BH ICU Manual
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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
  • 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
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