ULTERED LEVEL OF CONSCIOUSNESS

 

INTRODUCTION:  Unconsciousness also known as altered Level Of Consciousness (ALOC) is a condition in which the patient is unresponsive to and unaware of environmental stimuli, usually for a short duration. Coma is a clinical state which is an unarousable, unresponsive condition in which the patient is unaware of self or the environment for prolonged periods (days to months, or even years).  Akinetic mutism is a state of unresponsiveness to the environment in which the patient makes no voluntary movement. A persistent vegetative state is one in which the unresponsive patient resumes sleep–wake cycles after coma but is devoid of cognitive or affective mental function. Locked-in syndrome results from a lesion affecting the pons and results in paralysis and the inability to speak, but vertical eye movements and lid elevation remain intact and are used to indicate responsiveness.

CAUSES OF ALOC:  The causes of unconsciousness may be neurologic for example resulting from head injury or stroke, toxicologic such as following drug overdose, alcohol intoxication, or metabolic for example following hepatic or renal failure, diabetic ketoacidosis among others.

ASSESSMENT AND DIAGNOSTIC METHODS:  Neurologic examination (CT, MRI, positron emission tomography [PET], electroencephalography [EEG], single photon emission CT [SPECT]) to identify cause of loss of consciousness. Laboratory tests include; analysis of blood glucose, electrolytes, serum ammonia, and liver function tests; blood urea nitrogen (BUN) levels; serum osmolality; calcium level; and partial thromboplastin and prothrombin times.  Other studies may be used to evaluate serum ketones, alcohol and drug concentrations, and arterial blood gases.

MEDICAL MANAGEMENT:  The first priority is a patent and secure airway (intubation or tracheostomy). Then circulatory status (carotid pulse, heart rate and impulse, blood pressure) is assessed and adequate oxygenation maintained. An IV line is established to maintain fluid balance status, and nutritional support is provided (feeding tube or gastrostomy).  Neurologic care is based on specific pathology. Other measures include drug therapy and measures to prevent complications.

RELATED;

1.  The central nervous system

2.  Meningitis

3.  Hypoglycemia

4.  Parkinson's disease

5.  Medicine and surgery

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