury or precipitating factors for the patient's medical
condition
• consider cervical spinal precautions, if indicated
• assess of the patient’s level of consciousness
• establish and maintain an airway, if indicated
• consider the use of airway adjuncts if indicated
• suction, if indicated
• determine the presence of spontaneous respirations and pulse
• be prepared to support respiratory and circulatory functions, if indicated
• assess for sources of external bleeding
• manage any life threatening conditions when identified

• maintenance of an open airway and ensuring adequate respirations has priority over all other treatments,
including control of the cervical spine
• assist ventilations using a bag-valve mask, if indicated

• at all times be prepared for the patient to vomit or regurgitate

• consider load and go criteria

• secondary survey
• perform if circumstances and patient condition permit
• obtain vital signs
• assess the patient's neurological status using the Glasgow Coma Scale
• obtain a reliable bystander history, if available
• look for patient identification, assist in determining the cause of the patient's altered level of consciousness
• Medic-Alert bracelet, neck pendant, or wallet card
• rule out hypoglycemia by obtaining a blood glucose reading (see Diabetic Emergencies Guidelines)
• treat, as indicated

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Manitoba Health EMERGENCY TREATMENT GUIDELINES
GENERAL

• continue to reassess patient status

• load and go if required
• record any events that interfere with completing secondary survey
• maintain high concentration oxygen delivery to the patient
• assist ventilations if required
• reassess vital signs at regular intervals (5-15 min.) or when there is a change in the patient’s status

• initiate transport
• on scene times should be kept to a minimum
• treat other conditions en route
• transport the patient to the nearest appropriate health care facility
• transport the patient in a side lying position, injuries and life threatening conditions permitting
• notify the receiving health care facility of the patient's status as soon as possible
• monitor and treat the patient en route
• report all findings to the receiving facility staff, and document on the patient care report

NOTE
• assume the patient has a spinal cord injury if unconsciousness due to trauma or unknown etiology (see Central
Nervous System Injuries Guideline)

• prepare to handle respiratory and cardiac arrest

• keep suction available at all times

• never assume a syncopal episode is “just a fainting spell”

• assess the patient thoroughly

• prepare to handle a combative, disoriented patient

• particularly when patient’s level of consciousness is increasing

• prepare to manage seizures

• talk to the patient, even if apparently unconscious

• hearing is the last sense to be lost

• find and transport all medications with the patient

• a list of medications that includes dosages is equally useful if medications cannot be located

• EMS personnel trained and certified in the management of hypoglycemia may do so, as outlined in the
Hypoglycemia Treatment Protocol

• EMS personnel trained and certified in the management of suspected opioid overdose may do so, as outlined
in the Management of Suspected Opioid Overdose with Naloxone Protocol

• do not administer anything by mouth unless otherwise indicated

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Manitoba Health EMERGENCY TREATMENT GUIDELINES
GENERAL

Syncope
• syncope may be due to many conditions, some of which are life-threatening
• cardiac ischemia or arrhythmia
• vascular disease
• hemorrhage or hypovolemia
• nervous system abnormality
• hypoglycemia or other metabolic abnormality
• psychogenic
• syncopal patients are initially unconscious but often regain consciousness prior to EMS arrival
• obtain as thorough a history as possible of the precipitating circumstances
• position the patient supine
• if the patient is hypotensive elevate lower limbs, unless injuries prevent this
• look for the underlying cause of the episode of syncope and treat as appropriate
• reassure the patient
• maintain the patient in the recovery position for transport if syncope persists
• do not allow the patient to exert him/herself - e.g. walking, standing unassisted to transfer to the stretcher,
etc.
• maintain high concentration oxygen delivery to the patient
• assist ventilations if required
• initiate transport
• on scene times should be kept to a minimum
• transport the patient to the nearest appropriate health care facility
• notify the receiving health care facility of the patient's status as soon as possible
• monitor and treat the patient en route
• additional surveys and treatments should be conducted en route
• report all findings to the receiving facility staff, and document on the patient care report

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Manitoba Health EMERGENCY TREATMENT GUIDELINES
GENERAL

NOTES :

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