How to manage a client with a changed level of consciousness or a loss of consciousness - LOC.
A person's level of consciousness may be affected and altered for several reasons. It could be a result from a change in their health condition, a change in medication, insufficient oxygenation, a traumatic injury, or changes to the chemical environment of the brain, an allergic response, or following a fall with a head strike. Some of these type of situations may affect a person's level of consciousness and induce a loss of consciousness. Loss of consciousness can be for a short or long period.
A loss of consciousness refers to a state in which an individual lacks normal awareness of self and the surrounding environment. Syncope is the medical term for temporary loss of consciousness. This means the person is not responsive and will not react to any activity or physical stimulation. The person may have lost consciousness. Their are several scenarios below that describe what you can do if a person has a loss of consciousness.
Scenario 1 - Fainting
If someone has a loss of consciousness for several seconds, they may have fainted.
Ask loudly: 'Are you all right?' or 'Open your eyes'.
If they don't respond, pinch their earlobe or gently shake their shoulders.
Elevate their legs and recline their head.
Call for help and stay with the person until emergency medical help arrives.
Keep the person warm and monitor them.
If they have fainted, their recovery can last for several minutes, so do not provide food or drinks to the person until they are fully roused.
The person may feel nauseous as they recover.
If they still don't respond, then you can presume they're unresponsive.
Commence your First Aid Responder Skills - DRABCD.
If you arrive on shift and it appears that the client has had a fall because they are laying on the floor, are unresponsive and breathing, they are experiencing a loss of consciousness. You don't know how long they have there, so commence your First Aid Responder Skills - DRABCD. However, if you observe broken or misplaced furniture, or the person is laying in a narrow hallway, or their limbs are in an awkward position, presume they have a serious injury and/or a spinal, neck or head strike injury and:
do not move them.
carefully try to open their airway without moving their neck.
call 000 for emergency help and an ambulance.
keep them warm with a blanket. Do NOT place a pillow under their head.
report incident verbally on the 24/7 1800 717 590 number.
complete an incident report as soon as possible.
If you DO NOT think there is a serious limb, spinal, neck or head injury, as their is no evidence of broken or misplaced furniture, the person is laying in an open space, their limbs are NOT in an awkward position, and there is no evidence of a head strike, then complete the following 5 steps:
Step 1 of 5: Ensure their airway remains open
Place one hand on the person's forehead and gently tilt their head back. As you do this, the mouth will fall open slightly.
Place the fingertips of your other hand on the point of the person's chin and lift the chin.
Step 2 of 5: Continue to check for breathing
Look, listen and feel for normal breathing - chest movement, sounds and breaths on your cheek. Do this for no more than ten seconds.
Listen and feel for their breath on your cheek.
Step 3 of 5: Put them in the recovery position
This will keep their airway open.
Kneel next to them on the floor.
If you find the person lying on their back and you do not think they have a spinal, neck or head injury, follow the three steps below to place the person in the recovery position. You may not need all three steps if you find them lying on their side or front.
Place their arm nearest you at a right angle to their body, with their palm facing upwards.
Take their other arm and place it across their chest so the back of their hand is against their cheek nearest you, and hold it there. With your other hand, lift their far knee and pull it up until their foot is flat on the floor.
Now you're ready to roll them onto their side. Carefully pull on their bent knee and roll them towards you. Once you've done this, the top arm should support the head, and the bent leg should be on the floor to stop them from rolling over too far.
Roll the person on their side
Step 4 of 5: Call for help
Once you've put them safely into the recovery position, call 000 for medical help.
Until help arrives, keep checking the person's breathing.
If they stop breathing at any point, gently roll them onto their back and commence CPR (cardiopulmonary resuscitation - a combination of chest pressure and rescue breaths) as per your first aid training.
Contact HWH 24/7 on 1800 717 590.
Step 5 of 5: Complete an incident report
Scenario 3 - Possible Spinal, Neck or Head Strike Injury
As stated above, if you suspect the person has a serious limb, spinal, neck or head injury: DO NOT MOVE THE PERSON. Call for emergency help, an AMBULANCE, and keep the person warm. If the person becomes aroused, talk calmy to them, ask them to be still as possible, and let them know that emergency help is on the way.
If the person is already lying on their back and youthink that the person could have a spinal injury, you must keep their neck as still as possible. Instead of tilting their neck, use the jaw thrust technique: place your hands on either side of their face and, with your fingertips, gently lift the jaw to open the airway, avoiding any movement of their neck.
Support the neck and open their airway
Scenario 4 - Unresponsive and Not Breathing - Commence CPR
If an adult is unresponsive and not breathing, you'll need to do CPR (cardiopulmonary resuscitation). CPR involves giving someone a combination of chest compressions and rescue breaths to keep their heart and circulation going to try to save their life. If they start breathing normally again, stop CPR and put them in the recovery position.
If someone is with you, get them to call 000 for emergency help and ask them to get an automated external defibrillator (AED) if one is available.
How to perform CPR on an adult (see the basic life support chart above)
Step 1 of 4: Giving chest compressions
Kneel beside the person on the floor, level with their chest.
Place the heel of one hand towards the end of their breastbone, in the centre of their chest.
Hand location for compressions
Staff position for CPR
Place the heel of your other hand on top of the first hand and interlock your fingers, ensuring you keep the fingers off the ribs.
Lean over the person with straight arms, pressing vertically on the breastbone, and press the chest down by 5-6 cm (2-2½ in).
Release the pressure without removing your hands from their chest. Allow the chest to come back up fully - this is one compression.
Repeat 30 times, at a rate of about twice a second or the speed of the song 'Staying Alive'.
Give two rescue breaths.
Step 2 of 4: Giving rescue breaths
Ensure the person's airway is open.
Open Airway
Pinch their nose firmly closed.
Pinch the Nose
Take a deep breath and seal your lips around their mouth.
Blow into the mouth until the chest rises.
Breathwork
Remove your mouth and allow the chest to fall.
Watch the chest fall
Repeat once more.
Carry on giving 30 chest compressions followed by two rescue breaths for as long as you can, or until help arrives.
If an automated external defibrillator (AED) arrives, switch it on and follow its instructions.
If the person starts breathing normally again, stop CPR and put them in the recovery position.
Recovery position if breathing recommences
Step 3 of 4: Contact HWH 24/7 ph: 1800 717 590 and report the incident.
Step 4 of 4: Complete an incident report
Glascow Coma Scale - GCS
You may be alone until medical support arrives, and the CCM or Paramedic may ask you to check the person's responses against the Glascow Coma Scale - GCS, see below. As per your First Aid training, you can ask the person a series of questions and observe their responses to your requests for them to open their eyes, speak or move a finger or limb. GCS Observations - Post Fall
Glascow Coma Scale - GCS
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