assessing consciousness l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Assessing Consciousness PowerPoint Presentation
Download Presentation
Assessing Consciousness

Loading in 2 Seconds...

play fullscreen
1 / 25

Assessing Consciousness - PowerPoint PPT Presentation


  • 697 Views
  • Uploaded on

Assessing Consciousness. AVPU and Glasgow Coma Scale. Lesson objectives. Describe the common causes of a deteriorating conscious level. Describe how to assess a patient with a altered conscious level using the Glasgow coma scale.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Assessing Consciousness' - Leo


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
assessing consciousness

Assessing Consciousness

AVPU and Glasgow ComaScale

lesson objectives
Lesson objectives
  • Describe the common causes of a deteriorating conscious level.
  • Describe how to assess a patient with a altered conscious level using the Glasgow coma scale.
  • Describe the emergency management of a patient with a decreasing conscious level.
rapid assessment
Rapid Assessment
  • A Alert
  • V responds to Voice
  • P responds to Pain
  • U Unresponsive
glasgow coma scale
Glasgow Coma Scale
  • Assesses patient’s neurological condition
  • Value range 3 to 15
  • 3 totally comatose patient
  • 15 fully alert patient
classification of brain injury according to glasgow coma scale gcs hickey 2003
Classification of Brain InjuryAccording to Glasgow Coma Scale(GCS) (HICKEY 2003)

SEVERE

GCS 3-8

MODERATE

GCS 9-12

MILD

GCS 13-15

neurological chart
Neurological chart
  • GCS top section
  • Temperature/BP/pulse/respiratory rate
  • Pupil size / reaction to light
  • Limb movement – arms and legs
eye opening
Eye opening
  • Spontaneous = 4
  • To speech = 3
  • To pain = 2
  • None = 1
verbal response
Verbal response
  • Orientated = 5
  • Disorientated = 4
  • Monosyllabic = 3
  • Incomprehensive = 2
  • None = 1
motor response
Motor response
  • Obeys commands = 6
  • Localises pain = 5
  • Withdrawal to pain = 4
  • Flexion to pain = 3
  • Extension to pain = 2
  • None = 1
case 1
Case 1
  • 20 year old brought in by ambulance on stretcher/spinal board.
  • Fell down flight of stairs in night club.
  • Head injury/laceration scalp.
  • Loss of consciousness(LOC) approx10-15 mins.
  • Not speaking but groaning to pain stimuli.
  • Eyes open to pain stimuli.
  • When squeeze fingernail attempts to flex arm away from pain.
slide13

Signs of basal skull fracture

Blood or CSF from nose or ear

Periorbital haematoma

Mastoid haematoma (Battle's sign)

Haemotympanum

Radiological evidence of intra-cranial air

Radiological evidence of fluid levels in sinuses

case 2
Case 2
  • 66 year old brought in by ambulance and police.
  • Sat in a wheelchair.
  • Found in city centre staggering and unsteady on his feet.
  • He collapsed whilst with police.
  • No known injuries.
  • No loss of consciousness.
  • Talking to you, confused answers to questions. Eyes open, obeys commands.
  • What could be going on with this patient?
causes of a decreased conscious level
Causes of a decreased conscious level

Hypoxaemia

Hypotension

Hypercapnia

Hypoglycaemia

Drugs (sedatives,opiates,

overdoses,alcohol)

Seizures

Head injury

Intracranial haemorrhage

Cerebral infarction

Intracranial infection

Hypothermia

Hyperthermia

Hypothyroidism

Hepatic encephalopathy

early signs symptoms of raised icp
Early Signs & Symptoms of Raised ICP

Deterioration in level of consciousness (LOC)

Confusion

Restlessness

Lethargy

Headache

Pupillary dysfunction

Motor & sensory deficits

Cranial nerve palsy

transient signs symptoms of raised icp
Transient Signs & Symptoms of Raised ICP
  • Decreased LOC
  • Pupil abnormalities
  • Visual disturbance
  • Motor dysfunction
  • Headache & vomiting
  • Aphasia
  • Changes in respiratory pattern
  • Changes in vital signs
late signs symptoms of raised icp
Late Signs & Symptoms of Raised ICP
  • Continued deterioration in level of consciousness
  • Hemiplegia, decortication & decerebration
  • Alteration in vital signs
raised icp management of deteriorating conscious level
Raised ICP Management of Deteriorating Conscious Level
  • Ensure the patient’s airway is patent
  • Give high concentration oxygen to ensure good cerebral profusion
  • If ventilation is inadequate, provide assisted ventilation.
  • Ensure intravenous access and prescribe fluids as necessary
  • Reverse any drug – induced CNS depression.
  • Measure the blood glucose and treat if level is below 3mmol/l.
  • Place patient horizontally in the left lateral recovery position.
summary
Summary
  • A decreased level of consciousness is common in acute illness
  • Hypoxaemia,hypotension, hypoglycaemia are common causes of coma
  • A decreased consciousness level may cause airway obstruction and loss of protective airway reflexes
  • Failure to identify early signs and symptoms of raised intracranial pressure puts the patient at great risk, and opportunity for intervention may be lost
  • Potential if untreated a respiratory or cardiac arrest
  • Treatment of a deteriorating consciousness is focused on care of the airway, breathing, circulation disability and exposure
references
References
  • Critical care education group, SUHT Oct 2004
  • Hickey. J. (2003) 5th Ed The Clinical Practice of Neurological and Neurosurgical Nursing
  • Intranet – Marsden Manual. Neurological observation
  • Mooney G (2003) Neurological observations. Nursing times Vol 99/ No 17
  • Smith G (2003) Alert manual. University of Portsmouth
common causes of a decreased conscious level
Intracranial haemorrhage

Cerebral infarction

Intracranial infection

Hypothermia

Hyperthermia

Hypothyroidism

Hepatic encephalopathy

Common causes of a decreased conscious level.
3 parameters
3 parameters
  • Eye opening
  • Verbal response
  • Motor response
problems of decreased conscious levels
Problems of decreased conscious levels
  • Inability to protect airway – loss of cough

and gag reflexes

  • Increased risk of aspiration
  • Skin damage
  • Corneal ulceration