First aid - managing loss of consciousness

Managing a person who is suffering a loss of consciousness requires the nurse to have some understanding of its potential causes as well as being able to assess the level of the loss and the duration. Whether in the care setting or the community, the nurse will need to respond quickly and in a measured way in order to protect the patient, always acting within the limits of their own knowledge and competence (Nursing and Midwifery Council, 2018).

Level of loss of consciousness

In the first aid scenario, the assessment of a person’s level of loss of consciousness is quickly undertaken using the AVPU scale:

• Alert: fully awake but not necessarily orientated
• Voice: responds to the human voice, although may not be a full response, e.g. may open their eyes or moan when asked “how are you?”
• Pain: will withdraw or flex or extend a limb when painful stimulus applied
• Unresponsive (Carvalho et al, 2021)

This identifies, as does the Glasgow Coma Scale, that loss of consciousness may not necessarily be total.

Causes of loss of consciousness

The nurse should assess the potential cause of loss of consciousness rapidly as there are some causes which are quickly reversible and others, such as a simple faint, which are managed in a different way.

One commonly seen mnemonic is helpful in listing the more common causes of loss of consciousness.

Managing loss of consciousness

Management of loss of consciousness is dependent on the level of loss of consciousness the person is suffering, although the management of all levels of loss of consciousness is about managing the patient’s safety.

On discovering someone who has collapsed and is unresponsive, the nurse should undertake a primary survey (see: first aid - assessing a casualty) to exclude, for example, the need for cardiopulmonary resuscitation (see: first aid - CPR) or the management of bleeding (see: first aid - managing bleeding) (St John Ambulance, 2021b). If the patient is unresponsive and breathing, then they should place the patient in the recovery position (Resuscitation Council UK, 2021).

The Resuscitation Council UK (2021) recommend the following actions:

• kneel beside the patient and ensure both legs are straight
• place the nearest arm at right angles to the body with the hand palm facing upwards
• bring the

References

Carvalho F, Breen E-C, Bullock Z et al. Observations. In: Lister S, Hofland J, Grafton H and Wilson C (eds.). The Royal Marsden Manual of Clinical Nursing Procedures (10^th edn).  Chichester: Wiley Blackwell; 2021 pp. 719-800.

First Response. Unconsciousness. 2021. https://www.firstresponse.org.uk/first-aid-az/3-general/first-aid/113-unconsciousness  (accessed 16 May 2022).

Morgan S. Emergency Care. In: Delves-Yates (ed.) Essentials of Nursing Practice. (3^rd edn). Sage; 2022 pp. 509-530.

National Institute for Health and Care Excellence. Blackouts. 2021. https://cks.nice.org.uk/topics/blackouts/ (accessed 16 May 2022).

National Institute for Health and Care Excellence. Transient loss of consciousness ('blackouts') in over 16s: Clinical guideline [CG109]. 2014.  https://www.nice.org.uk/guidance/cg109 (accessed 16 May 2022).

Nursing and Midwifery Council.  Future nurse: Standards of proficiency for registered nurse. 2018.  https://www.nmc.org.uk/globalassets/sitedocuments/education-standards/future-nurse-proficiencies.pdf (accessed 16 May 2022).

Resuscitation Council. Adult basic life support Guidelines. 2021.  https://www.resus.org.uk/library/2021-resuscitation-guidelines/adult-basic-life-support-guidelines (accessed 16 May 2022).

Singletary EM, Zideman DA, De Buck EDJ et al. 2015 International Consensus on First Aid Science With Treatment Recommendations. Circulation. 2015; 132(16):S269-311.