"Loss of Consciousness"

[HERBIE1]

I'll agree with what doc says here about how everyone at least CLAIMS to have a loss of consciousness. I cannot count how many times someone has told me- even after very minor accidents with no MOI to suggest a loss of consciousness: "I think I blacked out for a minute." After further questioning, their "loss of consciousness" was more like- I was shook up, I couldn't believe I was just rear ended. I can't believe I just wrecked my car, how am I going to tell me husband/cousin/boyfriend I wrecked their car, etc. They recall events leading up to the accident, they recall the crash, they recall taking off their seat belt before we arrived(or putting it on before the cops get there), and their exam is completely benign.

The way I word such incidents in my verbal and written reports is: Patient alert and fully oriented, c/o of a LOC(I'll generally quote their exact words here), but does recall all events prior to, during, and after the accident. I let the hospital evaluate the need to further pursue the R/O head injury treatments but generally we give them the benefit of the doubt with treatment.

In our protocols, a simple loss of consciousness- in the absence of other factors or injuries- does not mean a patient needs a trauma center- just a comprehensive ER, which in our area means they will be equipped with a CT scanner, so their potential needs are covered.

[DwayneEMTP]

Yeah, loss of consciousness is the new 10/10 pain I think. "Hey, that's a pretty specific question, and a lot of people have asked me that, I'll bet they'll take me more seriously, and it will look better in court if I say yes."

I've abandoned asking patients if they lost consciousness and only ask if they remember everything about the incident, before, during, and after, and then quiz them on those events if it seems necessary. It seems to make it easier for those with syncope, that sometimes don't really seem to know if they were ever 'out' or not, and the internal dialog with the bs fender benders seems to become, "You bet your ass I remember everything! Every last detail! It was horrible!" (As I'm staring at the swipe in the dust where the kid ran into their car with a bicycle.) which becomes "Neg LOC" on my PCR.

Dwayne

[Aussieaid]

Look up epidural hematoma and lucid interval. That's just one of the reasons it's important to know if they had a loss of consciousness or not.

Just because it's seems like everyone is saying they had one it doesn't diminish the fact that it is important to know if they did have one, like the boy who cried wolf. If you are suspicious, then by all means ask more pertinent questions like Dwayne suggested. He is still looking for the same pertinent piece of information.....did they have an LOC or not. Half the time my patient's wouldn't remember but I used the same method of asking what they could recall of the actual event which still doesn't tell you if they definitely had an LOC but can more likely rule out if they didn't.

If there is even a brief LOC it is important to know, not only for the potential epidural (think Natasha Richardson) but also because it is relevant in classifying the degree of head injury. Studies have shown that multiple mild concussions can be just as bad as a single more severe head injury. If the force was severe enough for them to lose consciousness even for a short period then the brain has sustained a significant impact that warrants further investigation or at least monitoring for longer than a non LOC event.

Edited January 5, 2012 by Aussieaid

[smsturms]

I think if MOI is significant or other factors involved LOC would raise our index of suspicion to not only take the pt to a hosp with CT capability but to think outside the box a little and take them to somewhere with interventional capabilities. Based on increased age and also use of blood thinners kind of off topic but goes hand in hand...

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[Pavehawk]

I think that the OP is talking about "who goes to the trauma center" and not who gets treated first in an MCI. Here is a ling tot eh latest article about the CDC/NIH criteria. The goal was/is to try and stop the huge amount of over triage to trauma centers while trying not to miss those that do require trauma center intervention.

http://www.cdc.gov/mmwr/pdf/rr/rr6101.pdf

There are also some good references including pocket guides and wall charts of the 2011 guidelines here http://www.cdc.gov/fieldtriage/

Please keep in mind these ARE national level guidelines and may not be applicable to your state/county/local or even country protocols.

[AnthonyM83]

For clarification: Two forms of "triage" are being mentioned in this thread.

There is MCI Triage in which we patients are sorted into severity levels to decide who gets treated first. START Triage is an example (probably what you learned in school - RED, YLW, BLK, GRN)

There is also Trauma Triage. Criteria for sorting if a patient goes to a trauma center or regular local hospital. This might be regulated by your agency or by local EMS office. There is also a push to adopt National Trauma Triage Guidelines (where history of loss of consciousness isn't mentioned, but present decreased level of consciousness is mentioned - GCS less than 14)

Regardless, the question that you get asked every time is a very common and reasonable one to ask.

As far as patients claiming loss of consciousness...it's probably in how you're wording it.

Also, realize that many people close their eyes during car accidents and might not remember the event exactly, but they didn't lose consciousness.