Day 5 - Decreased LOC
Initial Management:
Assess ABCs
Ensure patient is protecting airway and does not require urgent intervention to secure airway (ie. intubation)
Check HR, BP, O2 sat and glucose
Secure adequate intravenous access
Metabolic
Hepatic encephalopathy
Uremic encephalopathy
Hypothyroidism
Adrenal crisis
Hypercarbia (COPD, OHS)
Hypercalcemia
Hyponatremia
Hypoglycemia
Toxins
Methanol
Ethanol
Ethylene glycol
Carbon monoxide
Heavy metals
Seizure
Post-ictal state
Non-convulsive status epilepticus
Other
Hypoactive delirium
Catatonia
Approach:
Assess patient, medication record & obtain collateral history for etiology in an organized fashion based on potential causes
Structural
Acute ischemic stroke (generally will not cause decreased LOC unless associated with shift and raised ICP)
Intracranial bleed
Intracranial mass
Raised ICP
Medications/drugs
Opioids
Benzodiazepines and other sedatives
Anticonvulsants
Anticholinergics
Antipsychotics
Salicylates
Infection
Meningitis/encephalitis
Intracranial abscess
Sepsis
Investigations:
Guided by differential for underlying etiology
Generally send:
CBC, electrolytes, extended electrolytes, creatinine, glucose, liver enzymes, venous blood gas, osmolar gap, blood cultures
Management:
Ensure airway protected, no hemodynamic collapse
Treat underlying cause