Assessment of level of consciousness Flashcards
What is the initial assessment of a patient who seems to have an impaired consciousness?
Airway
- Jaw thrust
- Nasopharyngeal airway
- Suction (if obstructed and can see)
- High concentration oxygen
Breathing
- Mask misting
- Chest movement
- (Breath sounds)
- Indicator mask
- Assist - intubation
Circulation - Signs of circulation (pulse, breathing effort, coughing, movement) - Capillary return - IV access/BM stix
Disability - AVPU, (GCS, pupils)
- Alert, Verbal, Pain, Unresponsive
2 line history
Tell me about suction in first line treatment.
Intermittent suction
Suck between teeth and cheek
Don’t such where you can’t see
Attention to detail, aspiration, hypoxia and coughing all bad for the brain
What are some immediate treatments for someone in life threatening condition?
Hypoxia - High flow oxygen
Hypoglycaemia - Glucose IV
Fitting - Lorazepam IV
Opiate OD - Naloxone IV+IM
What sort of full evaluation do you do in a life threatening case? (Once patient is stabilised)
History - Onset, pattern of change, previous episodes Examination - GCS, neurological, cardiovascular Investigations - Target to differential - CT scan when there is uncertainty
What are some scoring systems to assess consciousness?
First signs of impairment of consciousness
AVPU
Glasgow Coma Score
Tell me about first signs (assessing consciousness)
(Subtle) Change in behaviour Change in mood Unsteady on feet Difficulty finding words Slurring of speech
How is GCS worked out?
Best eye response - 1 to 4
Best verbal response - 1 to 5
Best motor response - 1 to 6
Record as a score out of 15
Eye opening 4 - Spontaneously 3 - To speech 2 - To pain 1 - None
Verbal response 5 - Orientated 4 - Confused 3 - Inappropriate words 2 - Incomprehensible 1 - None
Motor response 6 - Obeys commands 5 - Localise pain 4 - Flexion to pain 3 - Flexion/withdrawal 2 - Extension to pain 1 - None
What is important regarding GCS and patterns of change?
Reflection of global brain function
A change in GCS means a change in brain function
This is way more important than one score alone, continuous assessment means you can see if there is any change in brain function and so if there is a problem