Beyond A&O x4
So, clearly the MSE begins with determining the patients LOC or level of consciousness. But, a proper MSE encompasses more than simply determining if the patient is awake and alert. A&O x4 simply suggests the patient is able to recall basic knowledge about themselves or others. What about the pt's disposition though? Are they calm and cooperative? What about intoxication from drugs or alcohol? Two words that need to be INTEGRATED in to the MSE are cognition and coherency. What are the definitions of these words and why should we as prehospital providers use them? COGNITION is the mental state that demonstrates one's ability to acquire knowledge and then understand that knowledge through basic thought processes. COHERENCY is different than cognition. Coherency is ones ability to think logically and consistently through their thought process. So now that we have defined these two terms, what do they actually mean and how are they applied to the MSE. When a provider is able to converse with the patient and articulate their concerns in such a way that the patient demonstrates an understanding of those concerns in their own words, the patient's cognition is intact. Simply put, you have told the patient your concerns, informed their mental state with knowledge, and the pt has now processed that knowledge and is able to articulate their understanding of that knowledge back to you in their own words. Their cognition is intact by them demonstrating the ability to acquire knowledge and then process that knowledge and demonstrate an understanding of that knowledge by articulating the implications or consequences of your concerns. This in short is cognition. There is more though. Coherency is a thought process. Does the pt demonstrate a linear thought process? Are they able to articulate a consistent and logical thought process? Is the pt able to follow the thought process of your concerns logically? In other words, can you tell the pt what your concerns are while they demonstrate a logical or consistent thought by articulating what the conclusion of your concerns are? Simply put, can they go from point A to point B logically? If they can, they demonstrate coherency which in turn demonstrates their ability to understand the consequences of your concerns. If this sounds familiar it should. These two words summed up would be INFORMED. Make no mistake. You can not inform a patient who's cognitively impaired or thinking and speaking incoherently. Join us next time as we develop the methodical approach and assessment of the MSE. Until then... Own the day and go out the door with intent!
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