How Healthcare Providers Define Whether You're Really Unconscious

By Cristiano Antonino On Jun 24, 2022

When a person is unaware of their surroundings and unable to respond, this is described as being unconscious. Unconsciousness is a medical emergency, and it is often a sign of a serious health issue that could result in death or permanent disability

If you encounter a person who is unconscious, call for urgent medical attention and try to provide as much information to emergency medical responders as possible.

There are many causes of unconsciousness, and the medical team will work on identifying the cause while treatment is started.

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What Is Unconsciousness?

Consciousness is a spectrum. Being fully awake, alert, and oriented to your surroundings is the most common and normal state of consciousness. Altered levels of consciousness include normal stages of sleep, as well as states of diminished awareness due to illness or medication.

Unconsciousness includes:

General anesthesia, a medically induced state of unconsciousness that can be reversed when it’s time to wake up after surgery
Being unresponsive and unarousable to smells, touch, noises, or pain due to illness
Coma, unconsciousness that has lasted for a long period of time1

Unconscious patient: signs or Symptoms

During a period of unconsciousness, a person is not arousable, and will not respond or have any control of themselves.

Unconsciousness can occur suddenly, or it may develop gradually, depending on the cause.

A person might feel sick, dizzy, short of breath, have chest pain, or might feel lethargic or faint before becoming unconscious.

Lethargy is a state of being awake, but with diminished alertness and diminished ability to respond.

After recovering from unconsciousness, it usually takes hours, days, or longer to regain full awareness and ability to respond.

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Symptoms of unconsciousness include:

Appearing as if asleep
Unarousable and unresponsive
Not deliberately moving the body
May have involuntary physical movements, such as jerking, spasms, or seizures
Might vomit
Incontinent of urine and stool
Sometimes unable to urinate or have a bowel movement, leading to retention (which can be dangerous)
Might breathe on their own or have impaired breathing

Associated symptoms are typically related to the cause.

For example, a person who is unconscious due to sepsis or septicemia (severe infection and consequences of infection), could also have a fever, skin changes, and organ failure.

Causes

Consciousness is a function of the brain.

An altered level of consciousness is a sign that a medical condition has affected brain function.

Many different medical conditions can affect consciousness.2

For example, cardiac arrest leads to a sudden loss of consciousness because blood stops flowing to the brain. In cardiac arrest, the brain isn’t the problem—the heart is.

However, the loss of consciousness is the indicator of the problem.

Causes of altered levels of consciousness can be summarized with the mnemonic AEIOU TIPS:3

A – Alcohol: The amount of alcohol that can cause a person to lose consciousness varies from one person to another. For example, a person who takes medications that interact with alcohol or who has liver disease can become unconscious after drinking a relatively small amount of alcohol.

E – Epilepsy or exposure (heat stroke, hypothermia)

I – Insulin (diabetic emergency)

O – Overdose or oxygen deficiency: A recreational drug or medication overdose can cause loss of consciousness. Oxygen deficiency can occur due to heart or lung disease.

U – Uremia (toxins due to kidney failure)

T – Trauma (shock or head injury)

I – Infection

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P – Poisoning; This can occur due to ingesting toxins (such as a chemical cleaner) or as a result of organ failure, which can cause toxins to build up in the body.

S – Stroke

When a person is unconscious, the brain is functional

Unconsciousness is not the same as brain death. Brain death is a condition in which the brain is not functioning, and it can occur when the same medical issues that cause unconsciousness lead to severe and permanent brain damage.

Unconscious patient, First Aid

If someone is unconscious, you can take steps to assist while you are waiting for professional medical help to arrive.2

Things you can do include:

Check if they are breathing
Try to feel their pulse
Administer CPR if they need it and you know how to do it
Use the Heimlich maneuver if they need it and you know how to do it
Cover them with a warm blanket if the temperature is too cold
Place an ice pack on them if the temperature is too hot

What to Avoid

Do not place anything in their mouth
Do not administer medication
Do not move their neck or back—this can cause permanent paralysis if the spine is injured

Treatment of unconscious patient

Unconsciousness is treatable.

Immediate treatment can result in improved awareness, and it can also prevent death or lasting health effects.

Treatment involves urgent care to manage the immediate problem, as well as long-term care.

Treatment can include:

Non-invasive oxygen administration
Intravenous fluids
Medication to treat an acute heart condition
Cardioversion, in which electric shocks are administered on the chest
Medication to stop a seizure
Mechanical breathing support
Intubation
Many of these treatments can be started by first responders on the way to the emergency department.

References:

Maiese K. Overview of coma and impaired consciousness. Merck Manual Professional Version.
MedlinePlus. Unconsciousness—first aid.
Morrissey T. Altered mental status. Society for Academic Emergency Medicine.
Sattin D, Magnani FG, Bartesaghi L, et al. Theoretical models of consciousness: A scoping review. Brain Sci. 2021 Apr 24;11(5):535. doi:10.3390/brainsci11050535