MSE starts with LOC
This sounds simple and in some ways it is. However, this important principle has to be stated. Your Mental Status Exam begins with an immediate determination of the pt's Level of Consciousness. What is your methodical approach to determining what the pt's level of consciousness is? Have you considered it? Is the pt awake and clearly alert? Or, are they unconscious and unresponsive? What level of unconsciousness are they? Can they be stimulated to respond to verbal commands or to physical stimuli. How do you go about determining their level of responsiveness? Do you ask questions? Do you try and physically get them to respond? These are important in your initial approach. Now, once you've determined their level of consciousness you can easily proceed to your methodical approach to patient care. It may be clearly evident that they are unconscious and unresponsive, or on the other hand awake and communicating normally. Either way determining their LOC is an important part of the MSE. This is where the rest of the call goes. What sort of approach are you implementing now that you know? Is it an approach to a respiratory patient that is clearly awake, or now an immediate change in gears to the unconscious patient. And I use this example because this can happen to you on scene. Continually assessing the pt's LOC is important. It may be the change that you as a provider catch and mitigate that makes all the difference for the patient. Stay tuned as we dive deeper in the Mental Status Exam. Until next time... Own the day and go out the door with intent!
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