Your patter for assessing orientation

Brandon O

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When assessing a patient's degree of orientation, what questions do you like to ask? Everyone seems to do this differently and I think there's a lot to be learned from hearing different ideas. (For what it's worth I feel that this can vary some depending on emergency vs. transfer runs, and perhaps also depending on the type and severity of call... but it's all worth hearing.)

Additionally, what's the actual LOC assessment in your agency? I was originally taught A&Ox4, where the 4 are Person, Place, Time, and Event (PPTE), but I've also seen a lot of x3 (Person, Place, Time only) and even some x3 that are the other way (Place, Time, Event). This can cause some problems -- i.e. if you're told a patient's A&Ox3 that can either mean they're fully oriented or altered, depending. I've actually got two different run sheets in use at my company and each uses a different system. What's common in your area?
 

DV_EMT

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I do AOx4... with the 4th being "what happened"... but here in the hospital I work at... its x3 beacuse they don't need to recall the prior events.
 
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Brandon O

Brandon O

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i've known some to ask a pt if they know who the current president is

Seen this too, but was always a little leery of it -- I guess it's meant to assess Time, but it really seems like more of an assessment of awareness of current events... which I guess is important, but if you know what "time" it is relative to the things that affect you, but don't know who's in Washington, I'd be less concerned than if the reverse was true...
 

Epi-do

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We use A&Ox3 (person, place, time). Our medical director has went on several "rants" about how "ridiculous" x4 is. He thinks that saying someone is oriented to the event is a bit redundant because in order to accurately tell you what happened the patient would have to be oriented to the other three. In fact, at our last audit & review, he started making jokes about how patients that were described as A&Ox4 must be clairvoyant or something similar.

Personally, I will just start talking to the patient about why the called, how they are feeling, what is going on with them to see how appropriate they appear. If they seem to be a little bit "off," then I will start asking the who, what, when, where type questions to assess their orientation.
 
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Brandon O

Brandon O

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My personal method is probably more suited to IFT than emergencies. Like Epi I pretty much just chat, and involved in that is a number of questions that I sincerely want to know the answer to -- things like how long they've been in the facility I'm taking them from, where they're headed now and why they're going there, whether they were born "around here," how to pronounce that funny last name of theirs, and what the current date is for the paperwork because my darned watch never seems to work. Yeah, I already know the answer to most of those, but it's always nice to confirm, and if they have a different understanding of something (like what procedure they're going in for) it can be cleared up, and if we discuss all of the above then I've assessed their LOC without harassing them with the silly sort of questions they probably get all the time.

But to be honest, I probably wouldn't know the date or what the doc's doing to me today if I were some of these people, so context is pretty important. They don't usually know the weather either but that doesn't mean they're altered, just that their room doesn't have an oceanside view.
 

Linuss

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Do you know your name?

Do you know where you're at?

Do you know what day it is?

Do you know why we were called here/what were doing?
 

MMiz

I put the M in EMTLife
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I always said:

I know this is going to sound funny, but I ask all of my patients these questions:
1. Do you know who is the United States President? If not, I ask if they know their name.
2. Do you know where we are right now?
3. Do you know what day it is today?
 

Epi-do

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3. Do you know what day it is today?

I always feel like that one is a trick question, because half the time I have to look at my watch to make sure they are correct if I opt to ask them. I know I am oriented, but my world doesn't revolve around days of the week so much any more as it does A, B, or C shift.
 
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Brandon O

Brandon O

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And if you're en route, "where are you?" is even more tricky. I often have *no* idea where we are, and "in an ambulance" seems a little cute :rolleyes:
 

MMiz

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I always feel like that one is a trick question, because half the time I have to look at my watch to make sure they are correct if I opt to ask them. I know I am oriented, but my world doesn't revolve around days of the week so much any more as it does A, B, or C shift.
I agree with you completely on that one. I'm not asking it for the patient's sake... I really want to know what day it is. They all seem to blend together when you work the midnight shift :)
 

el Murpharino

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I've heard people ask how many quarters there are in a dollar...doesn't work well with everyone, obviously. I've also had people mention two or three random things (i.e. peanut butter, giraffe) and have the patient recall it back to them a minute or two later.

This in addition to the usual suspects: "whats your name, what dy of the week is it< where are you right now?" - although I may ask them their address or what type of vehicle they are in.

Usually one can get a good idea of mental status while asking them questions about their present medical condition/injuries without having to ask them the above mentioned questions.
 
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Brandon O

Brandon O

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I've heard people ask how many quarters there are in a dollar...doesn't work well with everyone, obviously.

Yeah, I don't think I make that much without overtime :p
 

Melclin

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There's a bit of debate at uni about questions to establish the confused/oriented part of the GCS.

I used to use "Who's the prime minister". But one sessional tutor told me once that some people may not actually know. I reckon that's BS. Honestly...who doesn't know who leads the nation. Maybe it takes you a moment to think past a mental block because you're tired, maybe you accidentally say the wrong name and quickly correct yourself...but to just straight up not know?

I reckon if the pt didn't know the explanation as to why that would follow would be enough to gauge the conscious state anyway.
 

wyoskibum

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i've known some to ask a pt if they know who the current president is

LOL! Not all patients can answer that question even if they aren't altered. I was confused during the last administration on who was the president. Was it George or ****? ;-D

You should only ask questions that the patient is expected to know. Person, Place, Time, and Events.
 

wyoskibum

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I used to use "Who's the prime minister". But one sessional tutor told me once that some people may not actually know. I reckon that's BS. Honestly...who doesn't know who leads the nation. Maybe it takes you a moment to think past a mental block because you're tired, maybe you accidentally say the wrong name and quickly correct yourself...but to just straight up not know? .

Don't you ever get stupid American Tourists? Or do all visitors have to pass a Social Studies test before they can enter the Country? LOL!
 

Akulahawk

EMT-P/ED RN
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My pattern for assessing orientation is determining person, place, time, (recent) event. This is modified for the situation, appropriate for the location. IOW: I won't ask the exact same question for someone on the street vs. someone in a SNF vs. someone in an acute care hospital, but I'm still looking for the same things.
 

Melclin

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Don't you ever get stupid American Tourists? Or do all visitors have to pass a Social Studies test before they can enter the Country? LOL!

Lol. We don't let Americans into the country since 'dance your *** off'.

thats what i mean about the explanation, its one of those questions where if they didn't know, they'd want to explain why. 'whos the pm? Whats a pm? Oh priyminista? Oh yeah little gai who looks like a baby'. Gcs ? 15. Dx? American.
 
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