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Level of consciousness should also be assessed upon initial contact with your patient and continuously monitored for changes throughout your contact with the patient.
a. AVPU
b. Glasgow Coma Scale
c. PEARRL
Use the guide PEARRL when assessing the pupillary response of the patient’s eyes.
(1) P: Pupils. Are they both present? What is their general condition?
(2) E: Equal. Are both pupils the same size? Unequal pupils can indicate a head injury causing pressure on the optic nerve. There is a small percent of the population that has unequal pupils normally, so a good patient history is critical.
(3) A: And.
(4) R: Round.
(5) R: Regular in size.
(6) L: React to light. Both eyes should be assessed twice for reaction to light. The first time the light is shined in the right eye, for example, you should watch the right eye for reaction, the second time the left eye should be watched to ensure sympathetic eye movement is present. (both eyes are doing the same thing at the same time).
d. Vital Signs
(1) The first set of vital signs establishes an important initial measurement of the patient’s condition and serves as a key baseline.
(2) Monitor vital signs for any changes from initial findings throughout care.
(3) Reassess and record vital signs at least every 15 minutes in a stable patient and at least every 5 minutes in an unstable patient.
(4) Reassess and record vital signs after all medical interventions.