LOC: Sedated vs comatose vs unconscious

[Underthemoonicp6]

I'm a traveler and on my current assignment the charting system offers the following options for LOC: alert, lethargic, obtunded, stuporous, comatose, or unconscious. To me a pt who is intubated and on sedation does not fall into any of these categories. I would chart their LOC ad sedated. I've noticed several nurses here chart it as comatose but I believe comatose to be on sedation + paralytics such as hypothermia protocol. What are some thoughts on this?

[icuRNmaggie, BSN, RN]

I turn the sedation down or off to assess neuro: level of conciousness, along with pupils, corneals, gag and cough, squeeze my hand, wiggle your toes, give me a thumbs up, on my initial assessment. I also do the GCS. On admission and once a shift.

If you can not do that due to ARDS or hypothermia protocol then I would chart unable to assess.

If the pt is not waking up from sedation, notify the MD. A CT may be needed to r/o a bleed or cerebral edema.

[Greenclip]

We have an option to choose "sedated". My problem is with obtunded. We don't have stuporous as an option. At my facility you are not supposed to choose obtunded unless the patient is almost unresponsive....you are supposed to pick lethargic instead. Result is that no one is ever charted as obtunded. (There is an old thread on this exact topic of lethargic vs. obtunded!)

It does help to have sedated as an option. Yes I turn sedation down or off for the neuro assessment. We also chart GCS separately, as well as response to commands, every four hours for all ICU patients. In the neuro ICU there are specific neuro checks which might be ordered more often.

[kool-aide, RN]

From what I understand obtunded to be, the pt should be sedated but able to awaken with verbal or gentle tactile stimulus and follow simple commands. Comatose, in my understanding, is the pt is not waking or following commands with sedation and paralytics off.

[spacemonkey15]

In the UK we use a sedation scoring system, something like this: Richmond Agitation-Sedation Scale - Wikipedia, the free encyclopedia

If someone is not sedated then we assess their conscious level using GCS. If someone is taking longer than expected to wake from sedation then assessing them using the GCS system is fair, in the end you base this on your own clinical judgement and the patient's condition, it's going to vary and this is where experience comes in.

[whofan, ADN, BSN, RN]

My hospital uses RASS as well, but there is also a separate Neuro assessment, but turning down sedation is always appropriate when doing a Neuro check