What is the immediate management for an unconscious patient following an accident?

Immediate Management of an Unconscious Accident Patient

For an unconscious patient following an accident, immediately ensure scene safety, check responsiveness, activate emergency services, open the airway with head tilt-chin lift (with C-spine protection if trauma suspected), assess breathing and pulse simultaneously for no more than 10 seconds, and initiate appropriate resuscitation based on findings—CPR if pulseless, rescue breathing if pulse present but not breathing, or recovery position if breathing spontaneously. 1

Scene Safety and Initial Assessment

• Ensure scene safety first before approaching the patient—assess for ongoing traffic hazards, falling debris, toxic fumes, fire risk, or other dangers that could harm you or the patient 1
• Check responsiveness by gently shaking the patient's shoulders and shouting "Are you all right?" 1
• Immediately shout for nearby help and activate emergency services (or send someone to do so) 1

Airway Management with Trauma Precautions

• Open the airway using head tilt-chin lift maneuver: place one hand on the forehead tilting the head back while lifting the chin with fingers of the other hand 1, 2
• In trauma patients, maintain C-spine protection while opening the airway—the American College of Surgeons emphasizes airway management with simultaneous cervical spine stabilization as the immediate priority 3
• Remove any visible obstruction from the mouth including dislodged dentures, but leave well-fitting dentures in place 1

Breathing and Pulse Assessment

• Simultaneously assess breathing and pulse for no more than 10 seconds 1
• Look for chest movements, listen at the mouth for breath sounds, and feel for air with your cheek 1, 2
• Check the carotid pulse while assessing breathing—take no more than 10 seconds total for this assessment 1
• Recognize agonal breathing (slow, irregular gasping) as a sign of cardiac arrest, not adequate breathing 1

Management Based on Assessment Findings

If Breathing Normally with Pulse Present:

• Place the patient in the recovery position (lateral recumbent) to prevent tongue obstruction and reduce aspiration risk 1, 2
• Position with the arm nearest you at right angle, far knee flexed, ensuring the airway remains open 1
• Monitor continuously until emergency responders arrive, checking breathing and responsiveness frequently 1

If Pulse Present but Not Breathing (or Only Gasping):

• Provide rescue breathing at 10 breaths per minute (one breath every 6 seconds) 1, 2
• Each breath should take approximately 1.5-2 seconds and achieve visible chest rise of 400-600 ml (adults) 1, 2
• Pinch the nose closed, maintain head tilt-chin lift, and create a good seal with your mouth over the patient's mouth 1, 2
• Recheck pulse every 2 minutes while continuing ventilation 1, 2
• If pulse becomes absent, immediately begin CPR 1, 2

If No Pulse and Not Breathing (Cardiac Arrest):

• Begin high-quality CPR immediately with chest compressions first (C-A-B sequence) 1, 3
• Compression technique: locate the lower half of the sternum, place heel of one hand with the other on top, interlock fingers 1
• Push hard and fast: at least 5 cm depth (4-5 cm per older guidelines), rate of 100-120 compressions per minute 1
• Allow complete chest recoil between compressions and minimize interruptions 1
• Deliver compressions and breaths in 30:2 ratio (30 compressions followed by 2 rescue breaths) 1
• Apply AED as soon as available and follow prompts for rhythm analysis and defibrillation 1, 3

Advanced Interventions (When Available)

• Establish IV/IO access for medication administration 4, 3
• Administer epinephrine 1 mg IV/IO every 3-5 minutes for cardiac arrest 4, 3, 2
• Secure advanced airway with endotracheal intubation or supraglottic device, confirmed with waveform capnography 4, 3
• Once advanced airway placed, provide 10 breaths per minute with continuous compressions (no pausing for breaths) 4, 3

Critical Pitfalls to Avoid

• Do not delay CPR to obtain history or assess for injuries—resuscitation takes absolute priority 2
• Do not check pulse for more than 10 seconds—healthcare providers often take too long, delaying CPR 1
• Do not assume adequate breathing if only gasping is present—this is agonal breathing indicating cardiac arrest 1
• Avoid excessive ventilation which increases intrathoracic pressure and decreases cardiac output 4, 2
• Do not apply chest compressions over the ribs or upper abdomen—position hands correctly on the lower half of the sternum 1

Post-Resuscitation Stabilization

• Maintain oxygen saturation 94-98% to avoid both hypoxemia and hyperoxemia 4
• Monitor blood pressure continuously and administer vasopressors as needed to maintain adequate perfusion 4
• Obtain 12-lead ECG to identify cardiac causes, particularly ST-elevation myocardial infarction 4
• Systematically evaluate reversible causes (H's and T's): hypovolemia, hypoxia, hydrogen ion (acidosis), hypo/hyperkalemia, hypothermia, tension pneumothorax, tamponade, toxins, thrombosis (pulmonary and coronary) 4, 3