Comparison of Neurological Assessment Tools Gcs Avpu and Four

Through basic observations, health professionals are able to evaluate the performance of an individual’s health status. In relation to Casey, it is noted in her Observation Chart that in the time span of two hours the patient’s health status had changed from being relatively normal (to the patient) to an increased respiratory rate, heart rate and temperature as well as a decrease in blood pressure. It is also noted that the patient has a score of 8 in the pain scale (compared to the score of zero two hours previously), relating to the lower abdomen. Programs such as Between the Flags acknowledges the fact that the early recognition of deterioration of patients can reduce harm to patients through designing and implementing systems which provide a structural response in the event of a deteriorating patient, such as Rapid Response and Clinical Review. There are two phases involved in the rapid response, which includes the afferent phase and the efferent phase. The afferent phase focuses on the overall monitoring and recognising the deteriorating patient whereas

As Jane was presenting with a symptom of a life threatening event it was important that treatment was immediate. Priority was initially made from assessment of the airways, breathing and circulation, level of consciousness and pain. Jane’s respirations on admission were recorded at a rate of 28 breaths per minute, she looked cyanosed. Jane’s other clinical observations recorded a heart rate of 105 beats per minute (sinus tachycardia), blood pressure (BP) of 140/85 and oxygen saturation (SPO2) on room air 87%. It is important to establish a base line so that the nurse is altered to sudden deterioration in the patient’s clinical condition. Jane’s PEWS score (Physiological Early Warning Score) was 4 and indicated a need for urgent medical attention (BTS 2006). Breathing was the most obvious issue and was the immediate priority.

Many studies have suggested that managing nonconvulsive status epilepticus (NCSE) presents many challenges, which would benefit from additional early measures to predict patient outcomes. Non-convulsive status epilepticus (NCSE) is status epilepticus without obvious tonic–clonic activity. NCSE is now known to be a heterogeneous disease with a variety of reasons, several subtypes (Shenker and Foundation 2003). In the mental status testing study researcher stated most patient were unexplained reduced level of consciousness or altered mental status and they only administer Folstein Mini-Mental State Examination (MMSE) when patients very mildly impaired. To determine the usefulness of the NCSE divided into Standardize NCSE exam and Glasgow coma

Careful monitoring of neurological status (Glasgow come scale, LOC, pupillary responses, extremity movement and strength, facial symmetry, speech and vital signs). Decrease in LOC may indicate increased ICP.

A neurological exam will assess motor and sensory skills and the functioning of one or more cranial nerves (National Institute of Neurological Disorders and Stroke, 2012). Initially, health care providers can rank a person’s functioning based on how long that person has been conscious, the length of their memory loss and their score on the Glasgow Coma Scale. The Glasgow Coma Scale is able to measure the individual’s functioning by looking at their ability to speak, open their eyes and ability to move. The RAVLT has been shown to be insensitive to psychiatric illness such as depression and anxiety. However, there is some evidence that psychological distress (including depression, post-traumatic stress, and other anxiety disorders) has some effect on RAVLT performance (Spreen &

What could make a difference is when a patient has a cognitive impairment or decline. Controversies about the administration of the GDS are high when a patient has a cognitive deterioration. The study says, "The GDS-15 is also known to perform less well with patients with significant cognitive decline," (Edwards, 2004, p. 493). This shows a weakness in the gold standard Geriatric Depression Scale. There are also issues with the GDS showing false positives as a result of the screen; whoever is overseeing the screen needs to be highly aware of these types of results. These false positives could stem from certain questions not being appropriate for the patient, for example there are questions that are not suited for housebound patients.

The first step in treating TBI is to determine the severity of the injury. To do this the Glasgow Coma Scale (GCS) is used early in the treatment process. GCS determines the severity of an injury by assigning a score for various functions after an injury. These include eye opening, motor response, and verbal response. The lower the score the more severe the injury is. But the GCS is not perfect. There are certain limitations. Factors like drug use, alcohol intoxication, shock, or low blood oxygen can alter a patient’s level of consciousness and in turn their score. GCS also is not effective for children too young for reliable language

Disability – Assessment of disability involves evaluating the patient’s central nervous system function. Assess the patient’s level of consciousness using the AVPU scale. Talk to the patient if they are alert and talking they are classified as A. If the patient is not fully awake establish whether they respond to the sound of your voice (opening their eyes, making any sounds) if they do they are classified as V. If the patient does not respond to voice administer a painful stimulus (gently rubbing the sternum bone). If they respond they are a P on the AVPU scale. And finally if they do not respond to any of the above they are a U, you should then move onto the more detailed Glasgow Coma Scale (GCS). You will assess the patient’s pupils (eyes) and motor responses (arms and legs) among other things to give the patient a score out of 15 (15 being the highest). A GCS of fewer than 8 is a medical emergency and you would then have to go back to assessing the patient’s airway.

A correct interpretation of both the background pattern and the transients is of high importance for correct diagnosis. However, it is known that this approach can be subjective and it is time consuming with low sensitivity and low inter-rater reliability in particular, the non-epilepsy cases (Malone et al., 2009; Piccinelli et al., 2005; Cooper et al., 1974; Seshia et al., 2008; Benbadis et al., 2009). In recent studies, the inter-rater agreement (Kappa coefficients) range from low (0.09) to significant (0.94) (Gerber et al., 2008; Haut et al., 2002; Azuma et al., 2003; Benbadis et al., 2009). This is mostly due to the lack of consistency in describing the properties accurately (Lodder, S and Van Putten, M 2013). A study by Azuma et al (2003) showed how inter-rater reliability was improved by having three reviewers agree to use the same guidelines, hence enhancing clarity between clinicians. As of present, no previous studies have evaluated the inter-rater variabilities on the prognostic value of post cardiac arrest

We tested five subjects with GTC epilepsy (n=5, Women, over 19 year old) and five controls. All subjects were matched in gender, age and education. Importantly, they were all matched in terms of educational levels and seizures onset. All GTC patients were on treatment since early age, between 12 and 16 years old. Their ages were above 19 and up to 41 years old and their controls are matching them. Additionally, we screened them for the absence of any neurological or psychiatric disorders that could interfere with epileptic symptoms. We allowed our subjects to perform AEALT, (Myers, et al., 2000, Myers, et al., 2003, Herzallah, et al., 2010 and Myers, et al., 2011), after they passed the average scores of several Intelligence Quotient (IQ) subtests, which represented Wechsler Intelligence Scale for Children, (WISC). The original WISC (Wechsler, 1949) is an adaption of several of the subtests used for the Wechsler Bellevue Intelligence Scale (Wechsler, 1939), which also proposed several specific subtests. These subtests were organized into Verbal and Performance scales, and provided scores for Verbal

Sedation level among the three groups was comparable (P>0.05). In addition, the studied groups had also a comparable stable hemodynamic profile at all times of measurements .Fig. 2, Fig.3.

American Academy of Neurology. "Brain scans may help predict recovery from coma." Science Daily. Science Daily, 11 Nov 2015.

Diagnosis of OHE is based mainly on clinical examination and clinical scales are used to determine its severity. The gold standard is the West Haven criteria (WHC) (table 3). However, they are subjective tools with limited inter-observer reliability (especially for grade I HE), because slight hypokinesia, psychomotor slowing, and a lack of attention can easily be overlooked in clinical examination (Bajaj et al., 2011). In patients with significantly altered consciousness, the Glasgow Coma Scale (GCS) is widely employed and supplies an operative, robust description (Vilstrup et al.,

The patients were assessed in the Pre –anaesthetic clinic. Data collected was entered in a pre-structured questionnaire.

UNCONSCIOUSNESS - FIRST AID Unconsciousness is when a person is unable to respond to people and activities. Doctors often call this a coma or being in a comatose state.