From the Guidelines
When a patient becomes unresponsive for a few seconds, immediate assessment and stabilization are essential, and the most recent guidelines from 2015 recommend that emergency dispatchers determine if a patient is unresponsive with abnormal breathing and activate the emergency response system if necessary 1. The first step is to ensure patient safety by positioning them to prevent falls or injury, then quickly assess airway, breathing, and circulation (ABC) as recommended by the American Heart Association guidelines 1. Key points to consider in the assessment include:
- Checking vital signs including blood pressure, heart rate, oxygen saturation, and blood glucose level
- Performing a focused neurological examination, including pupillary response and Glasgow Coma Scale
- Documenting the exact duration of unresponsiveness, any preceding symptoms, and whether the patient experienced confusion upon regaining consciousness
- Considering obtaining an ECG to evaluate for cardiac arrhythmias, and if clinically indicated, ordering laboratory tests including electrolytes, complete blood count, and toxicology screening
- Depending on the clinical presentation, further workup may include EEG to assess for seizure activity, brain imaging (CT or MRI), and cardiac monitoring as suggested by the guidelines 1. These brief episodes of unresponsiveness could represent syncope, seizures, transient ischemic attacks, or cardiac arrhythmias, each requiring different management approaches, and the comprehensive initial assessment helps determine the appropriate diagnostic pathway and prevents delays in identifying potentially serious underlying conditions 1. It is also important to note that dispatchers should instruct rescuers to provide CPR if the victim is unresponsive with no normal breathing, even when the victim demonstrates occasional gasps, as recommended by the 2015 guidelines 1. Overall, the key to managing a patient who becomes unresponsive for a few seconds is to act quickly and follow the most recent guidelines for assessment and stabilization.
From the Research
Immediate Response
When a patient becomes unresponsive for a few seconds, the following steps should be taken:
- Check the patient's airway, breathing, and circulation (ABCs) 2
- Ensure the patient is in a safe position and environment
- Call for emergency medical assistance if necessary
Diagnostic Evaluation
A focused diagnostic evaluation should be performed to determine the cause of the unresponsiveness, including:
- Checking vital signs 2
- Assessing for potential life-threatening causes such as cardiac arrest or stroke
- Considering regional epidemiology and evolving therapeutic management 2
Basic Life Support
If the patient is found to be unresponsive and not breathing, basic life support (BLS) should be initiated, including:
- Chest compressions 3, 4
- Rescue breaths 3, 4
- Use of an automated external defibrillator (AED) if available 3, 4
- Ensuring high-quality CPR 3, 4
Skill Retention and Training
It is essential to note that skill retention following BLS training can be poor, and regular training and practice are necessary to maintain proficiency 5