GENERAL SYMPTOMS
UNCONSCIOUS (OR SEMICONSCIOUS) VICTIM
As discussed in detail in the section “Major Medical Problems” (see page 21), a proper approach to the unconscious (comatose) victim may make the difference between life and death. You must evaluate the semiconscious (stuporous, dazed, confused, or combative) individual with the same degree of concern. To discover the cause of an altered mental status, you must be a bit of a detective, while also performing the tasks that prevent the victim from hurting himself. Always assume that an unconscious person may be seriously injured.
1. Open and maintain the airway (see page 22). Check for adequacy of the pulse (see page 33).
2. Protect the cervical spine (see page 37). Every injured person has a broken neck until proven otherwise.
3. Carefully examine the victim for evidence of an obvious injury and treat accordingly.
4. Consider low blood sugar, and treat the victim with glucose if he is alert enough to cooperate (see page 142). If not, and glucagon for injection is available, consider its use (see page 143).
1. Don’t shake a victim vigorously to awaken him without first protecting the neck. Never shake a victim to awaken him if you suspect that hypothermia (see page 305) is present. If you think that the victim is merely intoxicated, you may snap an ammonia inhalant or hold “smelling salts” under his nose, and allow him a few whiffs to stimulate awakening. If there is any chance of a neck injury, do not perform this maneuver without maintaining the head and neck in a stable position.
2. Don’t attempt to carry an unconscious victim or manage a belligerent person if this might exhaust you. Send someone for help and stay with the victim until help arrives.
3. Unless there is no other way to get lifesaving help, never leave an unconscious or dazed person unattended.
FAINTING
Fainting is defined as sudden brief loss of consciousness not associated with a head injury. There are innumerable causes of fainting, but most episodes are associated with decreased blood flow (oxygen and/or glucose) to the brain. This may be caused by low blood sugar (hypoglycemia—see page 142), slow heart rate (vagal reaction, in which the vagus nerve, which slows the heart rate, is overstimulated: fright, anxiety, stomach irritation, bowel dilation, drugs, fatigue, prolonged standing in one position), rhythm disturbances of the heart, dehydration, heat exhaustion, anemia, or bleeding.
After a victim suffers a fainting episode, he should be examined for any sign of serious illness or injury. If you don’t suspect anything serious, have him lie still for a few minutes, and then sit for a few minutes. If the victim is alert and capable of purposeful swallowing, offer him cool sweetened liquids to drink—preferably one that contains electrolytes (see page 208)’to correct dehydration. When the victim feels normal, he may slowly regain an upright posture. If the victim is elderly, and particularly if his pulse is irregular or he has chest discomfort, seek immediate medical assistance. Anticipate a heart attack (see page 50).
FATIGUE
Fatigue (lethargy, tiredness, exhaustion, generalized weakness, decreasing exercise tolerance) can be a sign of any disorder or dysfunction that diminishes a person’s energy level. Accompanied by fever, it can be indicative of an infection; accompanied by certain associated symptoms, it may indicate a hypoactive thyroid. In the outdoors, anyone who began the trip in good condition but is now fatigued should be examined carefully for signs and symptoms of hypothermia (see page 305), hyperthermia (see page 322), high-altitude illness (see page 335), infection, mental depression (see page 301), anemia (pale membranes inside the eyelid, pale fingernail beds, sallow skin complexion), dehydration (see page 207), or starvation. A diabetic who becomes fatigued may suffer from high or low blood sugar (see page 142). If fatigue is accompanied by shortness of breath, do not travel any farther from civilization until you determine a treatable cause, or the victim clearly improves. Sudden onset of fatigue can be indicative of a heart attack (see page 50).
In a situation of extreme exercise within a particular muscle group—the legs during forced or military-style marching, or long-distance or marathon running; the arms during repetitive, relentless exertion such as weight lifting—muscle tissue can be broken down. This is more common under conditions of environmental heat (see page 322). Substances (particularly myoglobin, a pigment that carries oxygen) are released into the bloodstream, which in large concentrations can cause the kidneys to fail. The victim has very darkened (brown) urine (myoglobinuria), sore muscles, and extreme fatigue. In this situation, remove the victim from environmental heat, place him at as near complete rest as possible, and encourage him to drink as much liquid as he can to correct dehydration and flush the pigment from his system (see page 208).
