Assessment of level of consciousness

Question 1

What is the initial assessment of a patient who seems to have an impaired consciousness?

Answer 1

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

Question 2

Tell me about suction in first line treatment.

Answer 2

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

Question 3

What are some immediate treatments for someone in life threatening condition?

Answer 3

Hypoxia - High flow oxygen
Hypoglycaemia - Glucose IV
Fitting - Lorazepam IV
Opiate OD - Naloxone IV+IM

Question 4

What sort of full evaluation do you do in a life threatening case? (Once patient is stabilised)

Answer 4

History
- Onset, pattern of change, previous episodes
Examination
- GCS, neurological, cardiovascular
Investigations
- Target to differential
- CT scan when there is uncertainty

Question 5

What are some scoring systems to assess consciousness?

Answer 5

First signs of impairment of consciousness

AVPU

Glasgow Coma Score

Question 6

Tell me about first signs (assessing consciousness)

Answer 6

(Subtle)
Change in behaviour
Change in mood
Unsteady on feet
Difficulty finding words
Slurring of speech

Question 7

How is GCS worked out?

Answer 7

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

Question 8

What is important regarding GCS and patterns of change?

Answer 8

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