From the Guidelines
If you find a comatose man on the street, immediately call emergency services and check if the person is breathing and has a pulse, then provide rescue breathing if necessary, as per the 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1. When checking the person, look for signs of breathing and a pulse, and if they are not breathing, provide rescue breathing, 1 breath every 6 seconds or 10 breaths per minute, as recommended in the guidelines 1.
- Check pulse every 2 minutes; if no pulse, start CPR, following the same guidelines 1.
- If it is a possible opioid overdose, administer naloxone if available per protocol, as suggested in the guidelines 1. Some key points to consider when dealing with a comatose person include:
- Placing the person in the recovery position (on their side with the head tilted back) if they're breathing but unresponsive, to help keep their airway open and prevent choking if they vomit.
- Not giving any food, drink, or medication to an unconscious person.
- Trying to protect them from environmental hazards like traffic or extreme temperatures.
- Looking for medical identification jewelry or cards that might indicate conditions like diabetes or epilepsy. It is crucial to remember that coma can result from various causes, including head injury, stroke, drug overdose, diabetic emergency, or infection, and prompt medical attention is crucial as these conditions can rapidly become life-threatening without proper treatment, which is why following the guidelines and seeking emergency help is essential 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Immediate Response
If you find a comatose man on the street, it is essential to act quickly and follow the proper steps to ensure his safety and potential recovery. Here are some actions you can take:
- Call emergency services immediately to report the situation and request assistance.
- Check the person's airway, breathing, and circulation (ABCs) to ensure they are stable.
- If the person is not breathing normally or has no pulse, begin cardiopulmonary resuscitation (CPR) if you are trained to do so 2.
- If you suspect an opioid overdose, consider administering naloxone if available and you are trained to use it 2.
Assessment and Diagnosis
It is crucial to identify the underlying cause of the coma to provide appropriate treatment. The differential diagnosis for a comatose patient includes:
- Structural abnormalities
- Seizures
- Encephalitis
- Metabolic derangements
- Toxicologic etiologies 3 A thorough physical examination, medical history, and diagnostic testing are necessary to determine the cause of the coma.
Opioid-Related Coma
If the coma is suspected to be related to opioid use, it is essential to understand the pathophysiology of opioid-associated out-of-hospital cardiac arrest. Opioid overdose can lead to respiratory depression, cardiac arrest, and even death 2. Effective ventilation and administration of naloxone can help prevent cardiac arrest and improve outcomes.
General Management
The management of a comatose patient involves:
- Establishing the cause of the coma and attempting to reverse or attenuate the damage
- Supporting the patient's vital signs and preventing medical complications associated with mechanical ventilation and prolonged immobility 4, 5
- Providing ongoing supportive care and considering neurorehabilitation options, although the effectiveness of these options is still underdeveloped 4.