Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

Featured on Channel NewsAsia

Unconsciousness

Whether or not the injured person is unconscious at the time of examination, head injuries should always be
regarded as potentially serious because grave complications can ensue.

Measures at the scene of injury
It is important to note that head injuries are associated with a high incidence of cervical spine injuries.Therefore all maneuvers must protect the cervical spine. In all unconscious patients it must be assumed that the patient has a neck and spinal cord injury.It is of vital importance to ensure immediately that the unconscious person has free air passage and is breathing normally. Obstruction of the airways in an unconscious individual due to any condition can cause death, and if breathing or heart activity stops for longer than 3–5 minutes, permanent brain damage occurs.

An injured person who is breathing unaided should not be moved except to remove anything that may obstruct the airway. If a safety helmet is worn, do not attempt to remove it—removal risks further injury to any neck problems. Access to the face can be obtained by removing any face guards.
If the injured person is not breathing, artificial respiration must be commenced, using mouth-to-mouth resuscitation. The injured person is placed in a supine position. Care must be taken to protect the neck while moving the patient; this requires several people, with one person in charge of holding the head to keep the neck and spine aligned correctly. Once the patient is supine, artificial respiration is started:

– the mouth cavity is cleared of objects such as dentures, loose teeth, soil, or vomit.
– the lower jaw is pulled up and the head tilted slightly backwards. The tongue of an unconscious person can fall against the back wall of the throat and obstruct breathing. Slight backward tilting of the injured person’s head and support of the chin is usually sufficient to free the air passages. One hand is put on the injured person’s forehead while the other supports the chin to pull the jaw forward. Care must be taken to avoid excess neck extension that could cause further injury.
Mouth-to-mouth resuscitation To administer mouth-to-mouth resuscitation (the ‘kiss of life’), take a deep breath, open your mouth wide and press it as closely as possible to that of the injured person (Figure 15.2). If it is an adult, pinch the nostrils closed and breathe out strongly into the mouth at the same time. (The patient’s chest should heave if this is done correctly.) Then lift your head, turn it sideways and breathe in while the patient breathes out.

Blow in at a rate of about 12 times a minute for adults, that is, once every 5 seconds. If the patient is a child, blow in more frequently, more gently, and preferably through the patient’s nose and mouth simultaneously.
Do not stop until the patient begins to breathe independently.
In addition, after two breaths, the patient’s pulse should be checked. If no pulse is present, cardiac chest compression should begin, following the guidelines from the American Heart Association for basic
cardiopulmonary resuscitation.
– The unconscious person should be taken to hospital as soon as possible,
– While waiting for transport the patient should be kept covered and something warm, such as a blanket,
should be placed beneath the person’s body.
– Give nothing to drink to a person who is or has been unconscious.
– Never leave anybody who is or has been unconscious alone.

Complications
In cases of head injury, it may take hours or days for evidence of complications to appear. Internal bleeding from ruptured blood vessels may occur even if there is no bony injury to the skull, and unless controlled will gradually compress the brain . The increased pressure on the brain tissues can affect the breathing center, and breathing may stop. Only an immediate operation to stop the bleeding and relieve the pressure will give the injured athlete a chance to recover. Bleeding from the ears or bleeding with a simultaneous flow of fluid from the nose suggests that a fracture of the base of the skull may have occurred. This may indicate a very severe injury and requires
emergency room evaluation. A variety of different techniques may be used for investigation, including Xrays, specialized scans and ultrasonography.

Comments are closed.