# CAOX4 vs AxOx4



## platypus (Jun 9, 2011)

can someone please explain the difference between the two?? and the proper way to use them in paperwork..this is probably a really stupid question but i'm confused :/

thanks!


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## abckidsmom (Jun 9, 2011)

Personal preference.  It doesn't matter.


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## MrBrown (Jun 9, 2011)

Keep things simple, use AVPU and GCS 

Brown has no seen anywhere outside the US that uses A&O or C&O

Some used to write "C+O" here until specifically instructed not to, because it is not a concept used by medical or nursing staff nor it is a commonly used abbreviation within the Ambulance Service so somebody reading it may have no idea what it means.


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## Shishkabob (Jun 9, 2011)

platypus said:


> can someone please explain the difference between the two?? and the proper way to use them in paperwork..this is probably a really stupid question but i'm confused :/
> 
> thanks!



Conscious, Alert and Oriented x4

Alert and Oriented x4


Honestly, if they are alert and oriented, the conscious part is implied.  Other than that, it's personal preference.


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## Chimpie (Jun 9, 2011)

platypus said:


> can someone please explain the ... proper way to use them in paperwork..



Ask your supervisor/FTO how they want you to complete the paperwork.  Every department/agency/company may be different.


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## BEorP (Jun 9, 2011)

MrBrown said:


> Keep things simple, use AVPU and GCS
> 
> Brown has no seen anywhere outside the US that uses A&O or C&O
> 
> Some used to write "C+O" here until specifically instructed not to, because it is not a concept used by medical or nursing staff nor it is a commonly used abbreviation within the Ambulance Service so somebody reading it may have no idea what it means.



Definitely better to keep it to GCS primarily. A patient who is GCS 15 is oriented. If they are GCS 14 and it is because I've put their verbal component down to 4 then I will usually note that they are oriented to whichever of person, place, time, and event (if any).


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## lightsandsirens5 (Jun 9, 2011)

BEorP said:


> Definitely better to keep it to GCS primarily. A patient who is GCS 15 is oriented. If they are GCS 14 and it is because I've put their verbal component down to 4 then I will usually note that they are oriented to whichever of person, place, time, and event (if any).



Good one. And I would add: If you write anything other than GCS=15, note what ones are lacking. For example, in my report I would write:

Neuro: GCS=10 (E=3, V=3, M=4).


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## abckidsmom (Jun 9, 2011)

lightsandsirens5 said:


> Good one. And I would add: If you write anything other than GCS=15, note what ones are lacking. For example, in my report I would write:
> 
> Neuro: GCS=10 (E=3, V=3, M=4).



Just a tip, if the patient is intubated, write GCS: 10T if he is alert and follows commands, and specify if his mental status is off from there.


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## lightsandsirens5 (Jun 10, 2011)

abckidsmom said:


> Just a tip, if the patient is intubated, write GCS: 10T if he is alert and follows commands, and specify if his mental status is off from there.



Wait, what? I are just a humble I-85.


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## Handsome Rob (Jun 10, 2011)

abckidsmom said:


> Just a tip, if the patient is intubated, write GCS: 10T if he is alert and follows commands, and specify if his mental status is off from there.



Word. Excellent advice. 

sent from my mobile command center. or phone. whatever.


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## abckidsmom (Jun 10, 2011)

lightsandsirens5 said:


> Wait, what? I are just a humble I-85.



GCS is made comprised of best eye, verbal and motor response.  If you intubate the patient (or if they have a trach), you've taken away the verbal response.  Standard documentation of GCS is such cases is to add up eye and motor response, and put a T on the end to indicate the tube.


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## hippocratical (Jul 18, 2011)

GCS and AVPU make much more sense, but is there a defined order for AOx4? Is it always in the order of Person, Place, Time, Event?

My main set of reading uses this order, but I'm sure I've seen it in a different order somewhere else. 

Also, would anyone ever say _"Pt is AOx2"_ or similar? -> It might not be Person, Place that they can do... or realistically if they are only aware of Person/Place would you really call the Pt _"orientated"_?


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## Aprz (Jul 18, 2011)

I've heard of person, place, purpose, and time. Purpose is similar to event, but they ask questions such as "Why are you here?", or something like that. I was trained to to say person, place, time, and event. I was once told that the order did matter because it's in order of what they'll forget or remember. I have not seen any research on that, and personally believe it's a language thing like saying peanut butter and jelly instead of jelly and peanut butter, which just seems odd. In my limited experience, I've seen patients remember it out of order e.g. person and time. In regard to how I verbalize and document it, I'll say "the patient is alert and oriented to person, place, time, and event", and or if they are only orient to a few things, I'll say which one e.g. "the patient is alert and oriented to person only", something like that. You could say the number followed by what they are oriented to.

Unfortunately where I live, a lot of paramedics don't remember the Glasgow coma scale, and they just wing it when a nurse requests it. A lot of EMT programs do not include it in their curriculum, or it will be briefly mentioned as "something you don't need to know".

I personally mention and document both in a report.

AVPU is already included in the alert part of alert and oriented. If they aren't alert, I don't ask AO questions. I will alternatively say what they are on AVPU and GCS.

Oh, I also find AO questions useful for distinguishing verbal 4 or 5 for GCS. It gives me an objective way that I can say to distinguish between confused and not confused.

To add to the t thing for when the are intubated, you could use c if they cannot open their eyes because of trauma, or something. I bet that's less commonly used though.


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## Melclin (Jul 19, 2011)

God, we used to teach GCS to first aiders and your highest level prehospital providers have trouble with it? Sigh.

Why you would use anything other than GCS to describe the conscious state is beyond me. 

If their conscious state is dynamic, I write something like this on my glove (not with the lines, I had to put them in there to keep the spaces).

E__2__3_______4_____
V__2_______3________
M__4___ 5_______6__
___8  

Where I just write whats changed and add/subtract from the original tally. There is fairly minimal writing involved and then afterwards you can figure out a trend for your paper work.


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## Aidey (Jul 19, 2011)

MrBrown said:


> Keep things simple, use AVPU and GCS



The way I was taught it, AOx4 is part of AVPU. If they are V, P, or U that is what you indicate, but if they are A, you indicate whether they are Ax1,2,3 or 4.


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## bstone (Jul 19, 2011)

x4? I was only ever taught x3.


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## Cup of Joe (Jul 19, 2011)

bstone said:


> x4? I was only ever taught x3.



Thats how I learned it: Name, aprox. time of day, and location.  if name is not verifiable or you need another question, ask current president.


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## Handsome Robb (Jul 19, 2011)

Linuss said:


> Conscious, Alert and Oriented x4



I have also heard Competent, Alert and Oriented but conscious makes more sense.


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## mpena (Jul 20, 2011)

Linuss said:


> Conscious, Alert and Oriented x4
> 
> Alert and Oriented x4
> 
> ...



agreed..lol


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## socalmedic (Jul 21, 2011)

i typically write "Awake, Alert, and Oriented, answering questions and acting appropriately, GCS=15." this implies that the patient is competent to make decisions. if they are not all of the above, I will explain what is lacking. ie "patient is awake, and alert however is asking repetitive questions and not following simple commands, GCS=13 E-4, V-4, M-5" with the advent of EPCRs and unlimited space to write a narrative you should be painting a very detailed picture, not only does it make you and your service look more professional but it will cover your *** better when you get chart audited. my service has 100% audit both internally and externally for ALS patients (my Training dept reads all PCRs and my base hospital has an RN that reviews all EMS charts:wacko


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