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  • A: Alert patients are patients that are awake and able to communicate with you. These patients can still have severe and life-threatening injuries but due to shock or adrenaline have yet to go unconscious. This category is subdivided by orientation. To determine this ask the patient basic questions:
    • Who are you?
    • Do you know where you are?
    • Can you tell me what happened?
    The subdivision scale can be used to assess the cognitive function of the patient.
    • A/O x4: the patient is alert and oriented to who they are, where they are, what’s happening when it is, and a “with it” question. This is determined by asking the patient the basic questions.
    • A/O x3: this patient may be alert and oriented but slightly confused on one of the basic questions. This could be due to mild head injury, an unknown or untreated medical issue, lack of knowledge of the source, or light intoxication.
    • A/O X2: this patient is moderately confused. This could be due to injury, medical emergency, age-related issues (dementia or Alzheimer’s), or heavy intoxication.
    • A/O x1: this patient is deeply confused. This could be due to severe injury, age-related issues, medical emergencies, or intoxication with a heavy narcotic or intoxicant.
    • A/O x0: this patient is alert but completely confused. They are unable to answer questions. This could be due to extremely severe injury, bad head wound, severe age-related issues, or medical emergency (blood sugar, dehydration, delirium, etc.)
  • Verbal: this patient only responds to verbal stimuli. If you say their name or attempt to get their attention via speaking they may turn to you and open their eyes but that’s about it.
  • Pain: if the patient doesn’t respond to verbal stimulation then pain stimulation is needed. This comes in three waves: First, attempt to use light pain (pinch earlobe or fingertip), then moderate pressure (pinch the pressure point located between shoulder and neck), and then finally the most severe stimulus is to be used. This is the eternal rub. The patient should react to one of these stimuli by either moving away from pain, groaning, or attempting to swat the source. Should the patient react like this then they are reactive to pain. Should the patient wake up and verbally reassess LOC.
  • Unresponsive: these patients do not respond to any stimuli. Begin immediate efforts to determine what could cause this (respiratory arrest, cardiac arrest, severe injury, blood sugar emergency, temperature emergency {hypo/hyperthermia, fever, etc.}). You may not be able to determine the cause. However immediate transport is always the best treatment as our role is not to cure but to attempt to stabilize in route to the highest level of care (hospitals)