Mental Status

Upon assessing a 32-year-old victim of a motorcycle crash, you find that he is only partially responsive. You notice that his eyes only open when verbally addressed and only for a few moments. He also appears to be confused and withdraws from painful stimuli. How would you rate him on the Glasgow Coma Scale?

11

Your patient is suffering from a head injury. You determine a Glasgow Coma score of 13. You should re-determine the GCS score every ____ minutes, with ongoing assessment.

5 *A patient with a score between 13 and 15 is considered to have a mild head injury. When a patient has a GCS less than 15, the GSC score should be determined every 5 minutes.

Which of the following is not one of the components that make up the Glasgow Coma Scale for assessing a patient's mental status?

Circulation *Circulation is not a component of the Glasgow Coma Scale. Remember, the Glasgow Coma Scale is used to assess mental status.

You are dispatched for a 65-year-old woman who had a ground level fall. She is lying on the kitchen floor and tracks you as you walk into the house. When you ask the patient what happened today, she responds with clear, but confused speech. The chief complaint is right foot pain. As you lean down and palpate her foot, she attempts to pull her leg away from you. With all of this information in mind, what is the patient's Glasgow Coma Scale (GCS) score?

12 *The woman has spontaneous eye movement (4), has confused speech (4), and withdraws from painful stimuli (4).

You find an unconscious male lying on the street that starts to come around when you begin assessing him. The patient opens his eyes in response to pain, is speaking with incomprehensible sounds, and withdraws from pain by extending both arms. What is his GCS score?

6 *Eye opening 2, Verbal 2, Motor 2.

The V in AVPU stands for what?

Verbal *AVPU stands for Alert, Verbal, Pain, and Unconscious. It is used to measure a patient's mental status.

Which of the following is not a metabolic cause of altered mental status?

Intracranial hemorrhage *Causes of altered mental status can be placed in two categories: structural and metabolic. Structural causes are a result of a change in the actual anatomy that results in problems associated with the reticular formation. Metabolic causes are a result of a metabolism or toxin issue (oxygen, glucose, drugs, etc.).

Which of the following is least likely to cause an alteration in a patient's mental status?

Long bone fracture *A long bone fracture will cause a lot of pain, but will most likely NOT cause an alteration in a patient's mental status.

AVPU is a mnemonic used to describe which of the following?

Mental status *AVPU stands for Alert, Verbal, Pain, and Unconscious. It is used to measure a patient's mental status

The P in AVPU stands for what?

Pain *AVPU stands for Alert, Verbal, Pain, and Unconscious. It is used to measure a patient's mental status.

The U in AVPU stands for what?

Unconscious *AVPU stands for Alert, Verbal, Pain, and Unconscious. It is used to measure a patient's mental status. Occasionally, you will see the U represented as Unresponsive, but like on the NREMT... pick the best answer that is available.

When assessing a 13-year-old male patient after a suspected concussion in a football game, you use the Glasgow Coma Scale. The patient's eyes open on verbal command, but are closed otherwise. He is able to talk, but the words don't go together or make sense. He grabs at his arm when you attempt to start an IV. What is this patient's GCS?

11 *Eye opening on verbal commands scores him at 3 out of 4. The use of inappropriate words gives the patient 3 out of 5 in the verbal response category. He is responsive to painful stimuli giving scores him at 5 out of 6 in the motor response assessment.

When you arrive to the report of a nosebleed, your 26-year-old female patient is acting very anxious and neurotic, screaming, My nose won't stop bleeding! What is this patient's GCS score?

15 *Eyes: 4. Motor: 5. Verbal: 6.

You get dispatched to a 3-year-old male who was found pulseless and apneic. Based on this information, what is this child's GCS score?

3 *Eyes: 1. Verbal: 1. Motor: 1. Total = 3

You arrive on scene to a man down. You find the patient outside next to a tree with a large branch lying next to him. The patient is bleeding from the top of his skull and is not responsive. When your partner places him in C-spine, he mumbles something and tries to move his head. You ask him to open his eyes and you get no response. What is this patient's GCS score?

4

You arrive on scene to find an elderly male, who after your assessment, appears to be having an extrapyramidal reaction. His eyes are fixed to the right, and moans when you ask him a question. His arms, legs, hands, and feet, are fixed inward. What is his GCS score?

6 *Eye: 1, Verbal: 2, Motor: 3

You are on scene at the local skate park for a 10-year-old male that crashed while not wearing a helmet. The patient fell off his bike while going off a jump. He landed directly on his head and has been unconscious since the accident. He does not open his eyes to verbal or painful stimuli, is making incomprehensible sounds, and has abnormal flexion to a sternal rub. What is this patient's GCS?

6 *No eye movement is a score of 1 for eye response. Incomprehensible sounds is a score of 2 for verbal response. Decorticate posturing (abnormal flexion) is a score of 3 for motor response. 1+2+3 = 6.

You are assessing a 36-year-old unconscious male who fell approximately 12' off a ladder while cleaning his gutters. At the time of assessment, his vital signs are as follows: BP 168/72, HR 54 regular, R 20 irregular. The patient groans to painful stimuli without regaining consciousness and begins flexion posturing while you are conducting your head to toe assessment. This patient's GCS is?

6 *No eye opening = 1, Incomprehensible sounds = 2, Flexion posturing = 3, for a total of 6

Your 83-year-old elderly female patient is suffering from sepsis. She opens her eyes when your rub her sternum, mumbles profusely, and only moves when you rub her sternum. What is her GCS score?

8

A patient involved in a motor vehicle collision opens their eyes to painful stimuli, speaks with inappropriate words, and withdraws to pain. What is this patient's GCS score?

9 *Eye open to pain- 2; verbal inappropriate words- 3; Motor withdraw to pain-4... Total= 9

When describing a patient's alertness, which of the following would you not use?

Active *Active is not a term that is used to describe someone's alertness. Active would be an adjective to describe a person's lifestyle.

The A in AVPU stands for what?

Alert *AVPU stands for Alert, Verbal, Pain, and Unconscious. It is used to measure a patient's mental status.

What is the pneumonic AEIOU TIPS used for?

Reasons for why a patient is unconscious *AEIOU TIPS is commonly used to help determine the cause for potential reasons for why a patient is unconscious, Alcohol, Epilepsy, Insulin, Oxygen, Uremia, Toxins, Infections, Psych, and Stroke.