Altered Level of Consciousness



Altered Level of Consciousness


Anna D. Jarvis



Introduction

Altered states of consciousness may vary from mild impairment to deep unresponsiveness and can signal present or impending life-threatening situations.


Definitions





















Consciousness:


Awareness of self and environment


Confusion:


Slowed, impaired cognitive abilities


Delirium:


Succession of confused and unconnected ideas


Obtundation:


Awake but not alert


Stupor:


Aroused only with repeated, vigorous stimuli


Coma:


Unresponsiveness even to pain




  • Accurate assessment of level of consciousness is essential, with serially repeated evaluations to track trends


  • The Glasgow Coma Scale is accurate but lengthy (see Ch. 7, Head Injury)


  • A valuable rapid quick assessment tool is the AVPU scale:



    • A = Awake and aware (alert)


    • V = Responsive to verbal stimuli


    • P = Responsive to painful stimuli


    • U = Unresponsive


Causes of Altered Level of Consciousness



  • Numerous causes of altered level of consciousness


  • A useful approach is “TIPS from the Vowels”






























T


Trauma


I


Infection, inflammatory


P


Poison, psychiatric


S


Shock, stroke, shunt malfunction


A


Alcohol, anoxia, acidosis


E


Epilepsy, endocrine, electrolytes


I


Insulin (hypoglycemia), intussusception, inborn error of metabolism


O


Opiates


U


Urea/metabolic










Table 46.1 Common Causes by Age


























INFANT


CHILD


ADOLESCENT


Infection


Toxin


Toxin


Metabolic


Infection


Trauma


Inborn error of metabolism


Seizure


Psychiatric


Seizure


Intussusception


Seizure


Maltreatment


Maltreatment


Jun 22, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Altered Level of Consciousness

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