Checklist for General Examination of an Unconscious Patient
Patient name: "Ramesh"
1. Safety and Initial Assessment
- Ensure scene safety: Check for hazards to the patient or responders.
- Example: Ensure there are no electrical hazards or traffic risks if Ramesh is found outdoors.
- Check responsiveness: Use verbal and tactile stimuli.
- Example: Call out, "Ramesh, can you hear me?" and gently shake his shoulders.
2. Airway
- Check for airway obstruction: Look, listen, and feel for breathing.
- Example: Tilt Ramesh’s head back and lift his chin; check for obstructions like the tongue or foreign objects.
3. Breathing
- Assess breathing: Look for chest rise, listen for breath sounds, and feel for airflow.
- Example: Place your ear near Ramesh’s nose and mouth while observing the chest for movement.
4. Circulation
- Check pulse: Preferably at the carotid artery in adults.
- Example: Feel for a pulse on the side of Ramesh's neck (carotid artery) for at least 5 seconds but no more than 10 seconds.
- Assess skin color and temperature: Check for pallor, cyanosis, or clamminess.
- Example: Look for bluish discoloration of Ramesh’s lips and nail beds; feel if his skin is cold and sweaty.
5. Disability (Neurological Assessment)
- Assess pupil response: Check for size, equality, and reaction to light.
- Example: Shine a penlight into each of Ramesh’s eyes and observe the response; pupils should constrict equally.
- Assess Glasgow Coma Scale (GCS): Evaluate eye, verbal, and motor responses.
- Example: Eye opening response (1-4), verbal response (1-5), motor response (1-6); total score ranges from 3 (deep unconsciousness) to 15 (fully alert). For Ramesh, Eye opening: 2, Verbal: 2, Motor: 4 (GCS = 8).
6. Exposure
- Fully expose the patient: Look for injuries, rashes, or medical alert bracelets.
- Example: Carefully remove Ramesh’s clothing as needed to check for signs of trauma, burns, or other injuries.
7. Vital Signs
- Measure vital signs: Blood pressure, heart rate, respiratory rate, temperature, and oxygen saturation.
- Example: Use a sphygmomanometer for blood pressure, pulse oximeter for oxygen saturation, and thermometer for body temperature.
Ramesh's BP: 110/70 mmHg, HR: 80 bpm, RR: 16/min, SpO2: 98%, Temp: 36.5°C.
8. Head-to-Toe Examination
- Perform a thorough examination: Check for injuries, deformities, and signs of medical conditions.
- Example: Inspect and palpate Ramesh’s scalp, face, neck, chest, abdomen, pelvis, extremities, and back. No signs of trauma, abdomen soft, no limb deformities.
9. History (if possible)
- Collect medical history: From bystanders, family, or medical records if available.
- Example: A bystander says Ramesh collapsed suddenly, wearing a medical alert bracelet indicating diabetes. No known allergies.
10. Ongoing Monitoring
- Regular reassessment: Continuously monitor and reassess vital signs and GCS.
- Example: Check Ramesh’s vital signs and GCS every 5 minutes until stable or further help arrives.
11. Documentation
- Document findings: Record all observations, assessments, and interventions.
- Example: Note the time of assessment, vital signs, GCS score, and any treatments provided for Ramesh.
12. Preparation for Transfer
- Prepare for transport: Ensure the patient is stable for transfer to a higher level of care.
- Example: Secure Ramesh on a stretcher with appropriate immobilization if there is suspected spinal injury. Transport to the emergency department.
Example Scenario Application
Scenario: Ramesh, an unconscious adult male, is found lying on the sidewalk.
1. Scene Safety: Ensure no traffic or environmental hazards.
2. Check Responsiveness: Call out, "Ramesh, can you hear me?" and gently shake his shoulder.
3. Airway: Head-tilt, chin-lift; no visible obstruction.
4. Breathing: Chest rising, breath sounds present, normal rate.
5. Circulation: Carotid pulse present, skin pale but warm.
6. Disability: Pupils equal and reactive; GCS score 8 (eyes 2, verbal 2, motor 4).
7. Exposure: No major injuries visible; medical alert bracelet indicates diabetes.
8. Vital Signs: BP 110/70 mmHg, HR 80 bpm, RR 16/min, SpO2 98%, temp 36.5°C.
9. Head-to-Toe Exam: No signs of trauma, abdomen soft, no limb deformities.
10. History: Witness says Ramesh collapsed suddenly, no known allergies.
11. Monitoring: Reassess every 5 minutes.
12. Documentation: Record all findings and interventions.
13. Prepare for Transfer: Ensure stable for transport to the emergency department.
