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Tue, 26 Feb 2002 22:10:16 +0200

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Don't remember where I picked this up years ago.

But, one can add to the GCS score the abbreviatons of:
S.T.P. : S =3D sedation (medication), T =3D tube, P =3D paralysis =
(medication)
This is to alert whoever is reading the score in the chart that the =
patient is under the influence of drugs.

Thus:
A GCS of 11-T : is an awake patient with an endotracheal tube in place.
A GCS of 8-ST : is an intubated patient with sedatives on board.
A GCS o 3-STP: can be an alert patient that was just tubed with the help =
of a sedative and a paralysing agent.
etc. etc.

Of course, one has to provide all the individual GCS parameters and not =
only the sum.
This can sometime help with the proper evaluation an especially, =
followup of the GCS.
No very scientific but can sometimes help.

Mickey Stein

  ----- Original Message -----=20
  From: Bjorn, Pret=20
  To: 'trauma-list@trauma.org'=20
  Sent: Tuesday, February 26, 2002 1:55 PM
  Subject: RE: AVPU trivia

  Charles,

  I think Jean is referring specifically to the motor component; I =
suspect this mostly because that's precisely what she wrote. =20

  Further, I believe that her concern relates to the fact that this =
particular motor score was '1' (as would be verbal score, and probably, =
though not certainly, the eye-opening) not as a result of coma, but =
rather from chemical paralysis.  In this case, as in all such cases, =
there is simply no accurate means of assessing level of consciousness.  =
GCS is "N/A."  So is AVPU, for that matter.  Just another example of =
inconvenient consequences arising from perfectly good decisions.

  Pret

  -----Original Message-----
  From: Krin135@aol.com [mailto:Krin135@aol.com]
  Sent: Tuesday, February 26, 2002 4:13 AM
  To: trauma-list@trauma.org
  Subject: Re: AVPU trivia

  In a message dated 26-Feb-02 02:05:07 Central Standard Time,
  Jean.A.Proehl@Hitchcock.ORG writes:

  >
  >  I couldn't agree more!  After emphasizing correct GCS assessment =
trauma
  > classes for almost 20 years I am still astounded to see experienced
  critical
  > care and emergency nurses give a motor score of 1 for a patient who =
is
  > chemically paralyzed!  I see this happen at least once a month if =
not more.

  > Has anyone found a way  to solve this? Remediation with every nurse, =
every
  > time is not always possible........
  >=20
  >  Jean Proehl
  >  Emergency Clinical Nurse Specialist

  ummmm...I thought that the *minimum* score in each category *was* 1? =
This
  would result in a fully paralyzed patient getting a 3 over all (no
  spontaneous eye opening, no speech and no motor movement in response =
to
  painful stimuli)...or did you mean that the *total* score was 1?

  ck

  Charles S. Krin, DO

  --
  trauma-list : TRAUMA.ORG
  To change your settings or unsubscribe visit:
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<BODY bgColor=3D#ffffff>
<DIV><FONT color=3D#0000ff>Don't remember where I picked this up years=20
ago.</FONT></DIV>
<DIV><FONT color=3D#0000ff></FONT>&nbsp;</DIV>
<DIV><FONT color=3D#0000ff>But, one can add to the GCS score the =
abbreviatons=20
of:</FONT></DIV>
<DIV><FONT color=3D#0000ff>S.T.P. : </FONT><FONT color=3D#0000ff>S =3D =
sedation=20
(medication), </FONT><FONT color=3D#0000ff>T =3D tube, </FONT><FONT =
color=3D#0000ff>P=20
=3D paralysis (medication)</FONT></DIV>
<DIV><FONT color=3D#0000ff>This is to&nbsp;alert whoever is reading the =
score in=20
the chart that&nbsp;the patient is under the influence of =
drugs.</FONT></DIV>
<DIV><FONT color=3D#0000ff></FONT>&nbsp;</DIV>
<DIV><FONT color=3D#0000ff>Thus:</FONT></DIV>
<DIV><FONT color=3D#0000ff>A&nbsp;GCS of 11-T : is an awake patient with =
an=20
endotracheal tube in place.</FONT></DIV>
<DIV><FONT color=3D#0000ff>A GCS of 8-ST : is an intubated patient with =
sedatives=20
on board.</FONT></DIV>
<DIV><FONT color=3D#0000ff>A GCS o 3-STP: can be an alert patient that =
was=20
just&nbsp;tubed with the&nbsp;help of a sedative and a paralysing=20
agent.</FONT></DIV>
<DIV><FONT color=3D#0000ff>etc. etc.</FONT></DIV>
<DIV><FONT color=3D#0000ff></FONT>&nbsp;</DIV>
<DIV><FONT color=3D#0000ff>Of course, one has to provide all the =
individual GCS=20
parameters and not only the sum.</FONT></DIV>
<DIV><FONT color=3D#0000ff>This can sometime help with the proper =
evaluation an=20
especially, followup of the GCS.</FONT></DIV>
<DIV><FONT color=3D#0000ff>No very scientific but can sometimes =
help.</FONT></DIV>
<DIV><FONT color=3D#0000ff></FONT>&nbsp;</DIV>
<DIV><FONT color=3D#0000ff>Mickey Stein</FONT></DIV>
<DIV><FONT color=3D#0000ff></FONT>&nbsp;</DIV>
<DIV><FONT color=3D#0000ff></FONT>&nbsp;</DIV>
<DIV><FONT color=3D#0000ff></FONT>&nbsp;</DIV>
<BLOCKQUOTE dir=3Dltr=20
style=3D"PADDING-RIGHT: 0px; PADDING-LEFT: 5px; MARGIN-LEFT: 5px; =
BORDER-LEFT: #0000ff 2px solid; MARGIN-RIGHT: 0px">
  <DIV style=3D"FONT: 10pt arial">----- Original Message ----- </DIV>
  <DIV=20
  style=3D"BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: =
black"><B>From:</B>=20
  <A title=3Dpbjorn@emh.org href=3D"mailto:pbjorn@emh.org">Bjorn, =
Pret</A> </DIV>
  <DIV style=3D"FONT: 10pt arial"><B>To:</B> <A =
title=3Dtrauma-list@trauma.org=20
  href=3D"mailto:'trauma-list@trauma.org'">'trauma-list@trauma.org'</A> =
</DIV>
  <DIV style=3D"FONT: 10pt arial"><B>Sent:</B> Tuesday, February 26, =
2002 1:55=20
  PM</DIV>
  <DIV style=3D"FONT: 10pt arial"><B>Subject:</B> RE: AVPU trivia</DIV>
  <DIV><BR></DIV>
  <P><FONT size=3D2><FONT face=3DArial color=3D#800000>Charles,<BR><BR>I =
think Jean is=20
  referring specifically to the motor component; I suspect this mostly =
because=20
  that's precisely what she wrote.&nbsp; </FONT></FONT></P>
  <P><FONT size=3D2><FONT face=3DArial color=3D#800000>Further, I =
believe that her=20
  concern relates to the fact that this particular motor score was '1' =
(as would=20
  be verbal score, and probably, though not certainly, the eye-opening) =
not as a=20
  result of coma, but rather from chemical paralysis.&nbsp; In this =
case, as in=20
  all such cases, there is simply no accurate means of assessing level =
of=20
  consciousness.&nbsp; GCS is "N/A."&nbsp; So is AVPU, for that =
matter.&nbsp;=20
  Just another example of inconvenient consequences arising from =
perfectly good=20
  decisions.<BR><BR>Pret<BR><BR></FONT>-----Original =
Message-----<BR>From:=20
  Krin135@aol.com [<A=20
  href=3D"mailto:Krin135@aol.com">mailto:Krin135@aol.com</A>]<BR>Sent: =
Tuesday,=20
  February 26, 2002 4:13 AM<BR>To: trauma-list@trauma.org<BR>Subject: =
Re: AVPU=20
  trivia<BR><BR><BR>In a message dated 26-Feb-02 02:05:07 Central =
Standard=20
  Time,<BR>Jean.A.Proehl@Hitchcock.ORG writes:<BR><BR>&gt;<BR>&gt;&nbsp; =
I=20
  couldn't agree more!&nbsp; After emphasizing correct GCS assessment=20
  trauma<BR>&gt; classes for almost 20 years I am still astounded to see =

  experienced<BR>critical<BR>&gt; care and emergency nurses give a motor =
score=20
  of 1 for a patient who is<BR>&gt; chemically paralyzed!&nbsp; I see =
this=20
  happen at least once a month if not more.<BR><BR>&gt; Has anyone found =
a=20
  way&nbsp; to solve this? Remediation with every nurse, every<BR>&gt; =
time is=20
  not always possible........<BR>&gt;&nbsp;<BR>&gt;&nbsp; Jean=20
  Proehl<BR>&gt;&nbsp; Emergency Clinical Nurse =
Specialist<BR><BR>ummmm...I=20
  thought that the *minimum* score in each category *was* 1? =
This<BR>would=20
  result in a fully paralyzed patient getting a 3 over all =
(no<BR>spontaneous=20
  eye opening, no speech and no motor movement in response to<BR>painful =

  stimuli)...or did you mean that the *total* score was=20
  1?<BR><BR>ck<BR><BR>Charles S. Krin, DO<BR><BR>--<BR>trauma-list :=20
  TRAUMA.ORG<BR>To change your settings or unsubscribe visit:<BR><A=20
  target=3D_blank=20
  =
href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2002/3D"http://www.trauma.org/traumalist.html">http://www.trauma.org/trau=
malist.html</A><BR></P></BLOCKQUOTE></FONT></BODY></HTML>

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