In the analgesia directive, along with the nausea/vomiting directive is has “unaltered” as a condition. Is this written for the acutely altered patient who has a TBI for example? If we have a patient with a baseline GCS of let’s say 13-14 with dementia who presents with pain and/or N/V but no decrease in baseline mental status, is a patch required, or are they considered unaltered from baseline? 

The patient’s GCS is determined based on a change from their baseline. From the ALS PCS Preamble/Vital Signs, “The word ‘altered’ refers to a GCS that is less than normal for the patient. The word ‘unaltered’ refers to a GCS that is normal for the patient. This may be a GCS <15.” 

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Altered, analgesia, GCS, LOA, Nausea/Vomiting, Unaltered

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