Presentation on theme: "Care of the Unconscious Patient Acute Care Day Case Studies Assessing GCS Looking after the Unconscious Patient."— Presentation transcript:
Care of the Unconscious Patient Acute Care Day Case Studies Assessing GCS Looking after the Unconscious Patient
Assessing Consciousness Using GCS Prevention of secondary complications of Coma Safely managing comatose patients
Principles of assessing Consciousness Glasgow Coma Scale Eye Response 4 Eyes open spontaneously 3Eyes open to verbal Command 2Eyes open to Pain 1No eye opening Motor Response 6Obeys Commands 5Localises to Pain 4Withdraws to pain 3Flexes to pain 2Extension to pain 1No Motor Response Verbal Response 5Orientated 4Confused 3Inappropriate Words 2Incomprehensible Sounds 1No Verbal Response
Assessing GCS Score should always be documented as the 3 components and not just a total Needs to be re-assessed regularly Make sure stimulus is applied above the clavicle when assessing – in case there is a high spinal lesion
Case 1 Acute Respiratory Care Day
Case 1 30 year old Found by shopkeeper when opening up shop sleeping in shop doorway, when asked to move on seemed a bit confused, Became progressively more drowsy and refused to move from doorway so ambulance called. You are called to assess him in A&E
Case 1 (1)
What are you going to do?
Assessment A B C D E
A and B Talking (confused) Respiratory rate 20 breaths per minute Oxygen saturations 97% on air Trachea central Normal Breath sounds
C Good Capillary return Pulse 120bpm BP 110/65 mmHg
D and E Assess GCS (Chart on your chart) Nothing else found on exposure Specifically no signs of trauma Sweaty
Case 1 D and E
Case 1 What Now? Further examination? Further Investigations? Further Management?
Case 1 Nurse calls you back to see him because she is concerned about his condition
Case 1 (2)
Case 1 (2 nd set obs)
Case 1 What is his coma scale now? Chart his coma scale now on your paper chart What further assessment do you need to do? –A – slight snoring, but has he still got protective reflexes –B- SaO2 95% on air, Air entry still OK –C pulse 115 Bp 140/85 What further investigations does he need? Potential causes for his acute change?
What Measures do you need to take to ensure safety of unconscious patient? Airway protection Positioning Preventing pressure sores Protecting neck and limbs from injury Corneal protection
Clinical Decisions in the Unconscious patient Combination of diagnostic steps and treatment decisions Pragmatic assessment of adequacy of medical support Find treatable disorder Initial care, diagnosis and treatment of reversible pathology Think about safety for transfer of patients Consent for treatment / Incapacity Forms
Prevent complications Aspiration Pressure Sores Dehydration Malnutrition Secondary brain injury Nosocomial infections Eye and mouth care DVT/PE Rhabdomyolysis
Case 2 33 year old man, has been found at bottom of flight of stairs in his close, He has blood on the back of his head, and the ambulance crew have said that there was some blood coming from his left ear when they arrived at the scene
Case 2 – Chart his GCS
Case 3: Presentation 18 year old 3 week history of dental abscess on left upper molar Too afraid to go to dentist so took his mothers co-codamol tablets Fever for 1 week, Found by mother in bedroom, could not wake him up this morning, called ambulance.
Case 3: Initial Assessment: A –Airway Clear (how do you test for that?) –No cough or gag reflex B –SaO2 96% on air, –Air entry both sides C –P 130 Sinus rhythm –Bp 85/32 –Warm, vasodilated,
Case 3 D and E
Case 3 GCS
What next? Any investigations?
Case 3: What next? Any investigations?Temp 40.5 C WCC 25 CRP 450 CT -