Initial Patient Presentation (LONG)

Use the LONG mnemonic to determine the baseline presentation of patient condition and use this assessment to determine overall improvement or decline.

L- Level Of Responsiveness

O-Orientation (mental and physical)

N- Name/Date Of Birth

G- General Impression

SCROLL DOWN TO LEARN MORE ABOUT THE INITIAL PATIENT PRESENTATION

Level Of Responsiveness

The level of responsiveness is often also referred to as the level of consciousness. Responsiveness is a better term as the assessment process is more directly linked to the response of the patient at each step.

The memory aid AVPU can be used to move through the process.

A: Alert

V: Verbal

P: Pain

U: Unresponsive

To be alert the patient has their eyes open and are aware of subtle changes in their environment.

A patient is responsive to voice or verbal stimulus when they open their eyes or otherwise respond after being addressed verbally.

A response to pain is a movement or moan as a result to a painful stimulus such as a pinch or other pressure applied.

A patient is unresponsive when they demonstrate no response to the previous painful stimulus.

*** If the patient is unresponsive it is important to move directly to the primary assessment***

Check back soon for more information about appropriate methods of providing a painful stimulus.

Determining Level of Responsiveness

The A in AVPU means what?: Alert

Orientation

Orientation has two primary components.

Physical orientation and mental orientation

Physical orientation is the patients relationship to the environment. A person lying face down on the ground generally has a more concerning condition than one sitting upright holding their arm.

Mental orientation is the patients ability to show awareness to their environment. Orientation is generally evaluated as "Times Four".

The four components to assess while determining how oriented the patient is are: Person, Place, Time and Event.

Person: Do they know who they are and any friends and family that are present?

Place: Do they know where they are, where they live and/or where they should be?

Time: Are they aware of the time of day, day of week, month and year?

Event: Are they able to provide accurate information about why they are sick or hurt?

Additionally it may be helpful to determine a deeper level of cognitive ability. Questions such as "how many quarters are there in a dollar" or "who is the president of the United States" may be used to more deeply determine orientation.

Name and Date Of Birth

Name and Date of Birth

Determining the patients name and date of birth (DOB) is usually conducted while evaluating orientation. If it is impossible to gain this information from the patient for any reason it is important to attempt to do so using friends, family and/or bystanders. Using the patients phone or wallet/purse information can be found about the patient or contact information for those that can.

If the patient is a good historian (meaning they are able to relay accurate information) it is good to get this demographic information ( Name, DOB, Address, Emergency Contact Information, etc) as early as possible in case they become non-verbal or otherwise unreliable.

General Impression

The general impression is an early determination of the overall condition of the patient and the circumstances of the event. The general impression can be organized by determining whether the patient is primarily suffering from a medical complaint or a trauma complaint. Another way of stating this is whether the patient has an illness or injury.

The general impression can also be divided into stable or unstable. A stable patient is one who is likely to improve while an unstable patient is likely to decline.

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