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



## mycrofft (Dec 20, 2008)

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).(


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## akflightmedic (Dec 20, 2008)

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?


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## KEVD18 (Dec 20, 2008)

person, place, time and event(situation)


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## Scout (Dec 20, 2008)

I dont use a/ox2 we have 

AVPU; alert, responds to voice, pain, nothing

And GCS 0-15


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## Airwaygoddess (Dec 20, 2008)

Same here in my neck of the woods, person, place, time and event along with AVPU and GCS


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## Code 3 (Dec 20, 2008)

akflightmedic said:


> The "new" way...that is funny.
> 
> It has been A/O x4 for many years now.
> 
> ...



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 SAMPL*E* and state whether or not the pt was aware.


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## KEVD18 (Dec 20, 2008)

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.


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## marineman (Dec 20, 2008)

Scout said:


> And GCS *0*-15



Are you sure on that?


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## 41 Duck (Dec 20, 2008)

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




Later!

--Coop


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## MSDeltaFlt (Dec 20, 2008)

Code 3 said:


> 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 SAMPL*E* and state whether or not the pt was aware.



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.


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## akflightmedic (Dec 20, 2008)

Scout said:


> I dont use a/ox2 we have
> 
> AVPU; alert, responds to voice, pain, nothing
> 
> And GCS 0-15



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.


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## Tincanfireman (Dec 20, 2008)

I have used CAO x 4 for years, but there are some who prefer the x3 variant. Either way, documentation is your friend.


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## Epi-do (Dec 20, 2008)

We use A&Ox3 around here, although I was taught A&Ox4 a long, long time ago in basic class.


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## EMT007 (Dec 20, 2008)

^ 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


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## traumateam1 (Dec 20, 2008)

Scout said:


> I dont use a/ox2 we have
> 
> AVPU; alert, responds to voice, pain, nothing
> 
> And GCS 0-15



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.


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## Scout (Dec 20, 2008)

cough 3-15, my bad, bit of a slip of the fingers.


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## BossyCow (Dec 21, 2008)

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.


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## JPINFV (Dec 21, 2008)

BossyCow said:


> but had no memory of what happened to them.


Did they have Korsakoff's?


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## BossyCow (Dec 21, 2008)

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.


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## mycrofft (Dec 21, 2008)

*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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## FF894 (Dec 22, 2008)

KEVD18 said:


> 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.



The "new" way is x4.  It has been this way for roughly 5 years or so.  Some areas are just slow to catch on, like any "new" thing.  All curriculum should be following this standard.


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