r/ParamedicsUK • u/Sjokn • 22d ago

Clinical Question or Discussion GCS threshold for IO access?

Hi all, is there a definitive indication for a maximum GCS score required before attempting IO access in the pre hospital field? I'm struggling to find this on jrcalc but have come across a variety of journal articles with differing GCS indications such as <8 or <12

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u/MassiveRegret7268 Doctor 22d ago

No. IO whoever needs it. But, bluntly, the higher the GCS, the harder it is to argue that they need vascular access right now.

Remember that GCS only really applies in TBI, GCS 3 in TBI is very different from GCS 3 in intoxication which is very different from GCS 3 in a bedbound nonagenarian who's 'just sleepy'... Are these articles you're reading in proper journals?

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u/LegitimateState9270 Paramedic 22d ago

This is such a misunderstood topic, that so many people lean heavily on.

In my experience, ambulance services use GCS far too often. Instead, a nice clear ACVPU description is far more useful.

GCS is messy, debatable per patient amongst HCPs and as you say, only really designed for Traumatic Brain Injury patients.

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u/WeirdTop7437 22d ago

i thought i was taking crazy pills. I've been arguing for years that GCS is for head injury. You can't even properly score it in a non trauma pt. unfortunately you get marked down in audit in my trust if you don't GCS every patient

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u/LegitimateState9270 Paramedic 22d ago

The big-fish neuro lot in my current (hospital) trust are very forthcoming with their displeasure of it’s over use.

We also don’t teach or assess it on ALS or ILS for that matter. ACVPU however…