# Loc



## remt (Apr 9, 2008)

hey guys
I have been reading this forum for a while, and now I actually have a question...
What is the importance of determining the correct LOC for a patient? Is it mainly used to monitor the change in mental status? For example...I just started working for a private ambulance company. My partners assign LOC values based on "oh she knows what's going on, but she is a little slow, and seems a little confused so shes a two"....which I could see the logic in, but it's not how I was taught. Or if a patient has history of SAD or mental retardation, he is automatically a 2.  So what I am trying to find out, is how much of a big deal is it? Am I alright just getting a baseline for myself, to make sure that there are no changes?
THanks in advance


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## Ridryder911 (Apr 9, 2008)

LOC should be evaluated per if the patient is conscious (this does not determine the alertness though) One can be conscious but have poor LOC. In other words the lights are on but there is no one home theory. 

So now, we have established they are conscious (they are awake) now check their alertness  so they make eye to eye contact, do they have to be awaken or stimulated? Now check their orientation are they are aware of whom they are?, (person) 1, place (where they are at) 2, what time (date/time) 3 and event (what happened) 4. 

So if a person only knows whom they are, they would be conscious, alert to person or C/A/O x 1, and so on. Some do not go into 4 levels. 

R/r 911


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## Ops Paramedic (Apr 9, 2008)

Is this another type of score that you use?

We use the AVPU score to briefly obtain a general state of consiousness,whereby you score againts the response of Alert, Verbal, Pain & then Unconsiousness.  

To see if a patient is orientated, we question them on: Date, time, place, and then throw in a question which they should know the answer to, i.e.: "Who is the president of our country?" What you need to take into consideration, specialy if you suspect something to be out of the norm (The patient is a bit slow...), is:  Is this the normal response for the patient?  You will have to question those who work and see the patient daily, they should be able to tell you if it is normal.

LOC is a very important aspect which we can use to monitor the patient.  If it improves (or maybe stays the same), we are doing something correct.  If not, something is happening to the patient, whether it be us or anything within the patient.  At this stage it might be of value to examin your treatment that you insituted as well as the patient.  Some people also refer to LOC as Loss of Consiousness.


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## tydek07 (Apr 9, 2008)

LOC is an important tool that should be evaluated on every patient. Just remember that some people will have a lower LOC, but that will be normal for them. I am sure that both you and I are A&O X 3 (on most days  ) Alert to person, place, and time. Now when you go to a nursing home, do you think everyone will know what day/ or even year it is? Nope. Dementia pts will, of course, probably have a lower LOC on the person,place,time, and that may normal for them. So AVPU will be your best tool to to go by to find their LOC, since they may not be able to answer what day it is, or where they are. But remember to ask the nurses what the pts normal state of mind is.


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## rmellish (Apr 9, 2008)

At my service we use the AOx4 scale (person, place, time, event) and also the Glasgow coma scale. although I realize that it was never really intended for measuring LOC in a prehospital setting, and I see the shortcomings of it. (May be AOx1, 2, or 3 and still have a 14). We only really use AVPU if they are not alert, and we still combine it with the GCS.


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## Ridryder911 (Apr 9, 2008)

Ops Paramedic said:


> Is this another type of score that you use?
> 
> We use the AVPU score to briefly obtain a general state of consciousness, whereby you score against the response of Alert, Verbal, Pain & then Unconsciousness.
> Some people also refer to LOC as Loss of Consciousness.



We use the AVPU system as well, only that describes the level of consciousness, not their degree of orientation. For them to have the ability to answer questions then one would address that if they had to be awaken per verbal/painful stimulus and then the degree of orientation. 

In regards to inability to answer or not appropriate, then one would document as such ..."_patient responsive to verbal stimulus only, orientated X 1 , with sluggish or delayed response"_.... or _ Patient responsive only to deep painful stimulus, with inappropriate response, groaning incomprehensible words"_......

Yes, I see LOC used a lot as Loss of Consciousness, when in reality it should be LLOC. 

R/r 911


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## skyemt (Apr 9, 2008)

i think it is also useful, in any case where you have reason to suspect mental status, to ask a family member or friend if the current mental status is normal...

i've been to calls where the patient seemed alert and sharp, only to find out from a family member that information is giving you during a history is completely off...

so, the scales are very useful guidelines, but if you want a completely accurate assessment of mental status, find out a baseline from someone who really knows it.


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## LucidResq (Apr 9, 2008)

It's important to document exactly what your patient is oriented/not oriented to if you're using AAO. Reason being that lacking orientation to yourself (I'm Abraham Lincoln!) may be considered a bit worse than not knowing what day it is. Also, AAOx4 is becoming more common, but it used to be taught (and still is being taught to many people) as AAOx3. So if you're using the AAOx4 scale and someone has no clue who they are so they're AAOx3 according to you, they're perfectly fine to someone who uses AAOx3.


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## Ops Paramedic (Apr 9, 2008)

Thanks Rid, got  the LLOC, i will use and advocate it in future!


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## Outbac1 (Apr 9, 2008)

We generally use the A&O X3 and a GCS score. As far as level of alertness, if I can determine from family or staff that the pt has diminished mental capacity normally, eg: dementia, mental handicap etc., I will ask if their current behavior is normal for them.  If it is then I will chart that their "LOC is normal for self" followed by a description of why their alertness is less than what we would usually call "normal".


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## emtwacker710 (Apr 23, 2008)

I will usually use the AVPU scale (A= Alert, V= responds to verbal stimuli, P= responds to painful stimuli, U= unresponsive.) Also if they are alert I will ask them a minimum of 3 questions such as, do you know where you are? what day it is? who the president is? if they answer 3 then the are alert and orientated X3. But also, I've been told and have seen first hand that some retired senior citizens may not know what day of the week it is simply because they dont have to work anymore and have no need to know, that is up to you to determine though.


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## skyemt (Apr 23, 2008)

also, when orienting someone to person place and time, there are more direct questions than "who is the president"...

believe it or not, there are many oriented persons who will not know, and will be fuzzy under pressure...

if they know who they are, where they are, and when it is, they really don't need a quiz on current events...


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## emtwacker710 (Apr 23, 2008)

skyemt said:


> also, when orienting someone to person place and time, there are more direct questions than "who is the president"...
> 
> believe it or not, there are many oriented persons who will not know, and will be fuzzy under pressure...
> 
> if they know who they are, where they are, and when it is, they really don't need a quiz on current events...



oh yes, thats why depending on the pt. I will ask many different questions and go from there...


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