How can you assess consciousness

Finally, reassess AVPU during treatment and transport. Monitoring AVPU and other vital signs will help determine if the patient is improving, worsening or responding to treatment. Greg served as the EMS1 editor-in-chief for five years. He has a bachelor's degree from the University of Wisconsin-Madison and a master's degree from the University of Idaho. He is an educator, author, national registry paramedic since , and a long-distance runner. Greg was a recipient of the EMS 10 Award for innovation.

He is also a three-time Jesse H. Connect with Greg on Twitter or LinkedIn and submit an article idea or ask questions with this form. You must enable JavaScript in your browser to view and post comments. More EMS1 Articles. More Product Listings. More Product news. Make EMS1 your homepage. How to buy personal protective equipment eBook.

A complete lack of eye opening is given a score of one. A patient with flaccid ocular muscles may lie with her or his eyes open all the time. Such a response should not be documented as spontaneous eye opening. If a patient is dysphasic, best verbal response cannot be determined with accuracy.

All three components must be identified correctly for a patient to be classified as orientated. Such a patient is allocated a score of five. A patient is classified as confused when one or more of the above questions are answered incorrectly.

A patient who is confused is allocated a score of four. A patient is classified as using inappropriate words when conversational exchange is absent, that is, she or he tends to use single words more than sentences. Swearing is also common. A patient who is using inappropriate words is allocated a score of three.

A patient is classified as using incomprehensible sounds when her or his words and speech cannot be identified. A patient may be mumbling, groaning or screaming. A patient who is making incomprehensible sounds is allocated a score of two. A lack of verbal response is allocated a score of one. The patient must grip and ungrip to discount a reflex action. If there is any doubt, the patient should be asked to raise her or his eyebrows. A patient who obeys the commands achieves a score of six.

If the patient is unresponsive to verbal commands she or he should be assessed for response to a painful stimulus. It is important to differentiate between localising to pain and flexion to pain: localising is a purposeful response and an indication of better brain function; flexion is not seen as a purposeful response and may be a reflex action.

Supraorbital ridge pressure is considered to be the most reliable and effective technique for distinguishing localising from flexion or abnormal flexion as the observed response to this method is less likely to be misinterpreted.

A painful stimulus is applied to the supraorbital ridge to stimulate the supraorbital nerve. In the presence of facial fractures or gross eye swelling, pinching the earlobe is more favourable than applying supraorbital ridge pressure. To be classified as localising to pain, a patient must move her or his hand to the point of stimulation, bringing the hand up beyond the chin and across the midline of the body. Eyes are open and focused; the patient can recognize you and follow eye movements.

The patient opens his eyes when spoken to or when directed to do so. The patient opens his eyes when given some sort of painful stimuli. The patient can talk and answer questions about his location, time, and who he is.

In some situations, it is also appropriate to question the patient to see if he is oriented to the event that led him to be in his current condition. The patient can talk and speak coherently, but is not entirely oriented to person, place, time, and event. The patient answers with some sort of inappropriate response to the question that was asked or answers with excessive use of profanity that is not associated with anger toward the event.

The patient can follow appropriate commands or requests. It is also important to asses the patient for the ability to follow commands across the central plane of the body. Conscious patients are awake and responsive to their surroundings Marcovitch, The level of consciousness has been described as the degree of arousal and awareness. A manifestation of altered consciousness implies an underlying brain dysfunction.

Its onset may be sudden, for example following an acute head injury, or it may occur more gradually, such as in hypoglycaemia.

A range of situations can lead to altered consciousness. These include: profound hypoxaemia; hypercapnia; cerebral hypoperfusion; stroke; convulsions; hypoglycaemia; recent administration of sedatives or analgesic drugs; drug overdose; subarachnoid haemorrhage; and alcohol intoxication Resuscitation Council UK, ; Wyatt et al, Staff caring for a patient with a head injury admitted for observation should all be able to assess:.