I have a 23-year-old woman with an obvious head wound (she got hit with the butt of a gun, but the first responders don’t know that) who’s been outside in 20’ish degree weather without a coat for an undetermined amount of time. She’s unconscious. Obviously an IV is started, but what else will paramedics do to treat her? Warming blankets? What would happen when she got to the ER?
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For an unconscious patient with an obvious head wound, but is unable to tell how her injury happened should be placed in C-spine precautions. That means C-collar and backboard. IV– yes. And warming. They’d get a set of vital signs, put her on a monitor and then do a full assessment to look for other injuries.
Checking her blood sugar is warranted because why is she unconscious? Did the injury to her head happen because she passed out from low blood sugar? Or is it too high? Looking for medical alert bracelets as well. They’d probably key in on a good neuro exam like are her pupils equal and reactive to light? What type of stimulation does she respond to (voice, touch or pain?) They might even give a dose of Narcan to rule out opiate overdose (like heroin.)
In the ER:
Full assessment as above and we’ll look for other injures. We’ll maintain C-spine precautions. She would be completely undressed (again– looking for other injuries.) We have a better ability to monitor temperature so we’ll know exactly where she’s at and work to rewarm her. This could range from warm blankets to warming lights and heated IV fluids. Full set of vital signs. We’d place her on the monitor as well to watch her HR, breathing and oxygen levels continuously.
As far as testing and procedures go, if she remains unconscious, I would say the following:
1. Spine X-rays.
2. CT of the head (to look for bleeding, stroke, tumor.)
3. Labs: Full metabolic panel (this will check blood sugar again), complete blood counts, alcohol level, aspirin level, Tylenol level. Tylenol and aspirin are drugs people will overdose on that can be very serious.
4. Urine toxicology panel (this would pick up on major substances of abuse but not everything.) Also urine pregnancy test.
5. ECG. To see if a heart arrhythmia or heart attack could be an explanation for her passing out.
Unless we know the exact mechanism of the injury we have to consider both inflicted wounds from another person but also that she might have just passed out and hit her head and what the reason for that might be.
If she’s truly unconscious and doesn’t respond to pain– she’d likely get a tube in every orifice as they say and they’d have to consider whether or not to intubate her (put a breathing tube in) to protect her airway. If that happens, then NG tube (placed probably through the mouth into the stomach) and a Foley catheter which drains your urine into a bag.
If she’s somewhat responsive but immediately drifts off– they could hold off on tube placements, check the tests I’ve listed, and give her some time to see if she wakes up on her own if she’s breathing well on her own.