Immediately call 911! (Call number 112)
Securing vital functions according to ABC scheme (scheme of measures within the framework of ACLS (Advanced Cardiac Life Support)):
- A (“Airway”): clear the airway and keep it open.
- B (“Breathing”): ventilate
- C (“Circulation“): compression of the chest (thorax) , ie performing chest compressions (HDM).
As far as possible neurological history or foreign history, as well as findings.
Almost all patients comatose on arrival in the emergency department require further intensive therapy.
Therapy for impaired consciousness depends on the cause.
Conventional nonsurgical therapeutic procedures
A Glasgow Coma Scale (GCS; see “Physical Examination” below) score of 8 or less indicates very severe brain dysfunction and a risk of life-threatening respiratory failure. If the GCS score is less than or equal to 8, securing the airway by endotracheal intubation* must be considered.
* Intubation is the insertion of a tube (a hollow probe) through the mouth or nose to secure the airway. It may involve insertion of an oropharyngeal tube (through the mouth, such as the Guedel tube) or a nasopharyngeal tube (through the nose, such as the Wendl tube). Both end in the pharynx and hold the tongue away from the posterior pharyngeal wall. Thus, intubation allows spontaneous breathing or ventilation with a resuscitator. In the above endotracheal intubation, an endotracheal tube is inserted through the mouth (orotracheal) or nose (nasotracheal) between the vocal folds of the larynx (voice box) and into the trachea (windpipe). This is performed in patients in unconsciousness (impaired consciousness), anesthesia, or acute respiratory failure to secure the airway from aspiration (inhalation of endogenous secretions such as saliva or gastric juice) and to allow external ventilation.
