Levels of Consciousness

Levels of Consciousness

■ Alert: Awake, alert, and oriented and responds appropriately.
■ Lethargic: Oriented to person, time, and place; sluggish speech; sleepy; awakens and remains awake with sufficient stimulation.
■ Confused: Disoriented to person, time, and place. Memory deficits, difficulty following commands, restless, agitated.
■ Obtunded: Extreme drowsiness, responds with one–two words, follows simple commands, but requires vigorous stimulation.
■ Stuporous: Minimal movement, responds unintelligibly, and awakensbriefly only to repeated vigorous stimulation.
■ Coma: Unresponsive to verbal stimuli. May have appropriate motor response (withdraws from pain) or nonpurposeful or no response.

AVPU Scale
A	Alert		Pt is alert and requires no stimulation.
V	Verbal		Pt responds only to verbal stimulation.
P	Painful		Pt responds only to painful stimulation.
U	Unresponsive		Pt is unresponsive to any stimulation.
Possible Causes of Altered LOC
Cause		Remarks
A	Alcohol		Protect airway, anticipate emesis.
E	Epilepsy		Protect Pt from injury, do not insert object into Pt’s mouth, assess seizure med levels.
	Electrolyte		Monitor and treat serial serum electrolytes.
I	Insulin		Protect airway, obtain stat blood glucose level and treat accordingly (dextrose for hypoglycemia or insulin for hyperglycemia).
O	Overdose		Protect airway, take precautions to protect self if Pt is aggressive, give reversal agents.
U	Uremia		Assess for overuse of NSAIDs, especially with elderly; Pts will require dialysis.
T	Trauma		Protect airway, immobilize cervical spine, assess pupils, assess for neurologic deficits.
	Temp		Obtain core (preferred) body temperature, administer prescribed antipyretics, use cooling blanket, lukewarm sponge bath as ordered.
I	Infection		Protect airway, obtain blood cultures, and administer antibiotics as ordered.
P	Psychiatric		Protect self, do not confront Pt, get help.
S	Stroke (neuro)		Protect airway, position Pt onto affected side, assess pupils, assess for neurologic deficits.
	Shock		Establish ABCs; immobilize c-spine as indicated.