Reduced consciousness
Learn to work through the drowsy or unconscious patient, step by step. Protect the airway, fix the instantly reversible causes, and find the serious ones. Built for revision, not live patient decisions.
Settle them, and check the basics
airway & glucose firstRed flags — what each should make you think
Two things first, every time: protect the airway (a GCS of 8 or less can't protect its own), and check the glucose. Hypoglycaemia is the great mimic — it can look like a stroke, a seizure or a drunk patient, and it's fixed in seconds.
Your first moves
- A–EAssess A–E, protect the airwayGCS ≤8 → call anaesthetics
- gluBlood glucose — immediatelytreat hypoglycaemia at once
- pupPupils + GCS + focal signspinpoint → consider naloxone
- ✚Bloods + VBGNa, glucose, U&E, LFT, ammonia, cultures
- RxGive the obvious antidoteglucose, or naloxone for opioid toxicity
- CTConsider CT headfor focal signs or no clear cause
Run through the reversible causes
don't miss a fixable oneThe causes to sweep through
- Hypoglycaemia — check and correct glucose
- Hypoxia / hypercapnia — oxygen, a gas
- Opioids / sedatives — pinpoint pupils, low RR → naloxone
- Intracranial — stroke, bleed, SAH → CT
- Infection — meningitis, encephalitis, sepsis → treat, don't delay
- Metabolic — sodium, DKA/HHS, hepatic or uraemic encephalopathy
- Toxins, seizure (post-ictal), hypothermia
Work A–E — assess and act as you go
Rule out the killers
tap to open eachWhat points toward it, what would rule it in, and how to manage it.
Diabetes on treatment, sweating, agitation or focal signs. Can mimic almost anything.
Low blood glucose.
Treat immediately — IV glucose or IM glucagon — then recheck. The fastest reversible cause there is.
Reduced consciousness, a low respiratory rate and pinpoint pupils.
The toxidrome and a response to naloxone.
Support ventilation; naloxone titrated to breathing. Watch for re-sedation as it wears off.
Focal neurology, a sudden severe headache, unequal pupils, or signs of raised intracranial pressure.
CT head.
Urgent imaging and referral to stroke or neurosurgery; protect the airway and maintain perfusion.
Fever, headache, neck stiffness, rash, or altered behaviour and seizures (encephalitis).
Lumbar puncture (after CT if indicated).
Don't delay — IV ceftriaxone and IV aciclovir if encephalitis is suspected; dexamethasone.
Sodium disturbance, DKA or HHS, hepatic or uraemic encephalopathy, or endocrine crises.
Bloods and a gas — glucose, sodium, ketones, urea, LFTs, ammonia.
Treat the specific derangement per local protocol; correct sodium cautiously and involve seniors.
Investigate — what to order, when, and what it tells you
test with a question in mindGlucose & VBG
Bloods
CT head
Further tests
How the plan comes together
disposition · handoverreversed
A clear reversible cause treated (e.g. hypoglycaemia, opioids) with full recovery and safe observation.
Then: treat the underlying issue and safety-net.
admit / escalate
Persisting reduced GCS, an airway concern, or a serious cause → admit; critical care/anaesthetics for airway protection.
Hand over: GCS trend, glucose, pupils, what you've excluded and what's still open.
Work it like a checklist of reversibles while you protect the airway — glucose, oxygen, opioids, then image and treat. The fixable causes are quick wins you never want to miss. Nicely done getting here.
Clerking template
copy or downloadReduced consciousness — documentation structure
A structure and prompt list to help you document and think systematically. It is not a completeness check and cannot guarantee nothing is missed — use your trust's own proforma, your seniors, and your clinical judgement. Content is AI-generated and not yet fully reviewed.