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I need the power of the panel here...Alert and oriented times FOUR?

Discussion in 'EMS Talk' started by mycrofft, Dec 20, 2008.

  1. mycrofft

    mycrofft Still crazy but elsewhere

    Location:
    Central California
    A new supervisor insists this is the "new" way to do it. Google comes up with ONE hit on the Internet. Suggestijons for the fourth orientation in this setting so far by staff members have included the following:
    1. Medical insurance carrier.
    2. Smell ("Is this a flower, or an ammonia inhaler?".
    3. Credit balance for their commissary account.
    4. Falling ("OOPS!" crash).;)(

  2. akflightmedic

    akflightmedic Well-Known Member

    The "new" way...that is funny.

    It has been A/O x4 for many years now.

    Alert to person, place, time and situation.

    Anyone else teaching or hear anything different?
  3. KEVD18

    KEVD18 New Member

    Location:
    mass
    person, place, time and event(situation)
  4. Scout

    Scout Para-Noid

    Location:
    Ireland
    I dont use a/ox2 we have

    AVPU; alert, responds to voice, pain, nothing

    And GCS 0-15
  5. Airwaygoddess

    Airwaygoddess New Member

    Location:
    The north country in Santa Barbara Ca.
    EMS Training:
    EMT-Basic
    Same here in my neck of the woods, person, place, time and event along with AVPU and GCS ;)
  6. Code 3

    Code 3 New Member

    Location:
    California
    EMS Training:
    EMT-Basic
    The 4th element is briefly mentioned in class, however the agencies in my area only use A/Ox3 (person, place, time). If you need/want to document the event(s) leading to the incident you can do so in your SAMPLE and state whether or not the pt was aware.
  7. KEVD18

    KEVD18 New Member

    Location:
    mass
    the problem becomes one of local custom. in one area, caox3 is perfect and in another its deficient.

    yet another reason why every emt needs to be taught the same standards.
  8. marineman

    marineman New Member

    Location:
    Neenah, WI
    Are you sure on that?
  9. 41 Duck

    41 Duck New Member

    Location:
    Pennsyltucky
    GCS is 3-15, way I learned it, and CAOx4= person, place, time, and event.




    Later!

    --Coop
  10. MSDeltaFlt

    MSDeltaFlt Lawn Dart

    Location:
    Cleveland, MS
    Well, here's the deal. If you're C-A-O x 4, then you know "who" you are, "where" you are, "when" you are and "why" you are. You can be C-A-O x 3 and have amnesia of events which should set off red flags on your assessment as far as neuro goes.
  11. akflightmedic

    akflightmedic Well-Known Member

    No such thing as a "0" GCS.

    The lowest possible GCS is 3.

    You can not use AVPU by itself if the patient is an "A, V or P". You then have to further document how much of an "A, V or P" they are.

    You could potentially rouse a patient with painful stimuli who is then able to answer some of the A/Ox 4 questions.

    The only patient you could get away with using only AVPU on is the Unresponsive patient and that is provided they never become responsive during your care.
  12. Tincanfireman

    Tincanfireman Airfield Operations

    Location:
    Southeastern US
    EMS Training:
    EMT-Intermediate
    I have used CAO x 4 for years, but there are some who prefer the x3 variant. Either way, documentation is your friend.
  13. Epi-do

    Epi-do I see dead people

    Location:
    central Indiana
    EMS Training:
    EMT-Paramedic
    We use A&Ox3 around here, although I was taught A&Ox4 a long, long time ago in basic class.
  14. EMT007

    EMT007 New Member

    Location:
    CA
    ^ yeah, when I learned it, we were told that A&Ox4 was the old way of doing it and that the current standard was A&Ox4. I still hear some of the older medics using x4, but everyone else (including ER staff) uses x3
  15. traumateam1

    traumateam1 New Member

    Keep in mind for GCS: You get 3, just for playing!

    But yeah, I use AVPU and GCS. But have head people say A&Ox4 before.
  16. Scout

    Scout Para-Noid

    Location:
    Ireland
    cough 3-15, my bad, bit of a slip of the fingers.
  17. BossyCow

    BossyCow New Member

    Location:
    Rural (no... really, really rural) Washington Stat
    EMS Training:
    EMT-Basic
    I use A&Ox4.. because I've had patients who knew who they were, where they were and when they were, but had no memory of what happened to them.
  18. JPINFV

    JPINFV Gadfly

    Location:
    404: No Meme Found
    Did they have Korsakoff's?
  19. BossyCow

    BossyCow New Member

    Location:
    Rural (no... really, really rural) Washington Stat
    EMS Training:
    EMT-Basic
    No primarily in the elderly.. after a TIA with no memory of the event.. or short term memory loss after a stroke. I even had one elderly lady found on the floor of her bathroom by her husband.. with no memory of how she go there. turns out her's was a UTI with a high fever.
  20. mycrofft

    mycrofft Still crazy but elsewhere

    Location:
    Central California
    I've trolled around, no pun intended

    Psych uses much more than four!
    Recent amnesia is not uncommon in traumatic events! Closed head injury is suspect, but most folks can't remember at once what happened even without closed head injury. (I never ask someone if they lost consciousness, I ask if they remember waking up. They get the darndest look on their faces!).

    Thanks. I have other funny LOC tales, but in our Booking area "situation" seems to be consonant with "place".
    Ask me about the drunk near the Nebraska state capitol sometime.;)

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