ALTERED LEVEL OF CONSCIOUSNESS

Altered Level of Consciousness 1. Stabilize A: Airway B: Breathing C: Circulation D: Disability (Glasgow Coma Scale) D: Dextrose check 2. Drugs Often no preceding syndrome May have signs/symptoms suggestive of toxidrome Usually no focal findings on neurological exam Tests: Urine drug screen, gas, osmolality, electrolytes Examples: Poisons/intoxications (e.g., opioids, beta blockers, diabetes medications, alcohol) 3. Infection Signs/symptoms suggestive of infection (e.g., fever) May or may not have focal neurological findings May have signs of increased intracranial pressure Tests: CBC, blood cultures, lumbar puncture ± head imaging Examples: Bacterial: Meningitis, intracranial abscess, Sepsis Viral: Encephalitis 4. Metabolic Usually no focal neurological findings Abnormal bloodwork on initial labs Tests: Urine drug screen, gas, osmolality, electrolytes; consider ammonia and lactate Examples: Hypoglycemia Hypernatremia Hyponatremia Metabolic disease 5. Structural Often focal neurological findings May have signs of increased intracranial pressure Tests: STAT head imaging Examples: Trauma/head injury Abusive head trauma Brain tumor Increased intracranial pressure (e.g., hydrocephalus, space-occupying lesions, idiopathic, drugs) Vascular (e.g., stroke, arteriovenous malformation, aneurysm) Concussion 6. Other Consider ancillary testing depending on history (e.g., bloodwork, EEG, EKG) Examples: Seizure/status epilepticus Cardiac (e.g., arrhythmia) Syncope Migraine (atypical presentation) Immune-mediated encephalitis Notes: Indicates Key Condition This is not an exhaustive list of medical conditions