A temporary loss of consciousness, or being “knocked out,” is a medical manifestation of a traumatic brain injury (TBI) or concussion. This state occurs when a sudden, forceful blow or jolt to the head causes the brain to move rapidly within the skull, disrupting normal brain function. Consciousness is lost when the force temporarily affects the brainstem, which regulates wakefulness, or when both cerebral hemispheres are simultaneously disrupted. Any period of unconsciousness, no matter how brief, indicates a serious alteration in brain status and must be treated as an immediate medical emergency.
Immediate Assessment and Calling for Help
The very first action upon discovering an unconscious person is to prioritize scene safety, ensuring the environment is free from hazards like traffic or unstable objects that could put the responder at risk. After confirming safety, the immediate next step is to check for responsiveness by speaking loudly to the person and gently tapping their shoulder or applying a firm rub to the sternum. If there is no reaction, they are considered unresponsive, and emergency medical services must be contacted immediately.
Once a lack of response is established, an assessment of the person’s airway, breathing, and circulation (ABCs) is necessary to determine the urgency of the situation. Check for signs of breathing for no more than ten seconds by looking for chest movement. The most important information to convey to the emergency dispatcher is that the person is unconscious and unresponsive, along with the precise location and the nature of the event that led to the injury.
Stabilizing the Patient Until Help Arrives
After the emergency call is placed, the focus shifts to maintaining the patient’s physical stability, with the highest priority being a clear airway. An unconscious person is at risk of airway obstruction, often because the tongue relaxes and falls back or due to aspiration of vomit. If the person is breathing, the primary goal is to maintain an open airway while simultaneously taking spinal precautions.
It is safest to assume a spinal injury has occurred, especially if the unconsciousness resulted from a fall, car crash, or sports injury. The patient should not be moved unless they are in immediate danger or if cardiopulmonary resuscitation (CPR) is necessary. If the patient is breathing and their airway is compromised by fluids, they must be gently rolled into the recovery position. This position uses gravity to keep the airway clear, allowing any blood or vomit to drain from the mouth.
Recovery Position Steps
To place an unconscious, breathing person into the recovery position:
- Kneel beside them and position the arm closest to you at a right angle with the palm up.
- Bring the arm farthest from you across the chest, holding the back of their hand against the cheek closest to you to support the head during the roll.
- Bend the far leg at the knee so the foot is flat on the ground.
- Use this bent knee and the arm across the chest to gently roll the person onto their side toward you.
- Once positioned, adjust the head slightly to ensure the chin is lifted and the airway remains open, then continue to monitor their breathing and level of consciousness until medical help arrives.
Recognizing Severe Head Injury Symptoms
The state of being “knocked out” is clinically defined as a traumatic brain injury (TBI). The unconsciousness itself is a sign of a significant functional disruption to the brain’s electrical activity. Certain “red flag” symptoms can signal a life-threatening complication, such as swelling or bleeding inside the skull, known as an intracranial hemorrhage.
The presence of specific signs requires immediate medical intervention, even if the person has regained consciousness. These severe warning signs include pupils that are unequal in size or do not react normally to light, the onset of seizures or convulsions, and any clear fluid or persistent bleeding from the ears or nose. A severe, worsening headache or repeated episodes of vomiting are also indicators of rising pressure within the skull.
Any alteration in mental status after waking up, such as increasing drowsiness, confusion, slurred speech, or the inability to recognize familiar people or places, suggests a worsening injury. Even if the person seems to recover quickly, a brief loss of consciousness warrants a thorough medical evaluation, as symptoms from internal bleeding can sometimes be delayed.