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Chapter 42 — 2
D and R - DANGER and RESPONSE
DANGER
It is important to protect yourself, others and the victim from further injury. It includes retrieval of
the victim from a drowning or hypothermic situation, protection from marine animal injuries (shark
attack, chironex tentacles etc.) and avoidance of physical trauma from boats, surf etc.
RESPONSE. Is the Victim Conscious?
Most problems arise in an unconscious victim. If the victim appears unconscious, confirm this by
shouting at him and squeezing the shoulder. If the victim does do not respond, he is probably
unconscious. If the victim is
conscious
he will normally take care of his own airway and breathing.
Exceptions to this are the sea snake, blue ringed octopus or box jellyfish (Chironex) envenomation,
where the victim may be conscious but paralysed. In these cases the victim will not respond to
shouting, so the management for an unconscious victim (which is appropriate) will be undertaken.
If the victim is
unconscious
he will be in danger of hypoxic hypoxia from obstruction of the airway
or inhibition of breathing, or of stagnant hypoxia from lack of circulation (see Chapter 20).
With an unconscious victim
, take care of the following systems:
• AIRWAY
• BREATHING
• CIRCULATION
This is easily remembered by the mnemonic — A-B-C.
Maintenance of airway, breathing and circulation takes precedence over other forms of care. Without
these functions, the victim is certain to die.
A — AIRWAY
An unconscious victim loses muscle control. Loss of control of the muscles of the throat and tongue
can cause the airway to become obstructed. This is particularly likely when the victim is lying on his
back, mainly due to the tongue falling backwards into the throat, due to gravity.
The airway can be further obstructed by vomit, saliva or foreign material. This would normally be
swallowed or spat out by a conscious person, while any material which entered the larynx or trachea
would elicit the reflexes of coughing and laryngeal closure. These reflexes may be lost in the
unconscious patient.