Unconcious patient question

[KAThomas]

I need some help here because I know I read it somewhere but not where or when....

A patient can be unconcious and crying/mewling at the same time...

Pt. 2 y/o posturing decerebrate and crying/moaning... debate stemmed from getting a line IO (protocol being this is only an option if the pt is unc).

Help guys.

Title edited to reflect content...AK

[ccmedoc]

Little more Hx???

Did they try other routes??

[KAThomas]

Medic tries twice in the AC and once in the foot... no luck...

Pt is a 2 y/o with no sig. medical hx (outstanding complications), found on scene hanging from curtain drawstring. Got the pt loaded, (BLS on scene/ ALS enroute) on the monitor... don't recall the numbers. Show up at the PMC w/o a line and they popped an IO and whisked the pt out to CT/MRI. Still mewling and posturing... Trauma nurse, monitor and Tech.

[ccmedoc]

I think the IO is the least of the kids problems..

If they needed the line..perfectly acceptable.

My opinion

[KAThomas]

My orginal question is being a little overshadowed

Can a patient can be unconcious and crying/mewling at the same time?

The medic stated he couldn't IO a conscious pt. presupposed by the crying.

[Dustdevil]

Good question. Certainly not one of those black-and-white questions that goes by the cookbook. Obviously, if consciousness was an all-or-nothing proposition, we wouldn't be discussing levels of consciousness. So no, one need not be comatose and flaccid in order to be considered "unconscious" in a medical sense. However, by popular use (as opposed to strict definition) unconsciousness is generally considered to mean comatose and flaccid. If your protocols do not define "unconsciousness" for the purpose of the protocols, then your protocols suck.

Noting as where you are located, I'm betting your medical control would not have considered the patient in question to be unconscious. But in better systems, that would be left to the medic's discretion.

[ccmedoc]

I would suppose that the child suffered from cerebral hypoxia, judging from how he was found. The posturing and moaning would not necessarily make him responsive to me. I don't think conscious would be an appropriate assessment of this child.

Did the child respond to any noxious stimuli, or any stimuli. Did he withdraw from the IV sticks??

I still think the child was most likely unconscious. To answer your question, unconscious patients can cry, moan, and grimace from pain...if the brain senses it.

Sedated patients in the ICU will respond to pain with an alteration in their vitals and, at times, facial changes.

[AZCEP]

Our interpretation of your description is weak at best. Could the sounds that were being made due to laryngospasm? Is it possible the child was having stridor, just not moving enough air to make it sound like it?

An intraosseous attempt is plenty to tell you that the patient is unconscious. If they don't withdraw from it, then they definitely need it.

[medic_texas]

Use the PGCS (Pediatric Glasgow Coma Score) to figure the LOC of the child. This is used for children 2 years old and younger.

Best eye response: (E)

4. Eyes opening spontaneously

3. Eye opening to speech

2. Eye opening to pain

1. No eye opening

Best verbal response: (V)

5. Infant coos or babbles (normal activity)

4. Infant is irritable and continually cries

3. Infant cries to pain

2. Infant moans to pain

1. No verbal response

Best motor responses: (M)

6. Infant moves spontaneously or purposefully

5. Infant withdraws from touch

4. Infant withdraws from pain

3. Abnormal flexion to pain for an infant (decorticate response)

2. Extension to pain (decerebrate response)

1. No motor response

A child can be crying AND have a significant decrease in their normal level of consciousness. I would have treated the child aggressively with IO/IV, RSI, and rapid transport. To answer your question, YES this child is "unconscious" enough for the IO.

[Connie31079]

I would personally call that being "obtunded" or "altered mental status", not "unconscious", especially if the child is not fully awake but still able to "cry" and/or "mew".

During my radio patch to the hospital, I wouldn't say the child was "unconscious". I think that the ER staff would expect the child to be comatose & flaccid when I wheeled through the doors if I described the child as being unconscious.

And I think an IO was perfectly acceptable in this situation, along with a few other aggressive measures.