# Lost of consciousness = aox3?



## Alas (Jun 21, 2014)

If someone hits their head and loses consciousness, but is now awake and oriented, are they aox3, losing one point for not remembering the event? What gcs would they then be?


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## Ewok Jerky (Jun 21, 2014)

Alas said:


> If someone hits their head and loses consciousness, but is now awake and oriented, are they aox3, losing one point for not remembering the event? What gcs would they then be?



If they are alert and oritented to person, place, and time, then they are BY DEFINITION A&Ox3.  Some systems have a culture of adding Event to make A&Ox4.  Make sure you know what the culture is where you work so avoid confusion (no pun intended) about a patient you are reporting as "A&Ox3".  You can have a +loss of counsciousness and still be A&Ox3, or A&Ox4.

A good way to avoid confusion is to drop the "A&O" and state "patient is oriented to person, place and time but not event".  This is why I hate abreviations because no one knows what the other is talking about when we have different standards.


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## TransportJockey (Jun 21, 2014)

beano said:


> If they are alert and oritented to person, place, and time, then they are BY DEFINITION A&Px3.  Some systems have a culture of adding Event to make A&Ox4.  Make sure you know what the culture is where you work so avoid confusion (no pun intended) about a patient you are reporting as "A&Ox3".  You can have a +loss of counsciousness and still be A&Ox3, or A&Ox4.
> 
> A good way to avoid confusion is to drop the "A&O" and state "patient is oriented to person, place and time but not event".  This is why I hate abreviations because no one knows what the other is talking about when we have different standards.


if I document A&Ox3 I will usually put A&Ox3/4 just to save the confusion. But it's another reason to have standardized abbreviations and not just whatever Joe Blow paramedic decides he's going to use


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## Novice001 (Jun 21, 2014)

*Follow GCS*

By the sounds of it your pt has a GCS score of 13-15. Just because the pt couldn't recall the event doesn't necessarily mean they have a neurologic disability. I wouldn't take a point off for that.

What is an aox3? I'm asking, because I am from South Africa and not familiar with the American EMS.


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## Alas (Jun 21, 2014)

Novice001 said:


> By the sounds of it your pt has a GCS score of 13-15. Just because the pt couldn't recall the event doesn't necessarily mean they have a neurologic disability. I wouldn't take a point off for that.
> 
> What is an aox3? I'm asking, because I am from South Africa and not familiar with the American EMS.



A way to report a person's mentation would be:
Alert and Oriented x4. You get a point for every question you answer correctly : name, place, time/date, event.
This pt would probably also be a minimum gcs14.


Beano I that answered my question thanks.


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## Underoath87 (Jun 21, 2014)

They would be A&O x 3/3 or 3/4. 
But not 4/4 if they don't recall the trauma that lead to their current predicament.


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## Alas (Jun 21, 2014)

Underoath87 said:


> They would be A&O x 3/3 or 3/4.
> But not 4/4 if they don't recall the trauma that lead to their current predicament.



Would you say then-

"Yeah I got punched and woke up on the floor"

Aox3/4 or aox4/4


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## STXmedic (Jun 21, 2014)

Alas said:


> Would you say then-
> 
> "Yeah I got punched and woke up on the floor"
> 
> Aox3/4 or aox4/4



For that, I would likely write "Patient is A&Ox4 with positive loss of consciousness."

He can answer person, place, and time, and he remembers the event that occurred. You should still be expanding on that in your narrative, though.


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## DesertMedic66 (Jun 21, 2014)

STXmedic said:


> For that, I would likely write "Patient is A&Ox4 with positive loss of consciousness."
> 
> He can answer person, place, and time, and he remembers the event that occurred.



This


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## Akulahawk (Jun 21, 2014)

Alas said:


> If someone hits their head and loses consciousness, but is now awake and oriented, are they aox3, losing one point for not remembering the event? What gcs would they then be?


By definition, a person who is alert and fully oriented is exactly that. You don't subtract points because they lost consciousness.

The patient that reports "Yeah, I got tripped and hit my head on something and woke up a little while ago" remembers the event. While I'm going to be watching him, I'm not going to be too concerned unless he starts having signs of brain injury. 

I'd be a bit _more_ concerned about the patient that says "I have no idea how I got here... I was sitting in the bar, then I talked to some guy, then I woke up right here and my head hurts." That would also be that same guy that's showing physical evidence of having been in a bar fight... He's the one that I would write as Alert & Oriented to... with amnesia to the event. You'd better believe that I'm going to be watching him really closely for extension of that amnesia.


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## Underoath87 (Jun 21, 2014)

Alas said:


> Would you say then-
> 
> "Yeah I got punched and woke up on the floor"
> 
> Aox3/4 or aox4/4



"I got punched" = 4/4
"I was sipping my beer, running my mouth to some guy across the bar, then woke up on the floor" = 3/4.


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## MagicTyler (Jun 21, 2014)

To me, event has nothing to do with past events. If they can tell me they are sitting in the back of an ambulance on the way to the hospital, the president, and any other current events, then I classify them as oriented to event. Losing consciousness does not mean they are not oriented to event. 

Otherwise, the person would be A&OX3 forever...


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## MSDeltaFlt (Jun 21, 2014)

Alas said:


> If someone hits their head and loses consciousness, but is now awake and oriented, are they aox3, losing one point for not remembering the event? What gcs would they then be?



When it comes to neuro, chart not only what they are but also chart what they are not.  If they are alert and oriented to person/place/time but not events, then chart that in this fashion.  Also, chart whether or not they are verbally appropriate.  Along with their GCS in the E/V/M format.  Especially if their GCS is between 3 and 15 to let the hospital kno lw where GCS is.


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## Underoath87 (Jun 22, 2014)

MagicTyler said:


> To me, event has nothing to do with past events. If they can tell me they are sitting in the back of an ambulance on the way to the hospital, the president, and any other current events, then I classify them as oriented to event. Losing consciousness does not mean they are not oriented to event.
> 
> Otherwise, the person would be A&OX3 forever...



How does "event" not mean the event that lead to their hospitalization/transport?
Obviously we do not expect one to know what happened while they were unconscious, but being oblivious to what caused their trip to the ER would indicate retrograde amnesia, which is highly clinically significant.

Btw, being able to name the current president counts leniently toward "time" for those with a handicap, not event.


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## Carlos Danger (Jun 22, 2014)

MagicTyler said:


> To me, event has nothing to do with past events. If they can tell me they are sitting in the back of an ambulance on the way to the hospital, the president, and any other current events, then I classify them as oriented to event. Losing consciousness does not mean they are not oriented to event.



No, event is supposed to measure their recall, so it means the event that led up to EMS being called, not current events, not what is happening now.

- person: can they tell you their name
- place: can they tell you where they are now
- time: what year is it or what time of day is it?
- event: what happened to them that resulted in EMS being called (some places use "situation" instead of "event")

Really though, I think we make this too complicated. None of those specifics really matter at all, to be honest. Confusion after a concussion is normal and the specifics of that confusion are varied and have little or no clinical or predictive value.

The important clinical predictors of brain injury severity are just loss of consciousness (basically, was he GCS ever <8?) and GCS after regaining consciousness. IIRC, even length of LOC has little value in predicting the severity of a CNS insult.


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## Novice001 (Jun 22, 2014)

Thanks for explaining the meaning of aox. Funny, I have the Tenth Edition of Emergency Care and Transportation of the Sick and Injured, but have never come across it and the text book is American.


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## Bearamedic (Jul 6, 2014)

TransportJockey said:


> if I document A&Ox3 I will usually put A&Ox3/4 just to save the confusion. But it's another reason to have standardized abbreviations and not just whatever Joe Blow paramedic decides he's going to use




I really like that fractional notation option, im going to start using it.


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## Rialaigh (Jul 6, 2014)

Remi said:


> No, event is supposed to measure their recall, so it means the event that led up to EMS being called, not current events, not what is happening now.
> 
> - person: can they tell you their name
> - place: can they tell you where they are now
> ...



This guy is right 


As far as this goes you will do little to nothing for this patient aside from transport, and whether you say alert and oriented x1 or x4 if they lost consciousness due to hitting their head there is about a 99.95% chance (at hospitals in my area at least) that they are getting a CT at the ER. The physician is going to make that decision based on his assessment and not your report. 

The only significant clinical factors I would worry about are things that would indicate a possible head bleed or other significant neuro insult that would require a change in transport destination decision or priority. If the patient is alert and oriented x3 or x4 then it is likely someone you will go non emergent with to the closest facility with a ct scanner.


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