Assessment and Management of the Patient with a Reduced Conscious Level - Flowchart
Assessment and Management of the Patient with a Reduced Conscious Level - Flowchart Assessment and Management of the Patient with a Reduced Conscious Level Assessment and Management of the Patient with a Reduced Conscious Level
Flowchart

Reduced conscious level

Reduced conscious level

Reduced conscious level

End

End

End

Assessment using ABCDE method
Key observations (Table 1.1)
Oxygen, ECG monitor, IV access
Stabilize airway and breathing
Consider need for endotracheal intubation (Chapter 112) and ventilatory support (Chapter 11)
Correct hypoglycaemia (Chapter 81)
Treat prolonged or recurrent major seizures (Chapter 16)
If opioid poisoning suspected, give naloxone

Assessment using ABCDE method
Key observations (Table 1.1)
Oxygen, ECG monitor, IV access
Stabilize airway and breathing
Consider need for endotracheal intubation (Chapter 112) and ventilatory support (Chapter 11)
Correct hypoglycaemia (Chapter 81)
Treat prolonged or recurrent major seizures (Chapter 16)
If opioid poisoning suspected, give naloxone

Assessment using ABCDE method
Key observations (Table 1.1)
Oxygen, ECG monitor, IV access
Stabilize airway and breathing
Consider need for endotracheal intubation (Chapter 112) and ventilatory support (Chapter 11)
Correct hypoglycaemia (Chapter 81)
Treat prolonged or recurrent major seizures (Chapter 16)
If opioid poisoning suspected, give naloxone


Table 1.1


Chapter 112 Chapter 11
Chapter 81
Chapter 16

Toxic metabolic or hypoxic cause likely

Toxic metabolic or hypoxic cause likely

Toxic metabolic or hypoxic cause likely

Stroke or SOL likely

Stroke or SOL likely

Stroke or SOL likely

CNS infection or SAH likely

CNS infection or SAH likely

CNS infection or SAH likely

Focused assessment (Table 3.2)
Urgent investigation (Table 3.3)

Focused assessment (Table 3.2)
Urgent investigation (Table 3.3)

Focused assessment (Table 3.2)
Urgent investigation (Table 3.3)

Table 3.2
Table 3.3

No focal signs or meningism

No focal signs or meningism

No focal signs or meningism

Meningism +/– fever

Meningism +/– fever

Meningism +/– fever

Focal signs or papilloedema

Focal signs or papilloedema

Focal signs or papilloedema

Review clinical features and results
Diagnosis and treatment of underlying disorder
Supportive care to prevent complications of coma

Review clinical features and results
Diagnosis and treatment of underlying disorder
Supportive care to prevent complications of coma

Review clinical features and results
Diagnosis and treatment of underlying disorder
Supportive care to prevent complications of coma



Empirical anti-microbial therapy
CT/MRI then LP (if no contra-indication)

Empirical anti-microbial therapy
CT/MRI then LP (if no contra-indication)

Empirical anti-microbial therapy
CT/MRI then LP (if no contra-indication)


Empirical anti-microbial therapy if CNS infection possible CT/MRI

Empirical anti-microbial therapy if CNS infection possible CT/MRI

Empirical anti-microbial therapy if CNS infection possible CT/MRI