How to care for a patient who is unresponsive?

According to the American Heart Association, less than 40% of adults receive CPR from a non-medically trained bystander during an emergency. Understanding how to care for a patient who is unresponsive is critical for improving outcomes and potentially saving a life.

Quick Summary

Begin care for an unresponsive person by ensuring the scene is safe, then call for emergency medical services immediately. Follow the 'shout-tap-shout' method to check for responsiveness and assess their breathing. Based on their condition, place them in the recovery position if breathing, or begin CPR if not, continuing to monitor them until help arrives.

Key Points

• Immediate Response: The top priority is ensuring the scene is safe, then immediately calling 911 or your local emergency number for an unresponsive patient.

• Check Responsiveness: Use the 'shout-tap-shout' method to confirm unresponsiveness and assess breathing, looking, listening, and feeling for breath for no more than 10 seconds.

• Recovery Position: If the patient is breathing normally and does not have a spinal injury, place them on their side to keep their airway open and prevent aspiration.

• Perform CPR: If the patient is not breathing normally, begin chest compressions immediately at a rate of 100-120 per minute. Add rescue breaths if you are trained.

• Prevent Complications: For long-term care, focus on preventing bedsores by regular repositioning, maintaining hygiene, and providing proper nutrition under medical supervision.

• Ongoing Monitoring: Continuously monitor vital signs and neurological status to detect changes, and provide sensory stimulation even if the patient appears unaware.

Immediate Steps: What to Do First

When faced with an unresponsive patient, your swift and calm actions are crucial. The initial priority is to ensure safety for both you and the patient, and to activate the emergency response system immediately. This is not the time for hesitation.

Assess the Scene and Ensure Safety

Before you approach, quickly scan the area for any potential dangers, such as live electrical wires, a fire, or oncoming traffic. Only proceed if it is safe to do so. Your safety is paramount, as you cannot help if you become a casualty yourself.

Check for Responsiveness

To check if the patient is unresponsive, use the 'shout-tap-shout' technique:

1. Shout: Call out loudly, asking if they are okay. Use their name if you know it.
2. Tap: Gently but firmly tap the patient's shoulder (for an adult or child) or flick the bottom of their foot (for an infant).
3. Shout again: Repeat the verbal query. If there is no response, they are unresponsive and you must proceed immediately.

Call for Emergency Medical Services (EMS)

As soon as you determine the patient is unresponsive, call 911 or your local emergency number. If others are present, delegate this task clearly by pointing to a specific person and instructing them to call for help and to retrieve an Automated External Defibrillator (AED) if one is nearby.

Basic Airway and Breathing Management

Effective airway management is a primary concern for any unconscious or unresponsive patient. The tongue can relax and block the airway, a common cause of breathing difficulties in this state.

The Recovery Position

If the patient is breathing normally and does not have a suspected spinal injury, place them in the recovery position. This prevents the tongue from blocking the airway and allows fluids (like vomit) to drain from the mouth. To do this:

1. Kneel beside the patient.
2. Straighten their legs.
3. Place the arm nearest to you at a right angle to their body, with their elbow bent and palm facing up.
4. Bring their far arm across their chest and hold the back of their hand against their cheek nearest to you.
5. With your other hand, grasp their far leg just above the knee and pull it up, keeping their foot on the ground.
6. Pull on the bent knee to roll the patient towards you onto their side.
7. Adjust the top leg so both hip and knee are bent at right angles.
8. Tilt their head back to ensure the airway is open.
9. Monitor their breathing continuously.

Performing CPR

If the patient is not breathing normally (or is only gasping) and is unresponsive, begin CPR immediately. Follow these steps:

1. Position the patient on their back on a firm, flat surface.
2. Start chest compressions: Place the heel of one hand in the center of the chest, with the other hand on top, interlacing your fingers. Push hard and fast at a rate of 100 to 120 compressions per minute.
3. Deliver rescue breaths (if trained): After 30 compressions, give two rescue breaths, each lasting one second, watching for the chest to rise. If you are not trained in rescue breathing, perform hands-only CPR, continuing compressions without interruption.
4. Continue the cycle until EMS arrives or the person shows signs of life.

Long-Term Care for an Unresponsive Patient (Professional Context)

If an unresponsive state persists and the patient is under medical supervision, long-term care becomes a complex, multi-faceted process requiring a coordinated healthcare team.

Preventing Complications

Long-term immobility poses numerous risks. Caregivers must be diligent in preventing complications like bedsores, muscle atrophy, and respiratory infections.

• Pressure Ulcers (Bedsores): Reposition the patient at least every two hours. Use pressure-reducing mattresses and cushions. Regularly inspect the skin for redness or breakdown, especially over bony areas.
• Muscle Atrophy: Perform passive range-of-motion exercises on the patient's limbs to prevent stiffness and muscle wasting. This involves gently moving their joints through their full range of motion.
• Respiratory Infections: Frequent repositioning and airway suctioning (if necessary) can help prevent pneumonia caused by stagnant lung secretions.

Providing Nutrition and Hydration

Unresponsive patients are unable to eat or drink safely, requiring alternative methods for nutrition and hydration. This is typically managed in a hospital setting and should be overseen by medical professionals.

• Feeding Tubes: A nasogastric (NG) tube or a gastric (G) tube may be used to deliver liquid nutrition directly into the stomach. Proper tube placement must be verified before each feeding to prevent serious complications.
• Intravenous (IV) Fluids: These may be used to provide hydration and essential electrolytes.

Monitoring Vital Signs and Neurological Status

Continuous monitoring is essential for tracking the patient's condition and detecting any changes.

• Vital Signs: Monitor heart rate, blood pressure, respiratory rate, and oxygen saturation regularly.
• Neurological Assessment: Use standardized scales like the Glasgow Coma Scale (GCS) to objectively assess changes in consciousness, eye-opening, and motor responses.

Psychosocial and Sensory Stimulation

Although unresponsive, patients may still be able to hear and feel things. Providing sensory input and human connection is vital for their well-being.

• Communication: Talk to the patient calmly and explain all procedures before performing them. Use a soothing tone of voice.
• Touch: Gentle touch, such as holding their hand or stroking their arm, can be comforting.
• Environment: Play familiar music, read to them, or have family and friends visit, speaking to them naturally.

Comparison of Immediate vs. Long-Term Unresponsive Care

Feature	Immediate Emergency Response	Long-Term Care (e.g., Hospital/Hospice)
Goal	Preserve life and prevent further injury.	Manage underlying condition, prevent complications, and provide comfort.
Priority	ABCs: Airway, Breathing, Circulation.	Comprehensive care: nutrition, hygiene, skin integrity, psychosocial support.
Timeline	First few minutes to hours.	Ongoing care over days, weeks, months, or years.
Location	Anywhere the patient is found.	Clinical or home-care setting with medical supervision.
Primary Responders	Bystanders, First Responders.	Nurses, Doctors, Specialists, Trained Caregivers.
Typical Interventions	Recovery position, CPR, calling EMS.	Feeding tubes, repositioning, passive exercise, medication management.

Conclusion

Caring for an unresponsive patient requires an immediate, prioritized response followed by meticulous, long-term care for persistent cases. While a bystander's quick action in an emergency can be the difference between life and death, professional medical supervision is mandatory for ongoing management. By focusing on airway, breathing, and circulation during the initial emergency, and then transitioning to comprehensive support, caregivers and medical staff can provide the best possible care. Understanding these distinct phases is essential for anyone who may find themselves in this critical situation, empowering them to act decisively and compassionately.

For more detailed, professionally vetted information on first-aid procedures and recovery positions, consult the American Red Cross.

Frequently Asked Questions

What is the very first step to take when you find an unresponsive person?

The first step is to check for safety. Assess the scene for any immediate dangers to yourself or the patient before approaching. Only after confirming it's safe should you check for responsiveness and call for help.

When should I perform CPR on an unresponsive patient?

Begin CPR immediately if the unresponsive patient is not breathing normally or is only gasping. If they have a pulse but are not breathing, start rescue breathing. If they are not breathing and have no pulse, perform cycles of chest compressions and rescue breaths (if trained).

How do I know if an unresponsive person has a spinal injury?

Assume a spinal injury if you are unsure of the cause of unresponsiveness or if it was caused by trauma, such as a fall or car accident. In such cases, avoid moving the patient's head or neck. Instead of using the head-tilt/chin-lift for the airway, use the jaw-thrust maneuver if you are trained.

What is the recovery position and when should I use it?

The recovery position is used for an unresponsive patient who is breathing normally. It involves carefully rolling the patient onto their side to help keep their airway open and allow fluids to drain from their mouth. This prevents choking and aspiration.

Can I give an unresponsive person food or water?

No, you should never give an unresponsive person any food, water, or medication by mouth. They are unable to swallow safely, which can lead to choking or aspiration pneumonia. Nutrition is provided via feeding tubes under medical guidance.

Should I shake or slap an unresponsive person to wake them up?

No, you should not shake or slap an unresponsive person. This can cause further injury, especially if a head or neck trauma is involved. Use gentle but firm verbal commands and tapping to check for responsiveness.

How often should a bedridden unresponsive patient be repositioned?

A bedridden unresponsive patient should be repositioned at least every two hours. This helps to prevent pressure ulcers, also known as bedsores, which can develop from prolonged pressure on the skin.