Thanks for the lovely comments. The issue of the unconscious patient is a challenging one. The bumper sticker answer is that there is no consensus on how to care for these types of patients. I encourage you to check out the Virtual Practicum DVD (which you can get at http://www.iafn.org if you don’t have it already). In the special topics area, there’s a great roundtable discussion about the issue. However you choose to approach these patients, my biggest piece of advice is to have a policy in place ahead of time. No one wants to hash this out at 3AM. Make sure you involve folks like Risk Management and your ED docs, as well, so everyone’s on the same page and you know people support your decision. Feel free to contact me off the site if you’d like to chat further about this.