Altered Conscious State
Suggested approach and Clinical Pearls
- Decreased conscious state can be due to:
- Intracranial causes
- Trauma
- Stroke (haemorrhagic or thrombotic)
- Seizures
- Infection
- Intracranial hypertension
- Extracranial causes
- Medication or poison related
- Delirium
- Metabolic (acid-base, glucose, thyroid, adrenal)
- Circulatory shock state
- Hypoxia
- Hypercapnea
- Intracranial causes
- Always check blood glucose in an unconscious patient
- Consider an undiagnosed intracranial cause for the patient’s behaviour, particularly if new or worsening unilateral signs
- Consider thiamine replacement
- Consider intoxications, particularly opiate analgesics (iatrogenic)
- Consider LP, CT brain or MRI as additional investigations