SJA, LOC and Neuro

Consciousness and Neurological Deficitwww.paddington.stjohnnsw.org.auE: [email protected]

www.paddington.stjohnnsw.org.auE: [email protected]

After this session you will be able toIdentify the conscious state of a Patient using AVPUUnderstand what a GCS isIdentify neurological deficit

Session Outcomeswww.paddington.stjohnnsw.org.auE: [email protected]


HowHow do we assess Conscious level?www.paddington.stjohnnsw.org.auE: [email protected]


WhyWhy do we asses conscious levelwww.paddington.stjohnnsw.org.auE: [email protected]


AVPUA quick and easy way to assess conscious level. A for alert V for responsive to voiceP for responsive to painU for unresponsiveA pt is considered unresponsive if they are a P or U



A- AVPUAlertA patient is fully alert and orientedKnows the timeKnows the placeKnows the dayKnows what is happening/has happenedwww.paddington.stjohnnsw.org.auE: [email protected]


V - AVPUVoiceThe paitent responds to you when you talk to them.They may grunt or moan, open their eyes, move their hands or feet.COWSCan you hear meOpen your eyesWhats your nameSqueeze my handswww.paddington.stjohnnsw.org.auE: [email protected]


P - AVPUPainResponsive to painful stimuliElicit pain using a trapezium squeeze onlyMay move hands to try to protect themselves from the pain, open their eyes or grunt/moanTHIS IS A MEDICAL EMERGENCY GET HELP



U AVPUUnresponsiveCompletely unresponsive to all stimuliTHIS IS A MEDICAL EMERGENCY GET HELP



Thats all you needwww.paddington.stjohnnsw.org.auE: [email protected]


Break www.paddington.stjohnnsw.org.auE: [email protected]


GCSDeveloped in 1974 by Graham Teasdale and Bryan J. Jennett, professors of neurosurgery at the University of Glasgow's Institute of Neurological Sciences at the city's Southern General Hospital.Will give a score between 3 and 15Less then 8 intubateAssessment is 3 stages. Eyes, Verbal and Motor



EyesUnable to open (trauma, surgery) 1/CNonePainSpeechSpontaneous



VerbalTracheostomy or endotracial tube 1/TNoneIncomprehensibleInappropriate wordsConfusedOrientated



MotorParalyzed or sedated 1/SNoneAbnormal ExtensionAbnormal FlexionWithdraws to painLocalises to PainObeys commands



Levels of consciousnessFully conscious awake, alert and oriented to person, place and time Confusion disoriented to time place or person. Agitated restless, irritable, increasingly confused at night. Shortened attention span. Memory problems and difficulty following commands Lethargy oriented to time, place and person, but very slow to respond, slow and sluggish in speech, mental processes and motor function Obtundation arousable with stimulation, responds verbally with a word or two, very drowsy, can follow simple commands (stick out you tongue) and responds to painful stimuli Stupor lies quietly with minimal spontaneous movements. Unresponsive except to vigorous and repeated stimuli. Incomprehensible sounds. Responds appropriately to painful stimuli Coma (light coma, coma and deep coma) differentiation is based on motor response to painful stimuli



Neurological deficitAssessingwww.paddington.stjohnnsw.org.auE: [email protected]


Pupil ReactionUsing only a Pen Torch if using an artificial light sourceAssess both left and right eyeRecord dilation in millimetersPEARL = Pupils Equal and Reactive to Light.Why would pupils not dilate?www.paddington.stjohnnsw.org.auE: [email protected]


Neurological FunctionAsk easy to answer questionsQuestions you know the answer tooWhere are youWhat day is itWho is running the country at the momentQuestions assessing their memoryWhat happenedHow did you get hereWho are you here withWhere do you liveHow are you getting home.Have you taken anything today any alcohol or recreational drugs



Why assess neuro functionIs this person telling us everything that has happenedBy assessing neurological function we can identify if a patient has a head injury they have forgotten or arent telling us aboutDo we give any medications that are contraindicated in a head injury.Are there any other factors that might be affecting their neurological stability.



Any Questionswww.paddington.stjohnnsw.org.auE: [email protected]


ReferencesSt John Ambulance Australia (2011). Australian First Aid (4th ed.). Canberra: St John Ambulance AustraliaBrain Complexity, Conceptual Artwork. [Photography]. Retrieved from Encyclopdia Britannica ImageQuest. http://quest.eb.com/images/132_1222784Coffee Cup. [Photography]. Retrieved from Encyclopdia Britannica ImageQuest. http://quest.eb.com/images/139_1943595McNarry, A. F., & Goldhill, D. R. (2004). Simple bedside assessment of level of consciousness: comparison of two simple assessment scales with the Glasgow Coma scale*. Anaesthesia, 59(1), 34-37. doi:10.1111/j.1365-2044.2004.03526.xRosenthal, M. (2014). Acute Care Nursing: Week 7. Lecture notes (Acute Neurological Dysfunction) distributed in the course NS2002 Acute Care Nursing, at the University of Notre Dame Australia, Darlinghurst on April 1, 2014.



Next weekAny suggestions forwww.paddington.stjohnnsw.org.auE: [email protected]


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SJA, LOC and Neuro

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