LEVEL OF CONSCIOUSNESS

Recognition and Management

By GBONEME S.E

OUTLINE

• INTRODUCTION

• DEFINITION OF TERMS

• AEITIOLOGY

• PATHOPHYSIOLOGY

• GLASGOW COMA SCORE

• INVESTIGATION

• MANAGMENT

INTRODUCTION

Content

Arousal

Consciousness

INTRODUCTION Contd

• Level of consciousness (LOC) is a measurement of a person's arousability and responsiveness to stimuli from the environment.

• Altered consciousness is one of the most common findings encountered by a neurosurgeon.

• Altered level of consciousness is a condition of being less responsive to and aware of external stimuli

Definition of Terms

• CONFUSED: disoriented to surroundings, may have impaired

judgment, may need cues to respond to commands.

• LETHARGIC: Drowsy, needs gentle verbal or touch stimulation to initiate

response.

• OBTUNDED: responds slowly to external stimulation and needs

repeated stimulation to maintain attention and response

• STUPOROUS: responds only minimally with vigorous stimulation,

may only moan as a verbal response

• COMATOSE: no observable response to any external stimuli

AEITIOLOGY

• Structural

Trauma: cerebral edema, subdural and epidural

hematoma.

Vascular: subarachnoid hemorrhage, infarction.

Infection: meningitis, encephalitis, brain abscess.

Neoplasms: metastatic tumor, primary brain tumor

AEITIOLOGY Contd:

• Metabolic:

Toxicity: drugs (opiates), heavy metals, carbon monoxide

Systemic metabolic derangement: hypoglycemia,

hyponatremia, diabetic ketoacidosis, hyperglycemia

Extremities of body temperature: Heat stroke,

hypothermia

Hypoxic encephalopathy: severe anemia, severe

pulmonary disease, severe heart failure.

PATHOPHYSIOLOGY

• Cellular brain edema or a disrupted chemical transmission at the receptor site results in faulty impulse transmission and impending communication within the brain or from the brain to other body parts.

Glasgow Coma Scale

• Glasgow Coma Scale (GCS) is a neurological scale which aims to give a reliable and objective way of recording the conscious state of a person for initial as well as subsequent assessment.

• It is also useful in the classification of head injury

CONTD:

• A patient is assessed against the criteria of the scale, and the resulting points give a patient score between 3 (indicating deep unconsciousness) and 15.

• A score of 15/15 with no LOC – Mild head injury

• 14/15 or15/15 with LOC – Minor head injury

• 9 -13/15 – Moderate head Injury

• 3-8/15 – Severe head injury

PHYSICAL EXAMINATION

INVESTIGATIONS

• Complete blood count ( Rule out severe anemia evidenced by low RBC’S, decreased PCV. Also, infection, evidenced by elevated WBC’s and differentials).

• Blood Glucose ( Rule out Hypo/Hyper glycaemia)

• Electrolytes/ Urea/ Creatinine (Rule out electrolyte derangement as well as uremic encephalopathy)

• Imaging Studies:• X-ray

• CT-SCAN

• MRI

RESUCUITATION

• The A..B..C..D’s

• A- Airway:• Stabilize Neck

• Ensure Airway is patent

• Suction if necessary

• Use of Airway adjunct.

• Use of endotracheal tube if indicated

• B- Breathing;• Use of mechanical ventilator is used to maintain adequate oxygenation

CONTD

• Circulation• Monitor circulatory status using the following parameters.

Blood pressure, heart rate. Ensure adequate perfusion to body and brain.

• Pass an intravenous catheter to provide fluid access

• Give adequate intravenous medications

• Determine and treat the underlying cause of the LOC