- GCS / ACVPU, obs and NEWS2?
- Glucose?
- Any opioids, sedatives or new drugs? Pupil size?
- Any fall or head injury? Is he on anticoagulants?
Do now
- A–E; airway first (GCS ≤ 8 → anaesthetics)
- Glucose immediately
- Check drug chart; pinpoint pupils → naloxone
- VBG: CO₂, Na, glucose; bloods
- CT head if focal signs or no clear cause
Key doses
- Glucose < 4: 150–200 mL 10% glucose IV over 15 min
- Opioid toxicity: naloxone 400 micrograms IV, titrate
- Pabrinex IV if alcohol
Typical adult doses — always check the BNF and your local guideline.
Call your senior if
- GCS ≤ 8 or falling
- Focal neurology
- Rising CO₂
- Not improving after reversal
Think of
- Opioids / sedatives
- Hypoglycaemia
- Hypercapnia
- Sepsis
- Stroke / bleed
- Hyponatraemia
Go deeper
The full walkthroughs behind this call.