# A&O X(insert number here)



## bstone (Apr 12, 2010)

When I was in Basic school in Chicago we had A&O x1, 2 and 3. 3 was oriented to person, place and time; 2 was oriented to person and place; 1 as only to person.

I have heard some folks talk about A&O x4. What does it mean?


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## Shishkabob (Apr 12, 2010)

X4 is "oriented to event" meaning do they know why we were called there and what happened. 

Helps with short term retrograde amnesia or possible loss of conciousness.


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## EMSLaw (Apr 12, 2010)

Oriented to person, place, time, and event.  In other words, they can tell you what happened to them.


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## bstone (Apr 12, 2010)

Very interesting. I can see it's use. I wonder why it wasn't in my old Basic textbook, or my Intermediate textbook.


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## TransportJockey (Apr 12, 2010)

I've been taught x4 since I was in basic. It seems to be a prehospital thing as well, as I've had nurses ask me when I was teching what the 4th A&O was


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## EMSLaw (Apr 12, 2010)

Six of one, half a dozen of the other.  They basically mean the same thing - someone AOx3 or 4 is conscious and reasonably "with it."


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## Shishkabob (Apr 12, 2010)

To an extent yes, but you should really try for the x4 as it helps that much more with possible neurolguc injuries. I've seen people not know the day, date, time, or month and still be totally oriented and neurogically intact. 

Now, if they claim it's 1999....


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## medichopeful (Apr 12, 2010)

bstone said:


> When I was in Basic school in Chicago we had A&O x1, 2 and 3. 3 was oriented to person, place and time; 2 was oriented to person and place; 1 as only to person.
> 
> I have heard some folks talk about A&O x4. What does it mean?



For us, CAOx4= conscious, alert, and oriented to person, place, time, and event.


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## adamjh3 (Apr 12, 2010)

We were taught x4 in school, but SD county only recognizes x3. As to why, I don't quite understand.


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## LondonMedic (Apr 12, 2010)

I've used the terminology myself, but in hindsight I don't think it's that helpful.

What does A+Ox1/2/3 mean when you say it? With any luck the person you say it to will still ask you to define.

It's like saying GCS12 - you still have to break it down into V, M & E scores.


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## lightsandsirens5 (Apr 12, 2010)

Yea, I was taught A&Ox4. I think it is just more detailed and makes for a slightly better assessment.


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## rook901 (Apr 12, 2010)

medichopeful said:


> For us, CAOx4= conscious, alert, and oriented to person, place, time, and event.



The "C" seems a little unnecessary. If you've determined that they are alert and oriented, it stands to reason that they're conscious, doesn't it?


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## abuan (Apr 13, 2010)

bstone said:


> When I was in Basic school in Chicago


i took a basic class in chicago at malcolm x college and i remember being taught a&ox4.


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## yogi20024 (Apr 13, 2010)

adamjh3 said:


> We were taught x4 in school, but SD county only recognizes x3. As to why, I don't quite understand.



I just got done with EMT-B in SD. I was told to use AOX4 because SD is supposedly making the switch from 3 to 4.


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## CAOX3 (Apr 13, 2010)

<---------- Whats in a name. 

I was taught if it wasnt already obvious:

Conscious and Alert, oriented to person, place and time.


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## mcdonl (Apr 13, 2010)

Do any of you do the method of saying three things and quizzing them on it later? One of my instructors will say three things... "penny", "balloon" and "firetruck" and then five minutes later ask the same thing. Is this in addition to CAOx4 or instead of?


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## FLEMTP (Apr 13, 2010)

Linuss said:


> Now, if they claim it's 1999....



.... wait... you mean its not ??!?!?!?!??:unsure:


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## Veneficus (Apr 13, 2010)

FLEMTP said:


> .... wait... you mean its not ??!?!?!?!??:unsure:



You must have been at one awesome party if you just now notice a few years have passed


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## Melclin (Apr 13, 2010)

Is the GCS not as popular in America?

I seems like its rarely mentioned in scenarios presented here.


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## TransportJockey (Apr 13, 2010)

Melclin said:


> Is the GCS not as popular in America?
> 
> I seems like its rarely mentioned in scenarios presented here.



I've always been taught you document a GCS for everyone as well. But GCS is universal


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## Veneficus (Apr 13, 2010)

Melclin said:


> Is the GCS not as popular in America?
> 
> I seems like its rarely mentioned in scenarios presented here.



GCS is not popular in US EMS.

Not to beat a dead horse, but if you don't know what the findings mean because you haven't been taught anything about neuroscience, it can seem inconsequential. 

I have seen many providers simlpy fill out the CGS retrospectively. 

Even EMS physicians have written articles on how GCS was too "complex" for field use in the US and suggest the A&O classifications.

http://www.jems.com/news_and_articl...IMPACT_Analysis_Prognostic_Value_Glasgow.html


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## EMSLaw (Apr 13, 2010)

Veneficus said:


> GCS is not popular in US EMS.
> 
> Not to beat a dead horse, but if you don't know what the findings mean because you haven't been taught anything about neuroscience, it can seem inconsequential.
> 
> ...



I don't disagree with you.  I doubt most EMTs are really familiar with the difference between a patient who localizes pain, as opposed to withdrawing, or who postures (though corticate and decerebrate posturing are fairly easy to spot).  

Of course, this is something that could be addressed through further training.  But for the most part, I would agree with the article that, in most cases, AVPU is sufficient.


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## firecoins (Apr 13, 2010)

I prefer GCS.


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## Melclin (Apr 13, 2010)

> It only has value once the patient reaches the hospital and is obtained in a reliably systematic manner.



We can't be taught to obtain a GCS in a reliably systematic manner?

Vene, what is the systematic approach to the GCS as taught by your fine institute of fancy medical book learnin'.


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## Veneficus (Apr 13, 2010)

Melclin said:


> We can't be taught to obtain a GCS in a reliably systematic manner?
> 
> Vene, what is the systematic approach to the GCS as taught by your fine institute of fancy medical book learnin'.



I do not agree with this author on a great many things. I was just demonstrating that in the US, field providers do not place emphasis on GCS.


I cannot think of one reason why a field provider even at the basic level cannot btain a GCS score. However, as I stated, if you don't know the significance of the findings, it doesn't have much use.

For us edumacated people who went to skule, GCS is indespensible, even in the field. Especially its prognostic value in disaster and mass casualty incidents.


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## MrBrown (Apr 13, 2010)

Yeah I have noticed that GCS is not mentioned much in the US.

We only use a GCS or AVPU however the latter is really to get a quick estimate of how sick your patient is and for anything more indepth we use a GCS.

I do not think it is a very hard tool to teach somebody to use but that it must be taught and acquired correctly in order to facilitate appropriate triage.

Somebody with the thousand yard stare (patient who has been belted over the noggin with 4x2 or a catatonic asthmatic) is eyes 1 and not eyes 4; likewise somebody who is dead is eyes 1 and not eyes 4 as to get eyes 4 you have to be able to [close and re]open your eyes.

As for localising vs withdrawing well I'd say if they attempt to move away or move you away when you give a stimulis that's withdraw, otherwise if make movement towards that area of your stimulis that's localising.


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## Melclin (Apr 13, 2010)

Veneficus said:


> I do not agree with this author on a great many things. I was just demonstrating that in the US, field providers do not place emphasis on GCS.



Of course. Reading my post back it might have seemed like i was having a go at you. I was actually asking if there is an official procedure taught to you so that I might compare it with ours.

I don't see the point in teaching EMTs to do a GCS but then, I don't see the point in having EMTs. But that's another story.


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## mcdonl (Apr 13, 2010)

Anyone got any popcorn?


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## MrBrown (Apr 13, 2010)

Melclin said:


> I don't see the point in teaching EMTs to do a GCS but then, I don't see the point in having EMTs. But that's another story.



I dsagree with half that ..... guess which half it might be 

Not sure why you shouldn't be teaching GCS, aren't I a spoilsport?


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## Outbac1 (Apr 13, 2010)

If A&O x 4 equals the pt knows their name (Mike), current place (in an ambulance), Day (Mon), Event (crashed my car). If they only know 3 out of 4  what does telling the RN or Dr that they are A&O x 3 really tell them? It needs to be explained as to the deficit. The GCS is more explicit, eyes 4, voice 5, motor 6. Any decrease in a number is much more explicit as to the pts condition. If the report is A&O x 4 or GCS 15 it tells that the pt is currently neurologically intact. Anything less needs to be explained. 
 One also has to consider how well either applies to the dementia or Alzheimer’s pt. These people often don't know where they are or what is going on. For these pts I ask staff or family if their mentation is "Normal" for themselves. If so I chart that their mentation is "Normal for self".


Glasgow Coma Scale

Eye Opening	           E
spontaneous           	4
to speech	           3
to pain	                      2
no response	           1

Best Motor Response	M
To Verbal Command:	 
obeys	                      6
To Painful Stimulus:	 
localizes pain	           5
flexion-withdrawal	4
flexion-abnormal	            3
extension	            2
no response	            1

Best Verbal Response      V
oriented and converses	  5
disoriented and converse  4
inappropriate words	  3
incomprehensible sounds	  2
no response	             1


E + M + V = 3 to 15

90% less than or equal to 8 are in coma 
Greater than or equal to 9 not in coma 
8 is the critical score 
Less than or equal to 8 at 6 hours - 50% die 
9-11 = moderate severity 
Greater than or equal to 12 = minor injury 


Coma is defined as: (1) not opening eyes, (2) not obeying commands, and (3) not uttering understandable words.

This is from www.neuroskills.com/glasgow.shtml


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## Veneficus (Apr 13, 2010)

Melclin said:


> I was actually asking if there is an official procedure taught to you so that I might compare it with ours..



I have not heard of any single "official" procedure. In my experience, different agencies (both EMS and hospital) have different practices. The most important points being when and how often it is reassessed and correlating the individual findings (E,V,M) to potential pathologies and following up with specific exam techniques to investigate the specific findings.

As I eluded to, it also has considerable accuracy in prognosis. 



Melclin said:


> I don't see the point in teaching EMTs to do a GCS but then, I don't see the point in having EMTs. But that's another story.



I think if you are going to teach it, you cannot simply tell somebody how to find the score, you have to correlate it with what the findings may point to. Otherwise it is simply a meaningless set of numbers. Why have somebody waste time doing something that they get no information from?


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## LngJohnSlvr (Apr 14, 2010)

I am still taking my Basic EMT class, and while the A+Ox3 was listed in our book, we were taught by the instuctor to use A+Ox4...


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## Melclin (Apr 14, 2010)

MrBrown said:


> I dsagree with half that ..... guess which half it might be
> 
> Not sure why you shouldn't be teaching GCS, aren't I a spoilsport?



I don't see the point in going to the effort to teach an advanced first aider a conscious state assessment that they won't get anything out of and after the weeks that comprise an EMT course, probably won't be applying correctly.


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## LngJohnSlvr (Apr 16, 2010)

Melclin said:


> I don't see the point in going to the effort to teach an advanced first aider a conscious state assessment that they won't get anything out of and after the weeks that comprise an EMT course, probably won't be applying correctly.



Well, we all have to start somewhere... and you may be right, we may not apply it all accurately... however, you don't need to be rude about it.


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## mycrofft (Apr 16, 2010)

*I hear four, four , four....do I hear four and a half?*

Follow your protocols. Five is four.


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