What is the immediate emergency management for an 18‑year‑old female found unconscious?

Immediate Emergency Management for an Unconscious 18-Year-Old Female

Immediately check responsiveness by tapping her shoulders and shouting, simultaneously assess breathing and pulse within 10 seconds, and if she has no pulse or only gasping respirations, activate emergency services and begin high-quality CPR with chest compressions at 100-120/min at a depth of at least 2 inches before rescue breaths (CAB sequence). 1

Initial Assessment (First 10 Seconds)

Scene Safety and Responsiveness:

• Ensure the scene is safe before approaching 1
• Tap the patient's shoulders and shout "Are you all right?" to check responsiveness 1
• Shout for nearby help immediately 1

Simultaneous Breathing and Pulse Check:

• While checking responsiveness, look for absent or abnormal breathing (only gasping counts as absent breathing) 1
• Check for a definite pulse for no more than 10 seconds—if you don't feel a pulse within this time, assume cardiac arrest 1
• Critical pitfall: Gasping respirations occur in 40-60% of cardiac arrests and are often mistaken for normal breathing—treat gasping as absent breathing 1

If Pulse Present But No Normal Breathing

Provide rescue breathing:

• Give 1 breath every 5-6 seconds (10-12 breaths/minute) 1
• Each breath should take 1-2 seconds and produce visible chest rise 2
• Maintain head tilt-chin lift continuously to keep airway open 1, 2
• Recheck pulse every 2 minutes 1, 2
• If pulse becomes absent at any point, immediately begin CPR 1, 2

If No Pulse or Only Gasping

Immediate Actions:

• Activate emergency response system immediately (call for help or send someone to call) 1
• Send second rescuer to retrieve AED/defibrillator if available 1

Begin High-Quality CPR (CAB Sequence):

Chest Compressions:

• Position patient supine on firm surface 1
• Place heel of one hand on lower half of sternum, other hand on top 1, 3
• Compress at least 2 inches (5 cm) deep 1, 3
• Rate of 100-120 compressions per minute 1, 3
• Allow complete chest recoil between compressions without leaning on chest 1, 3
• Minimize interruptions to less than 10 seconds 1, 3

Compression-to-Ventilation Ratio:

• Single rescuer: 30 compressions followed by 2 breaths 1, 3
• Two rescuers: Continue 30:2 ratio (15:2 is only for pediatric patients) 1, 3
• Each breath should take 1 second and produce visible chest rise 3
• Avoid excessive ventilation as it increases intrathoracic pressure and reduces cardiac output 1, 3

AED/Defibrillator Use

When AED Arrives:

• Apply AED pads immediately without stopping compressions during preparation 3
• Turn on AED and follow voice prompts 1
• Stop compressions only when AED analyzes rhythm (keep pause <10 seconds) 3

If Shockable Rhythm:

• Deliver one shock 1, 3
• Immediately resume CPR starting with chest compressions—do not check pulse or rhythm after shock 1, 3
• Continue CPR for full 2 minutes before next rhythm check 1, 3

If Non-Shockable Rhythm:

• Resume CPR immediately for 2 minutes 1
• Recheck rhythm every 2 minutes 1, 3

Advanced Interventions (When Available)

Vascular Access and Medications:

• Establish IV or intraosseous (IO) access 3, 4
• Administer epinephrine 1 mg IV/IO every 3-5 minutes for all cardiac arrest rhythms 3, 4
• For refractory VF/pulseless VT: amiodarone 300 mg IV/IO or lidocaine 1-1.5 mg/kg IV/IO 3, 4

Advanced Airway:

• Once endotracheal tube or supraglottic airway placed, provide 1 breath every 6 seconds (10 breaths/min) with continuous chest compressions—no pauses for ventilation 3, 4
• Confirm placement with waveform capnography 4

Special Considerations for Young Female

If Suicide Attempt Suspected (Asphyxia/Hanging):

• Prioritize airway management and rescue breathing as hypoxia is the primary problem 1, 2
• After stabilization, mandatory psychiatric evaluation is required 2
• Remove all means of self-harm from environment (firearms, medications) 2
• Do not discharge without confirmed psychiatric follow-up 2

If Drowning Suspected:

• Provide 5 cycles (about 2 minutes) of CPR before leaving to activate EMS if alone 1
• Prioritize rescue breathing as hypoxia is the primary insult 1
• Do not attempt abdominal thrusts or Heimlich maneuver—water is not an obstructive foreign body 1

Recovery Position (If Breathing Returns)

Only if patient has spontaneous breathing and definite pulse:

• Place in lateral recumbent position (recovery position) to prevent aspiration 1, 2
• Position arm nearest you at right angle, flex far knee, roll toward you 1, 2
• Tilt head back to maintain airway patency 1, 2
• Monitor continuously—if breathing deteriorates or becomes uncertain, reposition supine and reassess 2

Critical Pitfalls to Avoid

• Do not delay CPR to obtain history, assess for injuries, or determine cause of unconsciousness 2, 3
• Do not check pulse immediately after defibrillation—this wastes critical time when compressions should resume 3
• Do not mistake gasping for normal breathing—gasping indicates cardiac arrest 1
• Do not take longer than 10 seconds to check pulse—if uncertain, start compressions 1
• Do not hyperventilate—excessive ventilation decreases cardiac output and worsens outcomes 1, 3
• Do not interrupt compressions for longer than 10 seconds at any time 1, 3

Team Coordination

If two rescuers present:

• First rescuer begins chest compressions immediately 1
• Second rescuer activates emergency response and retrieves AED 1
• Change compressors every 2 minutes to prevent fatigue and maintain quality 1, 3, 4

Continue resuscitation until:

• Advanced life support providers arrive and take over 1
• Patient shows signs of life (movement, normal breathing, definite pulse) 1
• You are physically unable to continue 1
• Scene becomes unsafe 1