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Approach to
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Approach to Altered Level of Consciousness Text Summary
Definition: a change in a person’s normal alertness, awareness, or responsiveness to their environment.
Approach to patient:
- A, B, C’s. IV, O2, monitors, glucose
Causes of altered level of consciousness:
- Drugs
o Overdose or intoxication (sedatives)
o Withdrawal (stimulants)
o Prescription
- Infection
o Meningitis – neck stiffness, fever
o Pneumonia – hypoxia, consolidation, crackles
o Intraabdominal – recent surgery, elevated LFTs, lipase, bloody stool, diarrhea, nausea/vomiting, tenderness or distension on exam
o Genitourinary – dysuria, positive urinalysis or culture, hematuria
o Skin and soft tissue – rashes or wounds, joint swelling
o Bacteremia – invasive lines or ports, IVDU
o Infective endocarditis – Janeway lesions, osler nodes, roth spots, murmur, IVDU
- Metabolic
o Electrolyte abnormalities (hypo/hypernatremia, hypo/hypercalcemia, hypophosphatemia)
o Hepatic encephalopathy
o Uremic encephalopathy
o Wernicke’s encephalopathy
o Hypo/hyperthyroidism
o Hypo/hyperglycemia
o Hypercarbia
o Acid-base abnormalities
- Structural
o Intracranial bleed
o Ischemic stroke
o Tumour or mass
o Cerebral venous sinus thrombosis
o Encephalitis (AI, infectious, paraneoplastic)
o Leptomeningeal disease process (ie. Lymphoma)
o Seizure
o Hydrocephalus
- Systemic
o Cardiac arrest
o Shock
Initial Work up:
- CBC, electrolytes, creatinine, urea, extended electrolytes, VBG/ABG, LFTs, TSH, glucose, troponin, CK, urinalysis, urine toxicology screen, blood/urine cultures
- ECG
- CT head
Red Flags:
Failure to protect airway
Unequal or unresponsive pupils
Cushing’s triad (bradycardia, hypertension, irregular respirations)
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