ALTERED LEVEL OF CONSCIOUSNESS

Altered Level of Conciousness Stabilize: Airway Breathing Circulation Disability (Glasgow coma scale) Dextrose Check History and Physical Exam, Often no preceding prodrome. May have signs or symptoms suggestive of toxidrome. Usually no focal findings on neurological exam. Obtain urine drug screen gas osmolality electrolytes. Drugs poisoning/ intoxication (eg Opioids beta-blockers diabetes medications alcohol etc) Signs or symptoms suggestive of infection such as fever may or may not have focal findings on neurological exam. May have increased intracranial pressure. Perform CBC blood cultures lumbar puncture +/- head imaging infection bacterial (eg. meningitis, intracranial abscess, sepsis) Viral (eg. encephalitis) Usually no focal findings on neurological exam abnormal bloodwork on initial labs obtain urine drug screen gas osmolality electrolytes consider ammonia and lactate metabolic hypoglycemia hypernatremia hyponatremia metabolic disease often will have focal findings on neurological exam. may have signs of increased intracranial pressure. Obtain STAT head imaging Structural Trauma/head injury abusive head trauma brain tumor increases intracranial pressure (eg. hydrocephalus, space-occupying lesions, idiopathic, drugs) vascular (eg stroke, arteriovenous malformation, aneurysm) concussion. Consider ancillary testing depending of history (eg. bloodwork, EEG, EKG, etc) Other Seizure/status epilepticus cardiac (eg. arrythmia) sycope, migrane, (atypical presentation) immune-mediated encephalitis.