Comparison of Neurological Assessment Tools Gcs Avpu and Four

2356 Words Mar 4th, 2012 10 Pages
An assessment of the level of consciousness (LOC) should be carried out during the primary survey of all patients, using the ABCDE approach Cole (2009: 28). Any initial or subsequent reduction in the LOC of the patient may be caused by hypoxia; hypovolaemia; head injury; drug or medicine use; hypoglycaemia; hypothermia or alcohol ingestion (Cole, 2009:44).

An assessment of the LOC of the patient is vital for an accurate pain assessment and the administration of analgesia, and the subsequent assessment of its efficacy (Rose, et al. 2011). Regular evaluation of a patient’s LOC helps detect the onset of hypothermia and hypovolaemia. Muehlberger, et al. (2010) state that the development of pre-hospital hypothermia is a directly negative
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Staff assessing these patients found themselves recording GCS scores lower than what they felt was appropriate.

Since the GCS became widely adopted and its use became expanded beyond the original intention of the scale, certain additional limitations have been identified (Laureys, 2005). Verbal responses become difficult or impossible to assess when patients have been sedated or intubated (Majerus, 2005).

Some clinicians feel that scoring eye opening is not sufficient to indicate brainstem arousal and a number of coma scales have been proposed that include brainstem reflexes, most of them more complex than the GCS scale (Majerus, 2005). The Glasgow Liège scale is the simplest variation proposed (Born, et al., 1982). It combines the GCS with five brainstem reflexes, but has not been widely implemented outside Belgium, its country of origin (Laureys, 2005).

Finally, the remaining weaknesses of the GCS scale relate to the assessment of comatose patients. The GCS becomes unreliable in ongoing care for monitoring coma and recovery through vegetative or minimally conscious states, before returning to consciousness (Laureys, 2005).

The main advantage of the GCS is its simplicity, allowing it to be utilised by the full range of clinicians, with a minimal amount of training (Matis, 2008).

Rapid Assessment Tools (AVPU and ACDU)

More recently, early warning systems have been developed in an effort to recognise the at-risk patient who may be deteriorating

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