Recognising and Responding to the Seriously Ill Patient

Part 5 : Altered Conscious State

Possibly one of the the most challenging clinical presentations in emergency care the patient with altered conscious state. In many circumstances the history may be fragmented, examination limited and the presence or threat of violence may distract us from direct clinical care. Despite these factors there is a clinical imperative to identify and treat the underlying cause for the altered conscious state.

As we have seen earlier in this course having a structured or systematic approach is the starting point for approaching these patient. The Primary Survey aims to to identify and correct life threatening causes for altered conscious state such as hypoxia, shock and unstable arrhythmias, hypo and hyperglycaemia, raised intracranial pressure, opioid toxicity, hypo and hyperthermia and infection / sepsis. In patients where the cause is not identified during the initial assessment it is important to move quickly to a broader assessment of the patient and examine the patient's vital signs, gather more history, looks for clues on examination and arrange testing including ECG, BGL (Ketones), Urinalysis and Point of Care blood testing.

In this topic we explore the approach to bedside assessment, diagnosis and intervention in the patient with a deteriorating conscious state and identify some of the issues that arise in assessing and responding to these patients.

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