State of consciousness

The state of consciousness represents, at the victim of an accident, a disease or a faintness, the first stage of the neurological evaluation. The Conscience is one of the vital Fonctions, which ensures the survival of the person while enabling him to have a behavior adapted to the environment, and of share the reflexes of protection of the air Routes (Déglutition, Toux, muscular tone, in particular of the Sphincter Cardia, language and épiglotte…). The loss of these reflexes represents a danger to the person since it does not protect her air Routes spontaneously any more and is thus likely to die choked.

The evaluation of the conscience is done in three stages:

  1. absence/presence of the conscience:
  2. * if the person speaks or moves spontaneously, it is known as conscious,
  3. * if not, one takes the hand to him, one raises a simple question to him (standard you hear me?) and him a simple order is given (standard open the eyes!) ; if it reacts, it is known as conscious, if not it is known as unconscious,
  4. quality of the conscience:
  5. * if a person is conscious, one speaks to him and one asks him questions to determine if,
  6. ** it speaks in a coherent way, is directed (knows where it is, knows the date,…),
  7. ** speaks in a coherent way but is disorientated, presented a loss of initial conscience,
  8. ** speaks in a way incoherent or incomprehensible,
  9. ** is somnolent and reacts only to the word or with the touch,
  10. * if it is unconscious and that it breathes, one causes a pain but without causing wound (for example one presses to him on the nails) to determine if it reacts to the pain or if it does not react;
  11. a doctor, or possibly a male nurse, tests other reflexes to look further into the neurological assessment.
One can use the scale of Glasgow to quantify the state of consciousness. The determination of the state of consciousness is one of the elements of the assessment of first aid and of the assessment of first-aid worker. In a context of first aid, one uses sometimes the scale AVPU.

Action to be taken vis-a-vis the deterioration of the conscience

The deterioration of the conscience is a Symptôme. The most dramatic case is that of the cardiac arrest, which requires to call the helps and to undertake a Réanimation cardiopulmonaire.

If the person does not react but breathes, it is necessary to protect its air routes, by putting it on the side (in side Position of safety) even by Intubation trachéale, while waiting to determine the cause of this state.

If the person is conscious but present disorders of the conscience (somnolence apart from the natural rate/rhythm of the sleep, incoherent or incomprehensible words, fast and incomprehensible changes of mood, aggressive attitude,…), it is necessary to alert the helps and to describe the state of the person to them, then to follow their instructions.

For the reasons of the loss of conscience and the medical assumption of responsibility, to see the article Coma .

Normal states of the conscience

The physiologists distinguish at least three normal states from the conscience:

  • active awakening;
  • the slow sleep;
  • the paradoxical Sleep (with fast ocular movements and excitation of the sexual organs).
In these three well-known states, one can add a fourth state of consciousness which is spontaneously at the drowsiness and which is systematically cultivated by the methods of relieving. This state received several denominations “fourth state” (Wallace, Benson), “state sophropnic” (Caycedo), “state of paradoxical awakening” (Auriol followed by Roustang), etc

There exist also states modified of conscience.

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