COLLAPSE - LOSS OF CONSCIOUSNESS

This is a situation which is always very worrying if it happens to someone that you are with - especially if it is unexpected. It is not always a sign of a serious emergency though - it may be a simple faint or a fit in a known epileptic who is prone to occasional attacks. Remember that the most important thing to do with an unconscious patient is to safeguard their airway by keeping them in the recovery position - i.e. on their side with their neck slightly extended. Below is some guidance in case you are ever faced with this situation:

• A simple faint gets better quickly when the patient is lain flat in the Recovery Position and he/she soon gets back to feeling quite normal.If someone who is not known to be epileptic is still unconscious after two or three minutes in the recovery position then there is likely to be a significant problem and an emergency 999 ambulance should be called. If the patient is fitting then unless they are in immediate danger of, for example, falling then it is best not to intervene beyond putting the patient in the recovery position if it is possible to do this. Always with an unconscious patient check on breathing and pulse. If you think either are absent then summon help and take remedial action. (Contact the Red Cross, St. John's Ambulance or your employer if you want information on First Aid courses).

• Epileptic patients will probably be known to you as such or they will have a MedicAlert bracelet on their wrist. Usually fits stop after two or three minutes but the patient may take up to an hour to fully come round. The tendency is to follow a pattern so if it seems that a fit is unusually prolonged or the patient is still very drowsy after an hour or so then ring for an emergency doctor or ambulance.
• If after recovering from a presumed faint the patient appears confused or has any other associated symptoms then you should seek immediate advice.
• Diabetes. Low blood sugar can cause a diabetic to lose consciousness quite quickly. This can happen to diabetics on both insulin and tablets (See diabetic complications). The need is for the sugar level to be brought up to normal quickly - if the patient is not fully unconscious then they may be able to take some sugar in a drink but if not then some honey or golden syrup or a sugar paste placed between the cheek and teeth will get absorbed enabling sufficient recovery to take some oral calories. Some diabetics carry Hypostop which can be placed in the mouth. Also, glucagon injection may be carried by the diabetic but unless you know how to give it or can QUICKLY call upon someone who can then carry out the other measures first. Usually this situation can be dealt with without resort to medical help. More often than not the diabetic is confused rather than unconscious and provided some calories can be got into them quickly (e.g. milk+sugar and a biscuit) then unconsciousness will not occur but if it does and if you are unable to rouse them within five minutes by the above means or if you cannot quickly get hold of something to give them or if you simply feel the situation is beyond what you or anybody close at hand can deal with then call for a 999 ambulance. However, time is critical and ambulances can be delayed so seek advice from the ambulance switchboard as to what to do, mentioning that you suspect a diabetic low blood sugar coma.
• Diabetic high blood sugar coma. This occurs but is less common because the patient is likely to have been quite ill for a day or so beforehand. It requires urgent medical attention but is not as time critical as a low blood sugar coma. Unless you can be sure it is a high blood sugar coma (by doing a blood sugar) then treat for low blood sugar in case you are mistaken  as you will be unlikely to cause serious problems. However, missing a low blood sugar coma and doing nothing about it is potentially disastrous. There is nothing else that you can usefully do before the ambulance arrives except to protect the patient's airway as described above.
• Stroke. Can come on gradually or suddenly. An indication that this may be the cause is if the episode of unconsciousness was preceded by a period of confusion, loss of speech, weakness down one side, sudden severe headache or if the patient has a previous history of stroke, mini-stroke or high blood pressure. In any case the patient, if they lose consciousness, will be unrousable in the short term and a 999 ambulance should be called. Many strokes though don't cause unconsciousness and should be assessed by the emergency doctor before deciding whether admission is appropriate.
• Heart irregularity. Very occasionally this can cause loss of consciousness. The patient is likely to suffer frequent episodes which may be sudden and brief. This needs attention and may need treatment with drugs or a pacemaker. You need to see the doctor within 24hrs but please ring to discuss the symptoms in case more urgent action is required.

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