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 | |||||||||||||||||
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Neurologic Findings
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