Page 134 - PJ MED OPS Handbook 8th Ed

Loss of Consciousness (Without Seizures)

SPECIAL CONSIDERATIONS:
1. The most common cause of loss of consciousness in healthy adults is orthostatic hypo-
tension (associated with sudden standing) or vasovagal syncope (associated with sudden
adverse stimulus – injections are a common cause).
2. Also consider hypoglycemia, anaphylactic reaction, medication, recreational drug use,
head trauma, hyperthermia, hypothermia, myocardial infarction, lightning strikes, and
intracranial bleeding.

Signs and Symptoms:
Unconsciousness
Management:
1. Follow BLS guidelines.
2. Management of orthostatic hypotension and vasovagal syncope is accomplished by placing the
patient in a supine position, ensuring the airway is open. Patients experiencing these two disor-
ders should regain consciousness within a few seconds. If they don’t, consider other etiologies
and proceed to the steps below.
3. Pulse ox monitoring and supplemental O2 for O2 sat <90%.
4. Sugar or energy gel in buccal mucosal region for hypoglycemia.
5. IV fluid for dehydration.
6. Naloxone (Narcan) 0.8mg IV/IM for opioid overdose/pinpoint pupils. Repeat q2–3min PRN
to max dose of 10mg.
7. Antibiotics for fever or suspected severe infections, sepsis.
8. Epi, Benadryl, Decadron, Pepcid for suspected anaphylaxis.
9. If no response treat per appropriate Protocol per Special Considerations #2.

DISPOSITION:
1. Urgent evacuation, unless loss of consciousness due to orthostatic hypotension or vaso-
vagal hypotension.
2. The evacuation package should include personnel certified in Advanced Cardiac Life Sup-
port (ACLS), with equipment, supplies and medications necessary for ACLS care.

132 n Pararescue Medical Operations Handbook / 8th Edition