Overview of Patient Assessment

  1. Responsiveness: The first step in assessing LOC is to determine the patient’s responsiveness. Paramedics initiate a verbal and tactile stimulus to evaluate the patient’s level of alertness. A responsive patient may be fully awake, whereas a non-responsive patient may indicate altered consciousness, unconsciousness, or even a state of coma.
  2. Glasgow Coma Scale (GCS) Evaluation: Paramedics often employ the Glasgow Coma Scale, a standardized tool used to assess a patient’s LOC based on eye, verbal, and motor responses. The GCS score ranges from 3 to 15, with higher scores indicating better neurological function. A lower GCS score suggests a more severe impairment of consciousness.
  3. Pupillary Response: Assessing the patient’s pupils is an essential part of the LOC examination. Paramedics observe the size, equality, and reactivity of the pupils to light. Abnormalities, such as unequal or non-reactive pupils, could indicate neurological issues or brain injuries.
  4. Motor Response: Paramedics evaluate the patient’s motor responses by assessing their ability to follow commands or move spontaneously. Decerebrate or decorticate posturing, which involves abnormal limb movements, can provide critical insights into the level of brain dysfunction.
  5. Speech and Communication: The ability to speak and communicate effectively is another crucial aspect of assessing LOC. Paramedics observe the patient’s speech for coherence, comprehension, and appropriateness. Slurred or nonsensical speech may indicate neurological impairment or intoxication.
  6. Postictal State (Seizure Evaluation): In cases of suspected seizures, paramedics observe the patient’s postictal state, which is the period after a seizure. This evaluation helps determine the patient’s recovery status and any lingering neurological effects.
  7. Confusion and Disorientation: Paramedics look for signs of confusion or disorientation in the patient’s responses, such as not knowing the date, location, or the events leading to their current situation. These findings may indicate altered mental status or cognitive impairment.
  8. Monitoring Trends and Changes: Throughout their assessment, paramedics remain vigilant in monitoring LOC trends and changes over time. A deterioration in consciousness may signal worsening neurological conditions, requiring prompt intervention and further evaluation.