To measure orientation, does your system use A&Ox3 or 4? If you use 3, is the person considered oriented if they do not remember the event, but are aware of person, place, and time? If someone hits their head hard enough to lose memory of the event, but not hard enough to lose consciousness or orientation x3, is this considered a TBI with full c-spine precautions?

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What I normally do is the A&O X's 3 and then add a GCS. As far as hitting their head hard enough to not remember the event but did not loose conscousnes...they get the c-collar backboard treatment. Rather to err on the side of safety and covering my butt than not and they endp with a bleed.
Amnesia is often a symptom of a CNS injury. I'd strongly consider a full spinal package for this patient, but it includes other factors like mechanism of injury, vital signs, other signs and symptoms, the results of a physical exam, and how well the patient can verbalize his/her present mental capacity to make rational decisions about informed consent. On the other hand, if the patient is combative, it sometimes comes down to how big of a fight you're willing to get into with the patient in order to restrain him/her, or how big of a fight medical control is willing to sign off on. I'd rather talk the patient into a nice comfortable ride in the captain's chair than fight him/her into a spinal package in the absence of other related signs and symptoms.

Ben
We use A&Ox4 at all the services I've worked here in Oklahoma. Each catagory counts (and should). A Pt. that hits their head hard enough to "Ring their bell" gets the full treatment - C-Collar, etc. as a precaution. As Jeannie said it is far better to err on the side of caution and CYA. I would not consider this a TBI necessarily but would certianly watch this patient like a hawk, all the way to the hospital. There are many factors to consider on this call, always CYA and document the hell out of everything!
So A&O x 3 is Time Place and Person? What is x 4? What is TBI?

We don't use the abbreviations....
The 4th is Event. TBI = Traumatic Brain Injury. There are many definitions of tbi, but it's basically any trauma to the head that disrupts normal brain function. For instance, some argue that only a 'significant' loss of consciousness equals a tbi, while other believe that any loc is considered a tbi.

TheCannulator said:
So A&O x 3 is Time Place and Person? What is x 4? What is TBI?

We don't use the abbreviations....
Cheers,

TBI would be a conjectured one here too, I guess from one example, somewhat normal response to trauma such as LOC or retrograde amnesia compared to concussionwith specific symtomology.


Certainly GCS applied correctly is our main tool. With other A&O used as qualfiers and never in isolation, because of the variables in interpretation.
Chris Brixey said:
The 4th is Event. TBI = Traumatic Brain Injury. There are many definitions of tbi, but it's basically any trauma to the head that disrupts normal brain function. For instance, some argue that only a 'significant' loss of consciousness equals a tbi, while other believe that any loc is considered a tbi.

TheCannulator said:
So A&O x 3 is Time Place and Person? What is x 4? What is TBI?

We don't use the abbreviations....
I would add to this discussion that many neurologist and pathophysiologists would argue that retrograde amnesia is a loss of consciousness.
Recall/Memory would only be one component of consciousness? Wakefullness would perhaps be another.

Would a Nanna with a short term memory loss witha head strike be an LOC with retrograde amnesia or STML with a head strike?

Duncan Hitchcock said:
I would add to this discussion that many neurologist and pathophysiologists would argue that retrograde amnesia is a loss of consciousness.
I mostly agree with Ben Waller. The main issue IMO is whether or not the physical exam is in any way compromised. A lack of orientation to event does not necessarily imply confusion or altered mental status. If the patient has a normal level of alertness at the time of evaluation, a normal neuro exam, has no pain on palpation of the cervical spine, no evidence of intoxication, and no painful distracting injuries, then there is no significant spinal injury. People get knocked out in boxing/MMA all the time and they don't get a full spinal package.
The issue on the table is whether or not it's a TBI "with full c-spine precautions."
I asked a question, sorry we digressed in front of you! ;)

Tom Bouthillet said:
The issue on the table is whether or not it's a TBI "with full c-spine precautions."
I forgive you! :)

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