General Examination of an Unconscious Patient

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.