Decreased level of consciousness
The Problem:
The description 		What We Do:
Get a CT
Even if it is at night you can get a CT. Lytes and gases and vital signs are usually needed too.
It's a good idea to check code status and treatment goals before pursuing major new trreatments.
Be sure to check lytes (neurosurgery patients tend to do funny things with their sodium.).
Patients who show deteriorating levels of consciousness should be moved into Neuro Step-down or the ICU. As a rule, the attending should be made aware of the situation.
GCS 8 or less should probably be intubated.

Some common causes and things to consider:

  • seizures with post-ictal state
  • edema increasing whether from tumour, infarction, infection, venous thrombosis, trauma or other etiology
  • hydrocephalus
  • bleeding
  • medication effect
  • sepsis, especially meningitis, UTI, pneumonia
  • electrolyte disturbance (neurosurgery patients tend to do funny things with their sodiums!)



Links:
the links

Evidence Footnotes:
1. reference

Authorship: Dr Valerie Taylor Last Revised: 29 May 2002