Assessing an Unresponsive Pt

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benasack2000

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When i'm assessing an unresponsive patient in the initial assessment, am I only checking for the presence/absence of breathing and a pulse. Do I take account of rate and quality if they are present? Is the purpose of this in this situation just to see if they are breathing and blood is moving?
 
In your initial assessment you are checking to make sure they are breathing. You also want the quality (shallow, deep, labored) and how fast (not an exact number just normal, fast, slow, or none).

Same thing with the pulse. Is it there? Is it too fast? Too slow? Normal? Strong? Weak?
 
When you first assess presence/absence of pulses and respirations in an unconscious/unresponsive patient, yes you're looking to see just that if they are there or not....however after you determine that your patient is in fact still alive, then you proceed through with your normal assessment, including assessing rate/rhythm/quality/etc of said pulses and respirations (i.e. the patient is indeed breathing but do you need to assist that with a BVM or not?)
 
If it were me I would first check to ensure they are breathing, then check quality. I've ran on people who are unconscious and breathing but could tell they were barely breathing. That will tell you where to go from there, ex: NRB,BVM, or possibly Intubate. From there you can tell if this is a " load and go, or stay and play".
 
Gurby said:
Note that a patient can be in cardiac arrest but still breathing. Always check for a pulse RIGHT AWAY in any unresponsive patient:

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The occasional gasp doesn't really count as breathing.
 
Unresponsive patients are actually a lot easier to deal with. They don't yell at you, lie to you, talk back to you. Check Responsiveness, than pulse, Air Breathing, Rapid Trauma.

Remember Unresponsive is a Trauma Patient until proven otherwise.
 
EMT11KDL said:
Unresponsive patients are actually a lot easier to deal with. They don't yell at you, lie to you, talk back to you. Check Responsiveness, than pulse, Air Breathing, Rapid Trauma.

Remember Unresponsive is a Trauma Patient until proven otherwise.
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For testing purposes yes. For real world no.
 
Underoath87 said:
The occasional gasp doesn't really count as breathing.
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Sure. The point is that it'd be easy to get on scene to find the patient in the video and say, "oh, at least she's breathing so that's something..." And it takes you an extra 1-2 minutes to even realize she doesn't have a pulse, and you're thinking "but she's breathing...? Family says she does this all the time and it's just a seizure. I must just not be finding the pulse." So you have your partner check, and he can't find the pulse. 5 minutes later you've finally realized what's going on and started CPR. You get pulses back, but the pt's brain is gone.

I know prior to seeing that video I would probably have been mislead if I had been dispatched to that patient for cc of a seizure.
 
Gurby said:
Sure. The point is that it'd be easy to get on scene to find the patient in the video and say, "oh, at least she's breathing so that's something..." And it takes you an extra 1-2 minutes to even realize she doesn't have a pulse, and you're thinking "but she's breathing...? Family says she does this all the time and it's just a seizure. I must just not be finding the pulse." So you have your partner check, and he can't find the pulse. 5 minutes later you've finally realized what's going on and started CPR. You get pulses back, but the pt's brain is gone.

I know prior to seeing that video I would probably have been mislead if I had been dispatched to that patient for cc of a seizure.
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Well personally if that were the situation, and a pulse could not be found in 7 minutes, I would have long made the decision to manage the airway, and get some oxygenated blood moving into the brain. That's a very long time just Looking for a pulse! I can't imagine having such a lack in faith of my own skill lasting that long lol. Maybe your times are exaggerated?
 
MrLegsGuy said:
Well personally if that were the situation, and a pulse could not be found in 7 minutes, I would have long made the decision to manage the airway, and get some oxygenated blood moving into the brain. That's a very long time just Looking for a pulse! I can't imagine having such a lack in faith of my own skill lasting that long lol. Maybe your times are exaggerated?
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If you can't find a pulse why are you then moving to airway management? What do we do when we don't find a pulse?

Edit: I kinda misread your post. Still, the focus should be on airway management in this stage.
 
MrLegsGuy said:
Well personally if that were the situation, and a pulse could not be found in 7 minutes, I would have long made the decision to manage the airway, and get some oxygenated blood moving into the brain. That's a very long time just Looking for a pulse! I can't imagine having such a lack in faith of my own skill lasting that long lol. Maybe your times are exaggerated?
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I don't mean I'd stand there looking for a pulse for 7 minutes, I mean it would be pretty easy to screw this call up and delay starting CPR by that long.

You get dispatched for the seizure, get on scene and family says "she has these all the time", fire has not taken vitals and just tells you "she's been seizing since we got here, probably going to need ALS". Patient is unresponsive but breathing at ~30/minute... Cardiac arrest is probably not the first thing that comes to mind in this situation.

In school you learn CAB for unresponsive patients, so you should be checking a pulse right away... But in the real world it's easy to stray from these algorithms, especially when you're 2nd on scene and fire is giving you information, and you think you know what's going on.
 
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If fire hasn't given me any vitals that they've taken, I'm going to get a set... and that's pretty much right away, or at least check the ABCs quickly. Downtime without a pulse would have been minimized and certainly less than the 7 minutes on scene...
 
Akulahawk said:
If fire hasn't given me any vitals that they've taken, I'm going to get a set... and that's pretty much right away, or at least check the ABCs quickly. Downtime without a pulse would have been minimized and certainly less than the 7 minutes on scene...
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Maybe this is just a sore spot for me because I made almost this exact mistake when I was first starting. Get called for the seizure, find unconscious pt, fire and family say "he does this all the time, we caught him and lowered to the ground so no trauma, everything is cool". Fortunately they were right and it turned out that it WAS just a seizure and he was postictal... But if it had been a cardiac arrest, it would have been a poorly handled one.

Also the fact that pt is breathing and everyone is saying it's a seizure would make me question myself when I didn't find a pulse.
 
Gurby said:
I don't mean I'd stand there looking for a pulse for 7 minutes, I mean it would be pretty easy to screw this call up and delay starting CPR by that long.

You get dispatched for the seizure, get on scene and family says "she has these all the time", fire has not taken vitals and just tells you "she's been seizing since we got here, probably going to need ALS". Patient is unresponsive but breathing at ~30/minute... Cardiac arrest is probably not the first thing that comes to mind in this situation.

In school you learn CAB for unresponsive patients, so you should be checking a pulse right away... But in the real world it's easy to stray from these algorithms, especially when you're 2nd on scene and fire is giving you information, and you think you know what's going on.
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You should be feeling for a radial pulse pretty much immediately on every patient contact you make, regardless of what's going on. That's not a hard thing to remember to do.
 
Tigger said:
You should be feeling for a radial pulse pretty much immediately on every patient contact you make, regardless of what's going on. That's not a hard thing to remember to do.
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Exactly. And this must be done early on... Every time.
 
I find it hard to believe you guys really check a pulse immediately on every patient encounter

edit: perhaps not hard to believe, but rather, I've never seen that practice before, and it seems really unnecessary to me with the many if not a majority of patient contacts
 
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It's not very hard to to feel for a quick radial pulse when you introduce yourself. Just to ballpark a rate and regularity. Seems like that sort of information is indicated fairly regularly, no?
 
Tigger said:
It's not very hard to to feel for a quick radial pulse when you introduce yourself. Just to ballpark a rate and regularity. Seems like that sort of information is indicated fairly regularly, no?
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Pulse rate and quality gives you good info, sure. I'm just not sure how standard a practice it actually is to assess it right away on every patient encounter. Most of the patients I transported when I did ground were standing by the curb waiting with their suitcase in hand when we pulled up.....I rarely had any concerns about their hemodynamic status.
 
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