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Quick Chart
Introduction
  • For the management of patients with altered levels of consciousness.
Clinical Presentation

Patients that cannot be roused or do not respond appropriately to external stimuli due to:

Exclusion Criteria
Exclusion Criteria
Risk Assessment
  • Scene safety is paramount; where possible, establish a cause before approaching
    • Obtain history from bystanders
    • Consider environment, including exposure to gases, poisons and infection
    • Consider medications and drug/alcohol intake
      • Beware of polypharmacy
    • Consider trauma, mechanism and remaining threats
    • Consider relevant medical history, including medic alerts
  • Assess and manage airway compromise early
  • Consider both acute occlusion and aspiration risk (difficulties with secretions, regurgitation or vomiting are common)
  • All patients with an altered GCS (i.e. abnormal for the individual) should have a BGL test preformed and managed appropriately if symptomatic.
Management
Primary Care
Intermediate Care (EMT / Level 2)
  • Consider administering glucose gel if indicated (i.e. patient hypoglycaemic)
  • Consider administering naloxone if indicated
  • Apply cardiac monitor if trained and authorised
  • Warm or cool patient as indicated
  • Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
  • Transport Priority 1 if patient time critical, pre-notifying receiving facility
Advanced Care (AP)
Critical & Extended Care (CCP, PSO)
Additional Information
  • Good airway management is an intensive exercise. Consider early back-up, and clearly allocate roles early to promote focused treatment and observation.
  • Unconsciousness of unknown cause should be presumed stroke until proven otherwise[1]
  • Beware of QTc intervals >460msec in polypharmacy overdose and TBI; can be an early warning sign of dangerous dysrhythmia
  • See AEIOUTIPS for more information on possible causes

References
References
Key Terms & Links
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Directorate
Clinical Services

Responsible Manager
Head of Clinical Services

Published Date

Review Date

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