Contraindications and Critical Thinking: NTG/CPAP

Teasdale and Jennett only ever intended the GCS to measure responsiveness in patients with severe TBI. The fact it has become the default assessment of the conscious state is probably somewhat of an erroneous extrapolation. The components (scores) individually are helpful but "at a glance" the total scale on its own (sum of scores) I don't think is overly helpful in isolation of the greater clinical context.
 
Remi said:
Which GCS score indicates death?
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3 = coma or death from the way I understand it. My pt. was a 4 when having the seizure. So no he was not dead. As others have said it is a poor scale for some pts. that we encounter.
 
Yes, it's a poor scale for some of the patients that we encounter. For others, it's a fair way to measure changes in responsiveness and document those changes.

For example, using GCS for the documention of the change in responsiveness in a hypoglycemic, both prior and post dextrose administration, is entirely appropriate. For the sake of documentation.

Do we need something better for serial assessment of gross changes in responsiveness prehospital? Maybe. But we've been using the GCS for a minute, and while a bit clunky, it seems to get the job done in most cases. That is, It gets the point across to the emergency department as to the status of the patient over the course of your encounter.
 
My protocols also list AMS as a contraindication for CPAP. For nitro though... never heard of it. Even with an altered patient, a SL tab wouldn't concern me. They are tiny, and dissolve quickly. Keep their head up and there shouldn't be a problem.

In my case, I'd give SL NTG as we can only take nitro drips on transfers and CPAP is strictly contraindication in AMS under my protocols.
 
NPO said:
My protocols also list AMS as a contraindication for CPAP. For nitro though... never heard of it. Even with an altered patient, a SL tab wouldn't concern me. They are tiny, and dissolve quickly. Keep their head up and there shouldn't be a problem.

In my case, I'd give SL NTG as we can only take nitro drips on transfers and CPAP is strictly contraindication in AMS under my protocols.
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The level of AMS will be a judgement call; for me, it's the point where the pt becomes profoundly altered. If the pt is actively working, is aware of our presence but not necessarily interacting appropriately with us then they will still get CPAP. If they continue to deteriorate then I'll discontinue and switch to the BVM.


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Im sure someone probably touched on this, but a BVM, PEEP valve and NC under the mask could provide a pseudo-CPAP you are looking for.
 
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