What is the step‑by‑step approach to managing an unconscious patient in an emergency?

Emergency Management of an Unconscious Person

Immediately ensure scene safety, check responsiveness by shaking and shouting, then follow the systematic ABCDE approach prioritizing airway patency and breathing assessment within 10 seconds to determine if CPR is needed. 1

Initial Scene Safety and Response Assessment

• Before approaching, rapidly assess environmental hazards including traffic, falling debris, toxic fumes, gas, or chemical exposure—never place yourself at greater risk than the victim 1
• Check responsiveness by shaking the victim's shoulders and shouting loudly 1
• If unresponsive, immediately call for help or activate emergency medical services 1
• Position the victim on their back on a firm, flat surface if not already in this position 1

A - Airway Management

Open the airway immediately using the head-tilt-chin-lift maneuver: 1, 2

• Place one hand on the victim's forehead and gently tilt the head backward 1, 2
• Place two fingertips under the bony part of the chin (not soft tissue) and lift upward 1
• Remove any visible obstructions from the mouth including dislodged dentures, but leave well-fitting dentures in place 1

Critical pitfall: In suspected spinal injury, use jaw-thrust without head tilt, though airway patency takes priority over potential spinal injury in life-threatening situations 3

B - Breathing Assessment

Assess breathing for NO MORE than 10 seconds using the look-listen-feel technique: 1, 2

• Look for chest movements and rise 1
• Listen at the victim's mouth for breath sounds 1
• Feel for air movement against your cheek 1

Critical pitfall: Do not mistake agonal gasps (occasional weak gasps) for normal breathing—these indicate cardiac arrest and require immediate CPR 2, 3

If Breathing is ABSENT or Only Agonal Gasps Present:

Give 2 effective rescue breaths immediately: 1

• Maintain head tilt and chin lift 1
• Pinch the soft part of the nose closed with thumb and index finger 1
• Take a breath, seal your lips around the victim's mouth 1
• Blow steadily for 1.5-2 seconds, watching for chest rise (400-600 ml in adults) 1
• Allow chest to fall completely between breaths 1
• If unsuccessful after 2 attempts, recheck mouth for obstruction and head position, making up to 5 attempts total to achieve 2 effective breaths 1
• Even if unsuccessful, proceed immediately to circulation assessment 1

If Breathing is Present and Normal:

• Place victim in recovery position (see below) 1, 2
• Monitor breathing continuously and be prepared to reposition if breathing deteriorates 2

C - Circulation Assessment

Check for signs of circulation for NO MORE than 10 seconds: 1

• Look for any movement, swallowing, or normal breathing 1
• Check the carotid pulse (though pulse assessment alone is unreliable—if uncertain, assume cardiac arrest) 1

If Circulation is PRESENT but Breathing is ABSENT:

Provide rescue breathing at 10 breaths per minute (one breath every 6 seconds): 1, 2

• Each breath should take approximately 2 seconds and achieve visible chest rise of 800-1200 ml 1, 2
• Maintain continuous head tilt-chin lift throughout 1
• Reassess pulse every 2 minutes (or about every 10 breaths) 1
• Avoid excessive ventilation which increases intrathoracic pressure and impairs venous return 2

If Circulation is ABSENT or Uncertain:

Begin high-quality CPR immediately—do not delay: 1, 2, 4

Chest Compression Technique: 1

• Locate the lower half of the sternum: slide fingers up the rib margin to where ribs join sternum, place middle finger at this point with index finger on sternum 1
• Place heel of other hand on sternum at the index finger position (middle of lower half of sternum) 1
• Place first hand on top, interlock fingers, lift fingers to avoid pressure on ribs 1
• Position yourself vertically above the chest with arms straight 1
• Compress 4-5 cm depth at rate of 100 compressions per minute (slightly less than 2 per second) 1, 2
• Allow complete chest recoil between compressions 2
• Compression and release phases should take equal time 1

Combine compressions with rescue breaths: 1

• Single rescuer: 15 compressions to 2 breaths ratio 1
• Two rescuers: 5 compressions to 1 breath ratio (if both proficient) 1
• Minimize interruptions in compressions 2
• Continue CPR without stopping to recheck pulse unless victim shows signs of movement 1

If AED available, apply immediately and follow prompts 2

Once vascular access established, administer epinephrine 1 mg IV/IO every 3-5 minutes 2

D - Disability (Neurological Status)

While not explicitly detailed in basic life support guidelines, assess level of consciousness once ABC stabilized 5

E - Exposure and Environment

Remove restrictive clothing as needed for chest compressions, but maintain patient dignity and prevent hypothermia 5

Recovery Position (for Unconscious but Breathing Victims)

Place in recovery position to prevent airway obstruction and aspiration: 1, 2

• Remove spectacles and bulky objects from pockets 1
• Ensure both legs are straight 1
• Place arm nearest to you at right angles to body, elbow bent, palm up 1
• Bring far arm across chest, holding back of hand against victim's nearest cheek 1
• Grasp far leg just above knee and pull up, keeping foot on ground 1
• Pull on leg to roll victim toward you onto their side while keeping hand pressed against cheek 1
• Adjust upper leg so hip and knee are bent at right angles 1
• Tilt head back to maintain open airway 1
• Monitor peripheral circulation of lower arm and minimize duration of pressure 1

Critical consideration: Recent evidence suggests maintaining head-tilt-chin-lift with continuous breathing monitoring may detect cardiac arrest more reliably than recovery position with periodic checks 6. If using recovery position, reassess breathing every minute rather than less frequently 6

When to Get Help

Timing of help activation depends on circumstances: 1

• If two rescuers available: one starts resuscitation while other calls for help 1
• Lone rescuer with adult victim (non-trauma, non-drowning): assume heart problem and call for help immediately after confirming no breathing 1
• Lone rescuer with trauma, drowning, infant, or child: perform resuscitation for 1 minute before leaving to call for help 1

Special Circumstances

Airway Obstruction (Choking)

If unable to achieve effective breaths despite proper technique: 1

• Give up to 5 sharp back slaps between shoulder blades (victim leaning forward if conscious, on side if unconscious) 1
• If unsuccessful, give up to 5 abdominal thrusts (Heimlich maneuver) 1
• Alternate 5 back slaps with 5 abdominal thrusts, rechecking mouth between cycles 1
• If victim becomes unconscious, follow standard life support sequence 1

Poisoning

• Follow standard resuscitation protocols 1
• For hydrogen cyanide or hydrogen sulphide poisoning, use mask with non-return valve to avoid rescuer exposure to exhaled air 1
• Fixed dilated pupils should not preclude resuscitation in poisoning cases 1

Post-Resuscitation Care

• Continue monitoring for airway occlusion, inadequate breathing, or deterioration 2
• Reposition supine immediately if respiratory status deteriorates 2
• For suicide attempt victims, arrange immediate psychiatric evaluation during or immediately after medical stabilization 2
• Remove all means of self-harm from environment including firearms and medications 2