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Information

This chart highlights the six stages of altered arousal. An alert patient responds to voice and exhibits purposeful movement and appropriate spontaneous activity.

StageManifestations
Confusion
  • Loss of ability to think rapidly and clearly
  • Impaired judgment and decision making
Disorientation
  • Beginning of loss of consciousness
  • Disorientation to time progressing to disorientation to place
  • Impaired memory
  • Lack of recognition of self (last)
Lethargy
  • Limited spontaneous movement or speech
  • Easily aroused by normal speech or touch
  • Possible disorientation to time, place, or person
Obtundation
  • Mild to moderate reduction in arousal
  • Limited responsiveness to environment
  • Ability to fall asleep easily without verbal or tactile stimulation
  • Minimum response to questions
Stupor
  • State of deep sleep or unresponsiveness
  • Arousable with difficulty (motor or verbal response only to vigorous and repeated stimulation)
  • Withdrawal or grabbing response to stimulation
Coma
  • No motor or verbal response to external environment or any stimuli
  • No response to noxious stimuli such as deep pain
  • Not arousable by any stimulus