WhiteCoat

Waking “Unresponsive” Patients

Ever have a patient who is brought in “unresponsive”? You know — the ones who blink their eyes when you touch their face and the ones whose hands always seem to drift to the side when held over their face and dropped. How to wake them??? Here’s a list of techniques that have been suggested by various authorities on the matter.

Painful stimuli are the most commonly used techniques. Sternal rubs, pressure to the nailbeds, and pressure to the supraorbital nerves have all been employed. One authority related the story about a patient who would not get off a stretcher when brought to the ED by an ambulance because the last time he came there unconscious the “motherf***ing doctor punched me in the chest and left a bruise.” Translate that into “the physician performed a vigorous sternal rub that brought the patient out of his unconscious state.”

Ammonia inhalants sometimes work – until the patients hold their breath. Do not stick one inhalant in each nostril and squeeze. Doing so could cause chemical burns.

Dripping water on the forehead or eyes also seems to work fairly well. This one has few side effects, but either dress in protective gear or have a towel ready in case the patient suddenly wakes up spitting.

One authority suggested inserting a cotton swab down the patient’s nostril. The authority stopped performing this maneuver when one patient suddenly turned her head to the side and the cotton swab snapped off in her nose.

Fear Factor: Saying in a loud voice “OK, lets cut the clothes off and put the catheter in the bladder” also seems to work. One expert on the matter related a story about a gentleman who was chronically intoxicated and repeatedly came to the emergency department “unconscious.” The paramedics repeatedly cut off his clothing, including his winter coat, in order to assess for occult injuries. After the patient sobered up, the ED staff would call his parents and tell them that he needed a set of clothing and a ride home. At one point the patient’s exasperated father politely asked “would you please stop cutting off his clothes . . . we have bought seven new coats in the past two months.”

Any new techniques we are missing?

2 Responses to “Waking “Unresponsive” Patients”

  1. scalpel says:

    Pop an ammonia capsule and quickly drop it into a 60cc syringe. Stick the tip into one nostril, occlude the other nostril, and quickly press the plunger. Step back quickly.

  2. SeaSpray says:

    I’m pretty sure they twist the patient’s nipples in the ER I worked with and once they even got reception. They lost it though when they wheeled the pt down to CT. ;)

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