FIRST AID FOR DISORDERS OF

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CONSCIOUSNESS

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MED109-6 Medical Skills
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PROF.DR. OSMAN ATA UYSAL

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What is disorder of consciousness ?

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It is a partial or complete loss of consciousness due to a

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disruption of the activities of the brain.

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Levels of consciousness

• Conscious : The patient responds to all stimuli

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(stimulations).

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• 1 st Degree Loss of Consciousness : The patient does not

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respond to audible stimuli only .

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• 2 nd Degree Loss of Consciousness : The patient does not
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respond to audible and touch stimuli.
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• 3 rd Degree Loss of Consciousness : The patient does not

respond to any stimuli, including painful stimuli.

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Disorders of Consciousness
Fainting (Syncope): It is a short-term, superficial and
temporary loss of consciousness.

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It occurs as a result of

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• decreased blood flow to the brain or

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• decreased concentration of glucose in the blood.

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Coma : It is a prolonged loss of consciousness.

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It is combined with
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• loss of reflexes such as swallowing and coughing,
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• decreased or disappearing response to external
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stimulation.
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 Frequent Reasons for Fainting

• extreme fear ,

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• extreme excitement ,

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• extreme hot climate ,

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• extreme tiredness ,

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• indoor environment with insufficient ventilation ,

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• extreme dirty air ,
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• sudden standing up ,
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• blood sugar drop ,

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• severe infections

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Main Signs of Fainting ( Syncope )

• dizziness,

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• falling to the ground ,

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• numbness in the legs ,

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• blurring of sight ,

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• paleness of the face ,
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• chills ( tremor ) , O
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• sweating fast ,
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• weak pulse
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First Aid for Fainting
• Shock position : Lying on the back, feet are lifted 30 cm from the

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ground and preferably support is placed under the legs

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• Tight clothes are loosened so that the patient can breathe

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comfortably (the chest can move freely) while lying on the back .

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 Frequent Reasons of Coma

• Fall from a height

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• Severe blow to the head (head trauma)

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Poisonings

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•

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• Excessive alcohol / drug use

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• Diabetes

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• Liver diseases

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• Stroke (sudden obstruction of a cerebral vessel)
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 Main Signs of Coma

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Loss of responses such as swallowing and coughing

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•

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No reaction to painful stimuli

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• Urinary and feces incontinence

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( inability to control urination or defecation )
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First Aid for Coma

• Consciousness and other life signs are evaluated

(C.A.B.)

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• If breathing and circulation is normal, coma

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position is given,

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• Emergency Medical Assistance is called

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(Tel.No.112),

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• breathing and circulation are checked
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intermittently (at every 2-3 min. ),
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• coma position is given for the other side at every

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20 minutes.

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Application of Coma Position

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What is convulsion ( epilepsy ) ?

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• There are uncontrollable (involuntary) contractions in

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the big muscles of the limbs and body.

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• It is an irritation to the brain.
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Frequent Reasons of Convulsions

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• Some diseases with high fever (some childhood diseases, etc.)

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• Some chronic diseases (epilepsy, etc.)

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• Brain injuries due to head trauma

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• Brain infections
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Types of Convulsions

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Febrile convulsion :

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It occurs when the body temperature rises above 40°C as a

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result of any disease. It usually occurs in children between the

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ages of 6 months and 6 years.

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Epileptic crisis ( epilepsy ) : It is a type of recurring convulsions
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due to inherited or acquired chronic disease ( head trauma ,

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brain infections , tumors, difficult birth , some metabolic

diseases etc. ) .

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First Aid for Febrile Convulsion

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• The patient is wrapped in wet towels or sheets.

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If the fever (body temperature) does not decrease with this method,

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• The patient can be placed in a bathtub filled with water at room

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temperature (warm).
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• Urgent medical assistance is required. ( Call Tel.No.112 )
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 Epilepsy ( epileptic crisis )

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• It's a chronic disease. It develops in people with

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brain tissue damage for any reason (congenital or

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acquired).

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• Although it is not always in the typical character

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of epilepsy crisis ( contractions in the extremities),
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some patients are aware of the condition to occur
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short time before because of the precursor
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symptoms.
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Epileptic Crisis - I
• Precursor symptoms may occur in the patient such as

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various smells , some images , headache , etc.

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Sometimes

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• the patient screams ,

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• loses consciousness ,

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• violently and suddenly collapses to the ground ,
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• intense and general muscle contractions usually may be
seen ,
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• gasping ( irregular breathing ) may occur for 10-20

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seconds ,
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• bruising of the tissues and face can be observed.

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Epileptic Crisis - II

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In addition

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• audible breathing,

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• excessive saliva secretion,

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• urinary and gaita incontinence,
• biting the tongue,
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• hitting and injuring the head on the ground

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may be observed.

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Epileptic Crisis - III

In the final stage the patient

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• wakes up,

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• is confused,

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• is in a state of sleepiness ,

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• is unaware of where he/she is.
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Convulsion - I

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Convulsion - II

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 First Aid for Epileptic Crisis - I
• Event scene security is ensured.

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•

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Contractions are expected to be completed.

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• No attempt is made to stop the contractions .

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• No attempt is made to open the locked jaw.

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• Any substances are not forced to be smelled.
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Any food and drink are not given by mouth.
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• Care is taken in order to prevent the patient to injure

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himself.
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• A soft support can be placed under the head to protect the

head.

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First Aid for Epileptic Crisis - II

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• Equipment that may cause injury is removed from the

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vicinity of the patient .

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• Squeezing clothes are loosened ( in order for the free

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moving of the chest).

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• Precautions are taken against vomiting
(head tilted sideways). O
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• If there are injuries as a result of the fall, necessary

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protection measures are taken for wounds.

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• Urgent medical help is required. ( Call Tel.No.112 )

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Blood sugar decrease ( Hypoglycemia )

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Hypoglycemia is the reduction of blood sugar concentration

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as a result of different reasons.

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Sudden Hypoglycemia may result in sudden loss of
consciousness.
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 Frequent Reasons of Hypoglycemia

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• Untreated diabetes

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• Mistreated diabetes ( overdose of diabetes medication)

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• Long exercises

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• Long periods of starvation
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• Bowel by-pass surgery
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Frequent Signs of Hypoglycemia
• Sweating
• Fast pulse

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• Tremor

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• Suddenly feeling hungry

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• Fatigue ( weakness )

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• Nausea

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• Headache
• Visual impairment O
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• Difficulty of speaking
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• Lethargy ( sleepiness )
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• Confusion ( loss of orientation )

• Dizziness ( vertigo )
• Loss of consciousness

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First Aid for Hypoglycemia
• C.A.B. (especially the level of consciousness ) is evaluated ,
• sugar or sugary drinks are given orally if the patient is
conscious and does not vomit ,

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• Even if the symptoms are caused by increased sugar,

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(hyperglycemia), it does not hurt to drink sugary water ,

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Because hypoglycemia is more dangerous than

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hyperglycemia ,

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• If the symptoms do not pass in 15-20 minutes, medical
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help is required ( Call Tel.No.112 ),
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• If the patient is unconscious, a coma position is given until

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the Ambulance arrived .

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Frequent Reasons of Strong Pain on the
Chest

• Heart Spasm,

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• Heart Attack (Myocardial infarction)

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Both occur as a result of reduced blood sent to

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a certain area of the heart muscle.
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Heart spasm and heart attack may result in

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sudden loss of consciousness.

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Frequent Signs of Heart Spasm

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• Distress

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• Shortness of breath (often)

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• Pain (can spread to the neck, back and jaw)

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• Pain occurs after physical strain, extreme excitement,

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sadness or overeating (often)

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• Pain lasts about 5-10 minutes
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• Pain stops with rest
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Frequent Symptoms and Signs of Heart Attack - I

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• Fear of death and intense distress ,

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• Sweating, nausea, vomiting, indigestion ,

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• Pain anywhere in the chest or stomach cavity,

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often on the neck and can spread to the

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shoulders, neck, jaw and left arm.
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• Although pain is similar to heart spasm pain, it is
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more severe and prolonged.
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• The shape and severity of pain does not change

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with rest or breathing.

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Frequent Symptoms and Signs of Heart Attack - II

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• The patient with heart attack most commonly shows the

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symptoms of indigestion, bowel gas pain or chest muscle

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pain.

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• Bowel gas pain or chest muscle pain should be considered

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as heart attack until proven otherwise.
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First Aid for Chest Pain
• The vital signs of the patient are checked ( C.A.B. ),

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• the patient is immediately put into rest ,

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• the patient is given a semi-seated position,

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• the patient is helped to take the heart medications

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if prescribed before and available ,

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• Urgent Medical Help is required ( Call Tel.No.112

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for Ambulance ) ,
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• Vital signs are monitored frequently during
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transportation because the condition of the patient may

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detoriorate any time .

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