An unresponsive patient demands an immediate, standardized, and rapid response. The state of unresponsiveness, where a person cannot be roused and does not respond to external stimuli, indicates a severe and potentially life-threatening disruption of normal brain function. In these situations, the difference between a successful outcome and long-term disability or death can be measured in mere minutes. A structured, protocol-driven approach is necessary to ensure that the most immediate threats to life are identified and addressed without delay.
Scene Safety and Emergency Activation
Before approaching the patient, the rescuer must first ensure that the environment is safe to enter. Potential hazards like spills, electrical sources, or unstable structures must be identified and neutralized to prevent the rescuer from becoming a second victim.
As soon as the patient’s unresponsiveness is confirmed, the facility’s emergency response system, often a “Code Blue” or Rapid Response Team, must be activated immediately. This action brings trained personnel and specialized equipment to the bedside, transitioning the response from a single rescuer to a coordinated team effort. If cardiopulmonary resuscitation (CPR) is anticipated, the patient must be placed supine on a firm, flat surface to allow for effective chest compressions.
The Primary Survey: Airway, Breathing, and Circulation
The immediate clinical focus shifts to the primary survey, which is a rapid check for life-threatening conditions. The first step involves checking for responsiveness by gently tapping the patient and shouting a verbal stimulus, such as “Are you okay?”. If there is no response, the rescuer simultaneously checks for a carotid pulse and normal breathing for no more than 10 seconds.
If no pulse is detected or the patient is not breathing normally (e.g., only agonal gasps are present), high-quality chest compressions must be initiated immediately. Compressions should be performed quickly and forcefully at a rate of 100 to 120 compressions per minute and to a depth of at least two inches (five centimeters) in adults. The airway is then opened using a head-tilt/chin-lift maneuver, or a jaw thrust if a cervical spine injury is suspected, to allow for rescue breaths.
The application of an Automated External Defibrillator (AED) is also a simultaneous priority. Once the AED is attached, it will analyze the heart rhythm and advise whether a shock is needed. Continuous, uninterrupted cycles of compressions and ventilations are maintained until the emergency response team arrives or the patient shows signs of recovery.
Focused Secondary Assessment and Stabilizing Measures
Once basic life support is underway and the patient is stabilized with circulation and ventilation secured, the secondary assessment begins, focusing on identifying the cause of the unresponsiveness. The initial steps involve obtaining a rapid set of vital signs, including heart rate, blood pressure, respiratory rate, and pulse oximetry (SpO2). If available, end-tidal carbon dioxide (ETCO2) monitoring provides valuable real-time feedback on the effectiveness of CPR and ventilation.
A point-of-care glucose check is considered mandatory for all unresponsive patients, as severe hypoglycemia (low blood sugar) is a quickly reversible, yet potentially devastating, cause of altered mental status. If the glucose level is critically low, a rapid infusion of concentrated dextrose (D50) is warranted. Simultaneously, healthcare providers work to establish intravenous (IV) access to administer fluids and medications.
A rapid neurological assessment, using tools like the Glasgow Coma Scale (GCS) and checking for pupillary response, helps to characterize the degree of brain injury. Information regarding the patient’s history, such as medications, allergies, and the events leading up to the unresponsiveness (often using the SAMPLE or AMPLE mnemonics), is gathered from family or bystanders. Targeted treatments, such as administering Naloxone if an opioid overdose is suspected, are initiated based on the assessment findings to address common reversible causes of unresponsiveness.