Assessing Consciousness Flashcards
How do you rapidly assess consciousness?
A: Alert- is the person alert?
V: responds to voice- can they respond without prompting? Do they only respond to your voice? Drowsy?
P: respond’s to pain- e.g. only respond when earlobe is pinched, groaning or grunting.
U: Unresponsive- no response from any previous tests.
What is the Glasgow Coma Scale?
Assesses the patients neurological condition- do they have specific issues due to consciousness? Brain injury?
Gives a value range 3-15.
3= totally comatose patient.
15= fully alert patient
What are the three stages of the Glasgow Coma Scale?
SEVERE: 3-5- may not recover
MODERATE: 9-12- may recover but cause for concern
MILD: 13-15
How do you score eye-opening?
SPONTANEOUS= 4: open eyes as you walk towards them.
TO SPEECH= 3: Responding to speech
TO PAIN= 2: Only respond to pain
NONE=1: eyes won’t open
How do you score verbal responses?
ORIENTATED= 5: Ask questions e.g. what day of the week is it, who's the prime minister, what time is it? This assesses if they know time or place. Keep one question the same each time you ask to not confuse patients. DISORIENTATED= 4: Answer wrong but after pressing they correct themself. MONOSYLLABIC= 3: Only answer with monosyllabic answers, as there has been a change in speech ability. INCOMPREHENSIVE= 2: Not forming words, just making sounds. NONE= 1: No verbal response.
How do you assess motor response?
OBEYS COMMANDS= 6: can raise hands, push against hands and raise legs etc.
LOCALISES PAIN= 5: Can’t obey commands but if you press fingertips they can tell you it’s sore.
WITHDRAWAL TO PAIN= 4: Don’t have to vocalise pain but withdraw.
FLEXION TO PAIN= 3: flexing away from pain.
EXTENSION TO PAIN= 2: can be normal or abnormal.
NONE= 1: No response.
What is normal and abnormal flexion?
Normal (extension posturing): e.g. pain to hand, they are moving their hand away in an abnormal way.
Abnormal flexion: they are flexing lower and upper limbs in an abnormal way, e.g. towards pain.
What are the most common causes of a decreased conscious level?
Intracranial haemorrhage: bleeding into the brain, blood starts occupying the space where the brain tissue is, and there is nowhere for the brain to swell, causing pressure on the brain.
Cerebral infarction: A clot dispersed into the brain tissue causing a blockage, reducing blood supply to that area, which can cause tissue death.
Intracranial infection: e.g. meningitis- look for other meningitis signs.
Hypothermia- shut down because they were in a clod situation.
Hyperthermia- too hot, may be due to sepsis
hypothyroidism- undiagnosed, underactive thyroid
hepatic encephalopathy- decline in brain function due to severe liver disease.
What is intercranial pressure (ICP)?
If someone has a brain injury and there is pressure on the brain tissue, resulting in pressure on the intercranial walls, making them in danger as the pressure needs to go somewhere.
How do you manage deterioration of consciousness level?
Ensure the patient’s airway is patent: maintain assessment of ABCDE. (Patent= open and unobstructed).
Give high concentration of O2 to ensure good cerebral profusion.
If ventilation is inadequate provide assisted ventilation e.g. intubated and put on ventilation equipment.
Ensure IV access and prescribe fluids as necessary.
Resuse any drug- induced CNS depression.
Measure the blood glucose and treat if it’s below 3mmol/l.
Place patient horizontally in the left lateral recovery position if they are maintaining their own breathing.
What are the problems of decreased consciousness levels?
Inability to protect airway- loss of cough and gag reflexes.
Increased risk of aspiration- breathing foreign objects into your lungs.
Can’t keep airway open and tongue can fall back and block it.
Skin damage- not moving themselves, stationary.
Corneal ulceration- ulcer on the front of eye, make sure that when there is induced unconsciousness eyes are kept lubricated and they are kept moving.
What does consciousness depend on?
It is dependent on relatively intact functional areas within the cerebral hemispheres that interact with each other as well as with the RAS (reticular activating system).
Injury to, or disease of, the cerebral hemispheres may cause diffuse damage that can inhibit or block the signals from the RAS, depressing the level of consciousness.
The damaged cortex is unable to interpret the incoming sensory impulses and therefore cannot transmit them to other areas for appropriate action.
What are acute impaired states of consciousness?
E.g. drug or alcohol intoxication, and are potentially reversible.
What are chronic impaired states of consciousness?
Chronic states tend to be irreversible as they are caused by invasive or destructive brain legions. E.g. dementia, cerebrovascular accident (CVA), infection, severe brain injury, persistent disorders of consciousness, locked-in syndrome.
What are the characteristics of lethargy?
Orientated, slow speech, slow mental process, slow motor activities.
