Altered Consciousness 🧠
Clinical guide for assessing altered consciousness. GCS calculator, DELIRIUM mnemonic, differential diagnosis, and emergency management for drowsy or unresponsive patients.
📞 What to Ask on the Phone
- Is the patient responsive to voice or pain?
- Any recent falls, head injury, seizures or confusion?
- What were the last known normal observations?
- Is there a history of diabetes, epilepsy, or alcohol use?
🔍 Immediate Assessment
- ABCDE assessment with GCS score
- Check blood glucose (CBG)
- Check pupils, posture, tone, limb movement
- Review medication chart for sedatives, opiates, insulin
🧪 Investigations
- CBG (always first)
- U&E, LFTs, calcium, CRP, FBC, TSH, B12/folate
- Septic screen if signs of infection
- ABG if hypoxic or concern for metabolic issue
- ECG if arrhythmia or cardiac history
- CT brain if headstrike, confusion or focal signs
🧠 Differential Diagnosis Mnemonic: DELIRIUM
- Drugs (opiates, benzos, anticholinergics)
- Electrolytes / endocrine (Na⁺, Ca²⁺, glucose)
- Liver or lung failure (hypercapnia, hepatic encephalopathy)
- Infection (UTI, pneumonia, meningitis)
- Retention (urinary, constipation)
- Intracranial event (stroke, bleed, seizure)
- Uraemia (renal failure)
- Metabolic or nutritional (thiamine, B12)
💊 Management
- Treat underlying cause (e.g. hypoglycaemia, infection, etc.)
- Consider IV thiamine if risk of Wernicke’s
- Avoid sedation unless risk to self/others
- Start neuro obs if concern for deterioration
✅ Actions for Interns
- Document GCS and neurological findings clearly
- Chart full obs and escalate abnormal vitals
- Inform senior if GCS <13 or fluctuating
- Ensure nursing staff aware to monitor closely
Glasgow Coma Scale (GCS)
For trained clinicians. Evaluate based on best observed response.
Eye Opening (E)
Verbal Response (V)
Motor Response (M)
Assessment Result
Total Score:15 / 15
✅ GCS 15 - Normal
Note Template
Ready-to-use clinical note structure
🕒 26 / 05 / 2026 — 17:57 ATRP re: ↓ GCS / altered mental status Patient: [age] [sex] Admission Dx: [reason for admission] PMHx: [epilepsy / dementia / diabetes / CVA] 🧾 Hx: • Onset / precipitating factors • Seizures? Head injury? Infection? • Collateral history • Medications / recent changes 🩺 Exam: • GCS: __ Vitals: HR __ BP __ RR __ Temp __ SpO₂ __ • Pupils: __ Focal neurology: [yes/no] • Signs of trauma, infection, or raised ICP 📋 Impression: Likely cause: [hypoglycaemia / seizure / infection / stroke] 📌 Plan: • Check CBG + electrolytes • Consider ABG, CTB, septic screen • Start treatment (e.g. glucose, abx, anticonvulsants) • Monitor GCS and escalate as needed 👤 [Your Name], [Role] IMC: _______