General principles of examining patients who have lost consciousness. Providing emergency medical care (lecture)

The issue of providing emergency medical care to victims in cases of loss of consciousness has its own peculiarities, which are related to the very short period of time available for diagnosis and provision of assistance in cases where vital functions are at risk, and the lack of medical history and case history. In such conditions, the doctor must perform the diagnostic (ABCDEF) and therapeutic algorithm as quickly and accurately as possible. In the first instance, when providing emergency medical care to a victim (patient), it is necessary to perform measures aimed at restoring and maintaining vital functions. These measures are aimed at preventing irreversible brain damage, namely: 1) diagnosis of adequate external respiration and, if necessary, its restoration, 2) diagnosis of hemodynamic disorders and correction if necessary. Only on this basis can the structural and functional state of the brain be maintained. The complexity of the situation when a patient loses consciousness for an emergency medical doctor lies in the need to work in all directions at once, since the «price» for lost time and incorrect actions is irrever­sible damage to brain tissue. Diagnosis of a comatose state is an absolute indication for emergency hospitalization of the victim with simultaneous provision of emergency medical care. In other cases, this is justified only when the patient is in an agonal state, in the event of brain death, or in the presence of clear contraindications for transportation. At the same time, transportation to a medical facility (in intensive care department, morgue) is not removed from the agenda under any circumstances. In coma, drugs are administered only parenterally. Catheterization of a peripheral vein is indicated for infusions (primarily isotonic sodium chloride solution), and if necessary, intravenous administration of drugs can be started immediately. If the doctor witnesses a sudden loss of consciousness, they should remember and describe (in the chart) this condition. Correct interpretation of the data obtained can be a great help in determining the diagnosis and providing emergency care. If potentially life-threatening respiratory or circulatory disorders are detected at any stage of the general examination of the patient, emergency care should be provided and preparations made for transportation to a medical facility.