Loss of consciousness

The main characteristics of clear consciousness are vigilance and orientation in place and time. Vigilance means that you are able to respond appropriately to the people and things around you. Location and time orientation means you know who you are, where you are, where you live and what time it is. When consciousness is disturbed, your ability to stay awake, aware of what is happening around you and orienting yourself is impaired or completely lost. Impaired consciousness can be a reason for emergency medical care.

The brain, taking into account the performance of the whole organism, is ultimately responsible for maintaining consciousness. Your brain needs a certain amount of oxygen and glucose to function properly.

Many substances that you consume in food, drink, or in the form of drugs, supplements, or illegal drugs can affect your brain chemistry. These substances help to maintain a clear consciousness or provoke its partial or complete loss. For example, caffeine is a stimulant, it increases your level of brain activity. Caffeine is found in many of the foods and drinks you consume every day, such as coffee, soda, and chocolate. On the other hand, painkillers and tranquilizers cause drowsiness and disorientation. This side effect is a peculiar form of violation of clear consciousness. Diseases that damage your brain cells can also cause impaired consciousness. Coma is the most serious disturbance of consciousness.

Signs of loss of consciousness

It is important to distinguish between disturbances of consciousness and its complete loss. This is important when providing assistance in the future, when diagnosing the causes and treating the pathology. Symptoms that may be associated with impaired consciousness include:

• convulsive seizures (against the background of them, consciousness is usually completely turned off);
• loss of bowel or bladder function;
• imbalance, coordination, falling;
• difficulty walking;
• fainting (from loss of consciousness they are distinguished by short duration, they do not last more than 2 – 5 minutes);
• violation of mental functions, confusion of thinking and speech;
• arrhythmia, rapid pulse;
• low blood pressure
• sweating;
• heat;
• weakness in the face, arms, or legs.

Depending on the depth of brain disorders, different levels of impaired consciousness are possible, up to its complete loss. Levels of impairment of consciousness include:

• disorientation;
• rave;
• confusion (stupor);
• stupor;
• brake;
• to whom (of varying severity).

Disorientation is the inability to understand how you relate to the people, places, objects and time around you. The first stage of disorientation is usually associated with awareness of the current environment (for example, why you are in the hospital). The next stage is disorientation in time (years, months, days). This is followed by disorientation about the place, which means that you may not know or understand where you are. Loss of short-term memory follows disorientation about the place. The most extreme form of disorientation is when you lose memory of yourself.

Delirium – if you are delirious, your thoughts, actions, feelings are confused and illogical. Delirious people are often disoriented. Their emotional reactions range from fear to anger. People who are delirious are also often very agitated.

Confusion (stupor) This condition is characterized by a lack of clear thinking and can lead to inadequate decision making. There is drowsiness, but the speech of others is still perceived.

Stupor (sometimes referred to as lethargy) is a state of lowered consciousness, reminiscent of a long sleep. In a state of stupor, you are unable to respond to stimulants such as the sound of an alarm clock or the presence of a fire.

Sopor – this is a deeper level of impaired consciousness, in which it is very difficult for you to respond to any stimuli other than severe pain.

Coma – the deepest level of violation of consciousness. If you are in a coma, you cannot respond to any stimuli, even pain, sounds, lights.

Causes of loss of consciousness

Unconsciousness is a life-threatening event. An unconscious person may appear to be asleep, but may not respond to external events such as loud noises or touch, sudden movements (if disturbed).

Fainting is a distinct type of unconsciousness that occurs suddenly and may last only a few seconds. After a faint, a person is relatively easy to bring to life. Unconsciousness can last much longer, and a person’s vital signs can change up to a deep coma. Common causes of loss of consciousness include:

• alcohol or drug abuse;
• certain drugs (including poisoning with them);
• epilepsy (convulsive seizures);
• low blood sugar (hypoglycemia below 2,5 mmol/l);
• stroke (both ischemic type and cerebral hemorrhage – hemorrhagic stroke);
• lack of oxygen in the brain (hypoxia and asphyxia).

Other possible causes of impaired consciousness include:

• hemorrhage in the brain and its membranes;
• dementia, including Alzheimer’s disease;
• head injury;
• a brain tumor;
• heart disease with acute circulatory disorders;
• heatstroke;
• liver disease;
• uremia or end-stage renal disease;
• different types of shock.

First aid for loss of consciousness

When someone passes out, it is important for those around you to know what to do. Some simple first aid steps, such as checking vital signs and signs of serious injury, can help an injured person before an ambulance arrives. If the person is not breathing, cardiopulmonary resuscitation may be needed.

What to do first when a person is unconscious

If the person is unconscious or unresponsive, call an ambulance.

When it seems to you that someone is unconscious or not behaving quite adequately, the first thing to do is to ask him if he is okay (in a loud voice); then gently shake the shoulder (unless spinal cord injury or any other injury is suspected). If the person does not respond, follow these steps in this order:

• make sure the airway is open, there are no signs of blockage, such as labored breathing or high-pitched sounds, wheezing, gasping for breath;
• look for signs that the person is breathing;
• check for a pulse (neck, carotid area) or heartbeat.

Call or have someone call the emergency medical service 03 or 112, if a person:

• has no pulse or only a weak pulse;
• not breathing;
• does not respond or does not regain consciousness within 1 minute;
• possibly seriously injured, or bleeding is visible.

When talking to emergency services by phone, do not hang up until you are instructed to do so.

Check the person’s wrists, pockets, chest, and neck. If the person is seriously ill, they will usually wear a first aid card or badge, as this may give some indication of why they may have passed out. Share the information on the tag with emergency services.

First aid steps

Before acting, it is important to determine whether the unconscious person is breathing or not, as this will help in what to do next.

If the person is still conscious but seems overwhelmed, ask them basic questions, such as their name and birthday, or what date it is today. Incorrect answers or failure to answer may mean that he has a mental status change. Share this information with emergency medical services.

If it looks like the person might have a spinal injury, leave it as is. Take steps to keep your head and neck fixed and immobile.

If the person is breathing and unlikely to have a spinal injury, rotate the person to the lateral recovery position. Adjust the person’s legs so that their hips and knees form right angles. Gently tilt your head back to make sure your airway is open.

If the unconscious person is not breathing, it may be necessary to gently move them onto their back while protecting their neck to perform cardiopulmonary resuscitation (CPR). Call XNUMX before performing CPR. Symptoms such as movement, coughing or breathing are good signs. If these signs are not present, continue CPR until emergency help arrives.

If an unconscious person is bleeding heavily, locate the injury and apply firm, direct pressure to the injury to slow the blood flow. If possible, apply a tourniquet over the bleeding area to slow the bleeding until the ambulance arrives. To apply a tourniquet, wrap a cord or bandage tightly around the affected limb.

How to perform CPR

Only trained individuals should perform the entire CPR procedure. CPR is an emergency procedure used to help people when they stop breathing and have no pulse. It consists of chest compressions, which is the cardiac part, and artificial respiration, which is the pulmonary part.

Only people with knowledge and experience in CPR should perform the entire procedure. To reduce the chance of potential injury, anyone who is not experienced with CPR should only perform chest compressions in steps 1 through 7 in the instructions below, and not the rest of the steps in steps 8 through 10. Chest compressions may still Promote the circulation of oxygen-rich blood for the organs of the body and the brain.

• tilt your head to open your airways;
• put one hand on the forehead, and the fingers of the other under the tip of the chin;
• then gently tilt your head back: this moves the tongue so that it does not block the airway;
• if a spinal injury is suspected, perform a jaw thrust instead: kneel near the top of the person with hands on either side of the face;
• gently open the jaws with your fingertips without moving the victim;

When the person’s airway is open, follow these steps to perform CPR:

1. Lay the person on their back on any flat, hard surface. Protect his neck from active movement if it looks like there is a spinal injury.
2. Sit on your knees next to his shoulders so that your torso is above his chest.
3. Place the palm of your hand in the center of your chest.
4. Place your other hand directly on top of your arm and interlock your fingers.
5. Keep your elbows straight and kneel to lift your shoulders and get more strength in your upper body.
6. Using weight and force from your upper body, press straight into your chest, squeezing it at least 5 to 7 cm for adults, then release the pressure. This is one compression.
7. Do sets of 30 compressions at a rate of 100 to 120 times per minute, that is, about twice per second.

   Only people who are proficient with CPR should follow these steps:

8. Tilt the person’s head back and raise the chin to keep the airway open.
9. Squeeze your nose and close your open mouth with your open mouth, creating an airtight seal.
10. Blow until you see your chest rise. It’s one breath. Take two breaths, allowing the lungs to relax and exhale between breaths.

Continue chest compressions and rescue breathing until emergency services arrive.

Important! If you have seen about CPR only in films and do not have the skills, it is better not to carry out manipulations, you can harm a person. Stop by to help.

What not to do

There are also some things to avoid when giving first aid until the paramedics arrive:

• do not place a pillow under the head of an unconscious person, as this may interfere with his breathing;
• do not try to force the person to sit down;
• do not splash water on an unconscious person and do not hit him on the cheeks;
• do not try to force him to drink water or other liquids. If something is visible at the back of the person’s throat or high in the throat that is blocking the airway, try removing the object using one finger. Do not move your finger or try to grab onto anything that is caught in the person’s throat if the foreign body is not visible. This may cause you to push it deeper. If the person is not breathing and has an object stuck in their throat, continue to perform chest compressions and check to see if the object has moved;
• do not leave an unconscious person unattended.

Treatment for loss of consciousness

The reasons for the loss of consciousness will be clarified by the doctors already in the hospital, where the patient, found unconscious, will be taken.

Diagnostics

Diagnosis of the causes of loss of consciousness begins with a complete medical history and physical examination, which includes a detailed neurological evaluation. The doctor will want to know about any medical problems such as diabetes, epilepsy, or depression. He will ask about any medications he is taking, such as insulin or anticonvulsants. He will also ask if there is a history of abuse of illicit drugs, prescription drugs, or alcohol.

In addition to this, the doctor may order the following tests:

• complete blood count (CBC) – this blood test shows if the hemoglobin level is low, which indicates anemia; an elevated white blood cell count indicates infections such as meningitis or pneumonia;
• blood for toxicology – this test uses a sample of blood or urine to determine the presence and level of medicines, drugs and poisons in the body;
• electrolyte panel – these blood tests measure sodium, potassium, chloride, and bicarbonate levels;
• liver function tests – these tests determine the health of the liver by measuring the level of proteins, liver enzymes, or bilirubin in the blood;
• electroencephalogram (EEG) – this test uses electrodes on the scalp to assess brain activity;
• electrocardiogram (ECG) – this test measures the electrical activity of the heart (such as heart rate and rhythm);
• chest x-ray – doctors use this test to visualize the heart and lungs
• CT scan of the head – CT scans use computers and rotating x-rays to produce high-resolution images of the brain. Doctors use these images to find abnormalities;
• Head MRI. MRI uses nuclear magnetic resonance imaging to produce high-resolution images of the brain.

Modern treatments

Treatment for loss of consciousness depends on what is causing it. You may need to change medications, start treatment, or simply address the symptoms of the underlying disease. For example, you need urgent medical treatment and possibly surgery to treat a cerebral hemorrhage. But if it is Alzheimer’s disease for which there is no effective cure, treatment of symptoms and maintenance of quality of life for as long as possible is indicated in this case.

Prevention of loss of consciousness at home

Sudden, temporary loss of consciousness can also result from fainting. Nerve-mediated syncope is the most common form of syncope. It is generally harmless and usually does not require medical treatment. Nervous syncope occurs when the brain does not properly respond to a trigger, such as blood or something shocking or unpleasant. This response cuts off the flow of oxygen to the brain and the person loses consciousness.

Some other causes of temporary unconsciousness include:

• dehydration;
• low blood pressure
• low blood sugar;
• heart problems such as arrhythmias;
• hyperventilation, very rapid breathing.

Fainting or temporary loss of consciousness is not always a sign that a person needs medical attention. However, contact the emergency room immediately for any of the following symptoms:

• loss of bladder or bowel control;
• convulsions or seizures;
• no breathing;
• no pulse;
• a person has diabetes;
• this is a pregnant woman.

If the person regains consciousness, look for other serious signs and symptoms, such as:

• unable to speak or have vision problems
• unable to move arms or legs
• chest pain or irregular heartbeat occurs.

These are serious signs and the person should seek emergency medical attention.

Popular questions and answers

We asked neurologist of the highest category Evgeny Mosin about loss of consciousness and possible problems associated with this condition.