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●First Aid in unconscious patient●Head injury●Spine column and spine injury●Positioning and transport

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Consciousness

● consciousness, spontaneus breathing, blood circulation are basic life signs● Wikipedia:

Consciousness is THE QUALITY or STATE of AWARNESS, or, of being aware of an EXTERNAL OBJECT or something WITHIN ONSELF.

- the most common causes of consciousness are alcohol, epilepsy,

cerebrocranial trauma, hypoglycemia, aneurism and poisoning

● dimensions/function/characteristics of consciousnes are: Vigilance (person is

vigilant – wakeful), Lucidity (Clouding), Idiogenesis● Vigilance – impairment of vigilance are at most characteristic for quantitative (strength) impairment of

consciousnes● Lucidity – impairrment of lucidity is characteristic sign for qualitative disorders (from a perspective of

reality)

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Causes of Unconsciousness

● Primary (Cerebral, brain damge is primary)

- traumatic: concussion, contussion, compression, loss of tissue, intracerebral

bleeding etc.

- nontraumatic: cerebrovascular accidents – CVA, stroke; inflammations, seizures;

expansive processes – such as tumors

● Secundary (Extracerebral, brain damage is secondary) decreased supplementation by oxygen

- decreased blood supply: chocking, heart attack, bleeding, shock -

- decreased of amount of oxygen in blood: impairment of respiratory

systém, drowning

- toxicity: endogenous factors – diabetic hyper- or hypoglycemia; failure of liver,

kidneys, any of endocrine glands

exogenous factors – ethanol, drugs, narcotics, carbon monoxide, heavy

metals

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Quantitative disorders

- person is vigilant if she/he is awake and alert

- level of diminution of consciousness is changed in quantitative disorders

Somnolentia – waking induced by regular stimulationSoporous – rousable only by a strong (usually painful) stimulation, does not achieve complete consciousness, soon a return to sleep Coma – unrousable

● GCS (Glasgow Coma Scale)

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Interpretation of GCS

Light: GCS = 13 to 15Medium: GCS = 9 to 12Severe: GCS = <9GCS is to be noted at first contact with the patient, further assessment is usually not possible due to analgosedatives + relaxation of the patient

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Qualitative disorders

- Lucid person is characterized by clear perception (clarity of thought) or understanding of itself, place and time she/he is in

- impairment of orientation if place, time, itself (idiogenesis)

Obnubilation – swooning (the affected is not conscious of their

activity, amnesia)Delirium – impairment of perception, hallucinationsAmentia - disorientationAmnesia – loss of memoryStupor – rigidity and stiffness

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Unconsciousness

● Impairment of consciousness can be accompanied by muscle relaxation (obstruction of airways), loss of basic reflexes (aspiration of regurgitation) impairment of other basic life signs

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Unsconsciousness – First Aid

● Be aware of puttin in danger yourself or the victim, if possible eliminate any further damage to the vicitim

● Do not move vicitm if not necessary● Do not abandon the patient, continuously

monitor vital functions● Thermal comfort● Do not serve anything per oral pathway

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Head trauma

● General consideration of wounds and their causes

● Brain is enclosed in cranium which can't, in adults, increase its volume – trauma direct or indirect leads to damage of tissue what is accompained by edema – load of volume in closed space determines THE PRESSURE

- excesive pressure leads to further damage

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Signs of brain damage

● Confusion, strange behaviour, loss of memory● Unusual breathing pattern● Blood or watery substance leakage from ears, nose● Weak, sensations in arms, legs● Visual sensations, visual problems● Nausea, vomitting, worsening headache● Increasing drowsiness

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Few types of brain injury

Concussion = brain shakeConcussion = brain shake

- temporal disturbance of brain activity- temporal disturbance of brain activity

No structural damage. Signs – temporal confusion, loss of memory, vomitting,

dizziness. Full recovery.

- First Aid >> consider spine injury, check for vital signs, call

Ambulance

ContussionContussion

- Brain tissue damage at the site of trauma (coup) + the opposite site (contrecoup)- Brain tissue damage at the site of trauma (coup) + the opposite site (contrecoup)

Structural damage. Signs - impaired consciousness, abnormal breathing pattern,

different pupil size (anisocory).

- First Aid >> consider spine injury, check for vital signs, call Ambulance

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Spine trauma

● Damage to spinal cord

causes loss of muscle

strength and

sesnsation below

the injured area

If unconscious – behave as spinal injury is present

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Spine trauma

● Spine trauma - can be both isolated and also as a part of polytraumas

● Common combinations – cerebrocranial and spinal trauma

● Seriousness – mainly due to the possibility of damage to the spinal chord, which passes through the spinal column and ensuing irreversible neurological damage

Most vulnerable to damage is the area of thorax (stabilization by ribcage) - automotive accidents (neck vertebrae), falls (thoracic vertebrae)

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Often causes of spine injuries

● Falling from a height● Diving into shallow pool● Falling from horse, motorbike● Sudden deceleration● Unusual movement

➔ fragments of fractured vertebra cut or compress spinal cord

➔ intervertebral disc displacement – damage to cord by pressure

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Spine injury – First Aid

● No manipulation if not needed, wait for and prefere professional transport using vacuum mat

● If manipulation with the patient is necessary, ensure a sufficient number of aiders, for safe manipulation with an adult five rescuers are needed

● If the victim is still in

danger, take care of it

to safe her/his life

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Instruments

The Philadelphia collar is a solid neck collar/brace made from firm plastic bi-valved shell, which keeps the head in a neutral position during transport

Schanz brace – a soft padding, it stabilizes and supports the spinal column, an improvised device

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Positioning and transportation

1.check and secure vital functions 2. take care of any further danger 3. choose the right position for - first aid - transport

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Positions

● Positioning sitting up, or semi-reclined with raised knees

Used in patients with abdominal injuries, with a raised thorax, supported head and the knees bent at 90 degrees (relaxation of abdominal muscles). Can be used with placement on the back with raised knees

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Positions

Fowlers’ positionThere are several types of Fowlers positions: low, semi-, and high Fowler's. High Fowler's position is when the patient's head is raised 80-90 degrees, whereas Low Fowler's position is when the patient's head is elevated 15-45 degrees.

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Autotransfuse positionThe aim of the antishock position is to use gravity to return the blood from the periphery to the heart and increase blood perfusion of vitally important organs (heart, brain). The full antishock position entails the elevation of all four limbs. In practice only the elevation of lower limbs is used, because the amount of blood in the upper limbs is low and they cannot be fixed.

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Positions

In the Trendelenburg position the body is laid flat on the back (supine position) with the feet higher than the head. For first aid it can be used as an alternative to the anti-shock position, especially if the patient is on a stretcher. The trendelenburg position can also be combined with the recovery position

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Transport

Transport using a chair can be used with patients that are conscious. After ensuring the chair is solid enough, remove any additional components. Fix the patient using wide bands of cloth across the thighs and chest to the chair. One rescuer holds the backrest, the other one takes the front chair legs, keeping the chair tilted. If possible the patient should be transported facing forwards.

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Transport using a stretcher. There are many types of strechers. Patient transport on these should be carried out with the patient on his back or in a stabilized position

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Getting out of vehicle

Rautek maneuver

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References

● Presentation form MUDr. Bures● Book: První Pomoc, Jan Lejsek, Petr Ruzicka, Jan

Bures; 2010● SIMS' Symptoms in the Mind Textbook of

Descriptive Psychopathology, Fifth Edition, Saunders

● Mentalni postizeni v pedagogickem, psychologickem a socialne-pravnim kontextu, Milan Valenta, Jan Michalik, Martin Lecbzch a kolektiv, 2012

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