Presentation on theme: "Assessing Consciousness"— Presentation transcript:
1 Assessing Consciousness AVPU and Glasgow Coma Scale
2 Lesson objectivesDescribe 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.
3 Rapid AssessmentA AlertV responds to VoiceP responds to PainU Unresponsive
4 Glasgow Coma Scale Assesses patient’s neurological condition Value range 3 to 153 totally comatose patient15 fully alert patient
5 Classification of Brain Injury According to Glasgow Coma Scale (GCS) (HICKEY 2003) SEVEREGCS 3-8MODERATEGCS 9-12MILDGCS 13-15
6 Neurological chart GCS top section Temperature/BP/pulse/respiratory ratePupil size / reaction to lightLimb movement – arms and legs9 OR BELOW CAUSE FOR ALARMPUPIL SIZE AND REACTIVITY 3RD CRANIAL NERVE CONTROLS THE PUPILS ABILITY TO CONSTRICT INJURY TO BRAIN INCREASES PRESSURE COMPRESSES NERVELIGHT SHONE DIRECTLY INTO ONE EYE CAUSING IT TO CONSTRCT CALLED DIRECT LIGHT REFLEX THIS CAUSES THE OTHER EYE TO CONSTRICT CALLED CONSESUAL REFLEX IF PUPILS ARE EFFECTED THIS IS A ALTE SIGN OF INCREASING PRESSURE IN SKULL.
11 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.GCS IS 9 CAUSE OF ALARMABCDE
13 Signs of basal skull fracture Blood or CSF from nose or earPeriorbital haematomaMastoid haematoma (Battle's sign)HaemotympanumRadiological evidence of intra-cranial airRadiological evidence of fluid levels in sinuses
14 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?NEVER ASSUME ANYTHINGABCDE PMH? DIABETIC? LOOK FOR MEDIC ALERT TAGS, FALL AT HOME POLICE ARE NOT AWARE OF INTRACRANIAL BLEED, CVA , DRUNK?
16 Causes of a decreased conscious level HypoxaemiaHypotensionHypercapniaHypoglycaemiaDrugs (sedatives,opiates,overdoses,alcohol)SeizuresHead injuryIntracranial haemorrhageCerebral infarctionIntracranial infectionHypothermiaHyperthermiaHypothyroidismHepatic encephalopathy
17 Early Signs & Symptoms of Raised ICP Deterioration in level of consciousness (LOC)ConfusionRestlessnessLethargyHeadachePupillary dysfunctionMotor & sensory deficitsCranial nerve palsy
18 Transient Signs & Symptoms of Raised ICP Decreased LOCPupil abnormalitiesVisual disturbanceMotor dysfunctionHeadache & vomitingAphasiaChanges in respiratory patternChanges in vital signs
19 Late Signs & Symptoms of Raised ICP Continued deterioration in level of consciousnessHemiplegia, decortication & decerebrationAlteration in vital signs
20 Raised ICP Management of Deteriorating Conscious Level Ensure the patient’s airway is patentGive high concentration oxygen to ensure good cerebral profusionIf ventilation is inadequate, provide assisted ventilation.Ensure intravenous access and prescribe fluids as necessaryReverse 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.½ LIFE OF REVERSAL DRUGS SUCH AS NAXALONE
21 Summary A decreased level of consciousness is common in acute illness Hypoxaemia,hypotension, hypoglycaemia are common causes of comaA decreased consciousness level may cause airway obstruction and loss of protective airway reflexesFailure to identify early signs and symptoms of raised intracranial pressure puts the patient at great risk, and opportunity for intervention may be lostPotential if untreated a respiratory or cardiac arrestTreatment of a deteriorating consciousness is focused on care of the airway, breathing, circulation disability and exposure
22 References Critical care education group, SUHT Oct 2004 Hickey. J. (2003) 5th Ed The Clinical Practice of Neurological and Neurosurgical NursingIntranet – Marsden Manual. Neurological observationMooney G (2003) Neurological observations. Nursing times Vol 99/ No 17Smith G (2003) Alert manual. University of Portsmouth
23 Common causes of a decreased conscious level. Intracranial haemorrhageCerebral infarctionIntracranial infectionHypothermiaHyperthermiaHypothyroidismHepatic encephalopathy